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August 1, 2017 Circulation. 2017;136:e60–e122. DOI: 10.1161/CIR.0000000000000499 e64 vention on the basis of the type, quantity, and consistency of data from clinical trials and other sources (Table 1).4–6 Glenn N. Levine, MD, FACC, FAHA Chair, ACC/AHA Task Force on Clinical Practice Guidelines 1 INTRODUCTION 1.1 Methodology and Evidence Review The recommendations listed in this guideline are, whenever possible, evidence based. An initial extensive evidence review, which included literature derived from research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline, was conducted from July to October 2015. Key search words included but were not limited to the following: athletes, autonomic neuropathy, bradycardia, carotid sinus hypersensitivity, carotid sinus syndrome, children, death, dehydration, diagnosis, driving, electrocardiogram, electrophysiological study, epidemiology, falls, implantable loop recorder, mortality, older populations, orthostatic hypotension, pediatrics, psychogenic pseudosyncope, recurrent syncope, risk stratification, supraventricular tachycardia, syncope unit, syncope, tilt-table test, vasovagal syncope, and ventricular arrhythmia. Additional relevant studies published through October 2016, during the guideline writing process, were also considered by the writing committee and added to the evidence tables when appropriate. The finalized evidence tables, included in the Online Data Supplement, summarize the evidence used by the writing committee to formulate recommendations. Lastly, the writing committee reviewed documents related to syncope previously published by the ACC and AHA and other organizations and societies. References selected and published in this document are representative and not all inclusive. An independent ERC was commissioned to perform a systematic review of clinical questions, the results of which were considered by the writing committee for incorporation into this guideline. The systematic review report “Pacing as a Treatment for Reflex-Mediated (Vasovagal, Situational, or Carotid Sinus Hypersensitivity) Syncope” is published in conjunction with this guideline.9 1.2 Organization of the Writing Committee The writing committee was composed of clinicians with expertise in caring for patients with syncope, including cardiologists, electrophysiologists, an emergency physician, and a pediatric cardiologist. The writing committee included representatives from the ACC, AHA, Heart Rhythm Society (HRS), American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine. 1.3 Document Review and Approval This document was reviewed by 2 official reviewers each nominated by the ACC, AHA, and HRS; 1 reviewer each from the American Academy of Neurology, American College of Emergency Physicians and Society for Academic Emergency Medicine, and Pediatric and Congenital Electrophysiology Society; a lay/patient representative; and 25 individual content reviewers. Reviewers’ RWI information was distributed to the writing committee and is published in this document (Appendix 2). This document was approved for publication by the governing bodies of the ACC, AHA, and HRS and was endorsed by the American College of Emergency Physicians, the Society for Academic Emergency Medicine, and the Pediatric and Congenital Electrophysiology Society. 1.4 Scope of the Guideline The purpose of this ACC/AHA/HRS guideline is to provide contemporary, accessible, and succinct guidance on the management of adult and pediatric patients with suspected syncope. This guideline is intended to be a practical document for cardiologists, arrhythmia specialists, neurologists, emergency physicians, general internists, geriatric specialists, sports medicine specialists, and other healthcare professionals involved in the care of this very large and heterogeneous population. It is not a review of physiology, pathophysiology, or mechanisms of underlying conditions associated with syncope. The nature of syncope as a symptom required that the writing committee consider numerous conditions for which it can be a symptom, and as much as possible, we have addressed the involvement of syncope only as a presenting symptom. Because of the plausible association of syncope and sudden cardiac death (SCD) in selected populations, this document discusses risk stratification and prevention of SCD when appropriate. The use of the terms selected populations and selected patients in this document is intended to direct healthcare providers to exercise clinical judgment, which is often required during the evaluation and management of patients with syncope. When a recommendation is made to refer a patient to a specialist with expertise for further evaluation, such as in the case of autonomic neurology, adult congenital heart disease (ACHD), older populations, or athletes, the writing committee Downloaded from http://ahajournals.org by on October 7, 2026