Exercise-induced neurocardiogenic syncope - Clinical data, pathophysiological aspects, and potential role of tilt table testing

The evaluation of syncope occurring during exercise or occurring spontaneou sly in highly trained individuals presents a unique diagnostic challenge. I t is of critical importance to exclude potential life-threatening disorders such as hypertrophic cardiomyopathy, long QT syndrome, right ventricular d ysplasia,anomalous coronary artery distribution, valvular heart disease, my ocarditis, or exercise-induced arrhythmia. This review is not directed towa rds identifying, treating, or determining athletic eligibility of individua ls with such disorders. Rather, we endeavour to discuss the pathophysiology of exercise-induced neurocardiogenic syncope and to address the role of he ad upright tilt testing in evaluating syncope in athletic individuals in wh om proper evaluation has excluded the presence of ischaemic heart disease o r primary structural or electrical heart disease. (C) 2000 The European Soc iety of Cardiology.