In 2025, advancements in the management and treatment of syncope will be crucial, continuing to evolve based on both clinical findings and updated guidelines. A holistic approach is necessary, considering various forms of syncope, including reflex, arrhythmic, and orthostatic causes, while emphasizing risk stratification, lifestyle modifications, and patient education.
The treatment of reflex syncope, such as vasovagal syncope, remains fundamentally directed towards avoidance of known triggers and enhancements in fluid and salt intake. Studies have shown that educating patients about their condition, along with prescribed interventions that include physical counter-pressure maneuvers and tilt training, can effectively prevent syncopal events and improve quality of life (Ahmadi et al., 2024; (Wen et al., 2020; Loughlin et al., 2020). Increased salt intake has been recognized as an important recommendation in several clinical management protocols, contributing to blood volume expansion and thus aiding symptom management (Wen et al., 2020; Loughlin et al., 2020).
In cases of high-risk syncope, particularly with significant cardiac etiology, an expedited evaluation is critical. The European Society of Cardiology (ESC) emphasizes that individuals exhibiting alarming clinical features should undergo an early intensive assessment, typically in specialized syncope units or observation units (Reed et al., 2023; (Ghariq et al., 2023; . Current guidelines further recommend that patients with unexplained syncope or those presenting with dangerous arrhythmic profiles should be monitored closely and may require the fitting of implantable cardioverter-defibrillators (ICDs) (Shabbir et al., 2022; Francisco‐Pascual et al., 2023). For patients with cardioinhibitory syncope caused by vagal mechanisms, pacing strategies, including the use of leadless devices, can provide effective management solutions (Brieger et al., 2024; Francisco‐Pascual et al., 2023).
Educational initiatives are vital for improving adherence to syncope management guidelines, as highlighted by studies focusing on enhancing healthcare providers' understanding of syncope diagnostics (Ghariq et al., 2023; Ghariq et al., 2021). Incorporating multidisciplinary approaches and standardized clinical pathways is essential to ensure appropriate care, reducing unnecessary testing and hospitalizations, which burden the healthcare system and compromise patient experience (Amin et al., 2021).
Furthermore, there is a growing interest in technological advancements, particularly artificial intelligence, that can enhance diagnostic accuracy and streamline syncope management workflows. AI tools are being explored to refine clinical decision-making processes, which may prove integral as the field advances (Amin et al., 2021; Johnston, 2025).
In essence, the recommended strategies for syncope management center on thorough diagnostic evaluations, tailored treatment plans based on syncope types, increased patient involvement through education, and the integration of innovative technologies to support clinical practices.
References:
- Ahmadi, A., Sabri, M., Navabi, Z., Dehghan, B., Taheri, M., & Mahdavi, C. (2024). The impact of self-care recommendations with and without tilt-training on quality of life in children and adolescents with vasovagal syncope: a randomized clinical trial. Iranian Journal of Nursing and Midwifery Research, 29(3), 358-367.
https://doi.org/10.4103/ijnmr.ijnmr_137_23
- Amin, S., Gupta, V., Du, G., McMullen, C., Sirrine, M., Williams, M., … & Li, J. (2021). Developing and demonstrating the viability and availability of the multilevel implementation strategy for syncope optimal care through engagement (mission) syncope app: evidence-based clinical decision support tool. Journal of Medical Internet Research, 23(11), e25192.
https://doi.org/10.2196/25192
- Brieger, D., Tofler, G., & Chia, K. (2024). Use of a leadless pacemaker in the management of swallow syncope: a case report. Pacing and Clinical Electrophysiology, 47(8), 1061-1064.
https://doi.org/10.1111/pace.14923
- Francisco‐Pascual, J., Jordán, P., Silva, J., & Rivas-Gándara, N. (2023). Arrhythmic syncope: from diagnosis to management. World Journal of Cardiology, 15(4), 119-141.
https://doi.org/10.4330/wjc.v15.i4.119
- Ghariq, M., Bodegom‐Vos, L., Brignole, M., Peeters, S., Groot, B., Kaal, E., … & Thijs, R. (2021). Factors facilitating and hindering the implementation of the european society of cardiology syncope guidelines at the emergency department: a nationwide qualitative study. International Journal of Cardiology, 333, 167-173.
https://doi.org/10.1016/j.ijcard.2021.02.067
- Ghariq, M., Hout, W., Dekkers, O., Bootsma, M., Groot, B., Groothuis, J., … & Fokke, C. (2023). Diagnostic and societal impact of implementing the syncope guidelines of the european society of cardiology (synergy study). BMC Medicine, 21(1).
https://doi.org/10.1186/s12916-023-03056-6
- Johnston, S. (2025). The hope and the hype of artificial intelligence for syncope management. European Heart Journal - Digital Health, 6(5), 1046-1054.
https://doi.org/10.1093/ehjdh/ztaf061
- Loughlin, E., Judge, C., Gorey, S., Costello, M., Murphy, R., Waters, R., … & Canavan, M. (2020). Increased salt intake for orthostatic intolerance syndromes: a systematic review and meta-analysis. The American Journal of Medicine, 133(12), 1471-1478.e4.
https://doi.org/10.1016/j.amjmed.2020.05.028
- Reed, M., Karuranga, S., Kearns, D., Alawiye, S., Clarke, B., Möckel, M., … & Laribi, S. (2023). Management of syncope in the emergency department: a european prospective cohort study (seed). European Journal of Emergency Medicine, 31(2), 136-146.
https://doi.org/10.1097/mej.0000000000001101
- Shabbir, M., Shaukat, M., Ehtesham, M., Murawski, S., Singh, S., & Alimohammad, R. (2022). Bifascicular block in unexplained syncope is underrecognized and under-evaluated: a single-center audit of esc guidelines adherence. Plos One, 17(2), e0263727.
https://doi.org/10.1371/journal.pone.0263727
- Wen, C., Wang, S., Zou, R., Wang, Y., Tan, C., Xu, Y., … & Wang, C. (2020). Duration of treatment with oral rehydration salts for vasovagal syncope in children and adolescents. The Turkish Journal of Pediatrics, 62(5), 820-825.
https://doi.org/10.24953/turkjped.2020.05.014