International Circulation:  ESC 2009 has presented new guidelines for the diagnosis and management of syncope. There’s a new definition of syncope therefore the diagnosis strategy has also been revised. Would you please talk about what are the impacts of these changes on the clinical practice?

Win-Kuang Shen:  First， the impact of syncope factors is enormous.  There is a very large population with syncope.  Secondly， even though patients come in for syncope evaluation there is often a worry that some patients may have life threatening rhythm disturbances yet the majority of patients have rather benign causes of syncope， the majority， especially the young， have reflex syncope.  The new practice guidelines really emphasized some of the pathophysiology of syncope.  At the same time we established evaluation and diagnostic pathways in hope that we could make the evaluation and treatment of patients with syncope more effective and efficient so we don’t waste a lot of time and money， and can establish a diagnosis effectively to then target the treatment.  In terms of treatment we now recognize that the treatment for brady arrhythmias， tachy arrhythmias， and other cardiac causes of syncope are pretty standard because there are many other guidelines that are already established.  For the treatment of reflex syncope， especially for vaso-vagal syncope， we realize that many of the drugs we have used for a long time are really not that effective.  There is a new pathway for treating patients with vaso-vagal syncope.  Lastly， we hope that we will be able to establish a triaging system for general practice so most hospitals will be able to follow a simple triaging system with a specialized syncope unit so we can improve the patient’s syncope evaluation.