Syncope in hypertrophic cardiomyopathy (part II): An expert consensus statement on the diagnosis and management

Hypertrophic cardiomyopathy (HCM) is an inherited heart disease with a high risk of ventricular arrhythmias (i.e., electrical disturbances originating from the ventricular chambers of the heart) and sudden cardiac death. Accurate risk assessment to quantify the risk of sudden cardiac death is crucial. Syncope (i.e., transient loss of consciousness) represents a significant concern in patients with HCM, since it is considered a significant risk factor for sudden cardiac death. However, not all the syncopal events are equivalent in HCM, and only some of them are serious events.

Current European and American guidelines on the management of patients with HCM consider syncopal events as risk factor for SCD when the syncope is suspected to be caused by ventricular arrhythmias or when it is unexplained. However, the cause of syncope is often under-investigated causing a significant risk overestimation in some cases. Indeed, to date, there is no specific diagnostic algorithm in literature to investigate the underlying cause of syncope.

In this expert consensus statement, an international panel of experts in the field of both syncope and HCM provide a practical guidance for the diagnosis and management of syncope in patients with HCM. They suggest a detailed diagnostic work-up focused at identifying the cause of the syncope (cardiac/non cardiac or unexplained) and the subsequent specific management of the underlying ethology of syncope. In addition, they agree on the need for a collaboration between experts in HCM and experts in syncope to generate a helpful clinical decision making in challenging cases, where the underlying cause of syncope is unexplained.


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Translated by Giuseppe Limongelli, University of Campania “Luigi Vanvitelli”, Naples, Italy

Brignole M, Cecchi F, Anastasakis A, Crotti L, Deharo JC, Elliott PM, Fedorowski A, Kaski JP, Limongelli G, Maron MS, Olivotto I, Ommen SR, Parati G, Shen W, Ungar A, Wilde A. Syncope in hypertrophic cardiomyopathy (part II): An expert consensus statement on the diagnosis and management. Int J Cardiol. 2023 Jan 1;370:330-337. doi: 10.1016/j.ijcard.2022.10.153. Epub 2022 Oct 26. PMID: 36309161.