Sponsored by Finapres Medical Systems

The new 2STEPS standardized diagnostic assessment for autonomic syncope: easy-to-apply, timesaving and highly efficient
Michele Brignole, MD
Senior Scientist, Cardiology,
Istituto Auxologico Italiano

The standardized 2STEPS protocol offers an easy-to-perform and time-saving diagnostic work-up allowing identification of the haemodynamic mechanism of loss of consciousness in most patients with autonomic syncope.
The two-step assessment includesg 24-h ambulatory blood pressure monitoring and short cardiovascular autonomic function assessment (SCAFA). SCAFA consists of carotid sinus massage (CSM), performed in patients ≥40 years old, a passive standing test, and a ‘fast’ head-up tilt test scheduled sequentially during one session on a tilt table This protocol provides the necessary background for a personalized mechanism-specific therapy.

Carotid sinus massage in patients with syncope - the six step method
Jelle de Jong, MD, PhD
Doctor of Cardiology,
Amsterdam University Medical Centre, University of Amsterdam

Carotid sinus massage is an important part of cardiovasculair autonomic reflex testing in patients with unexplained syncope. Carotid sinus massage is indicated in all patients older than 40 presenting with syncope of unknown origin, and with a suspected (autonomic) reflex mechanism. However, carotid sinus massage is frequently omitted during the evaluation of syncope, or not performed properly. This presentation aims to guide physicians in the practical skill of carotid sinus massage using the six-step method.
A boundary for physicians for performing carotid sinus massage is fear of ischemic stroke, based on studies before 2000. Studies performed since 2000 show a very low complication rate of 1 in 10,000 for transient ischemic attacks. Thus performing carotid sinus massage is safe and can guide in the treatment of patients with syncope.