What are the referral criteria for a patient with palpitations and associated syncope?

Referral criteria for a patient presenting with palpitations and associated syncope:

• Urgent referral to cardiology is indicated if the patient has a history of syncope or near syncope associated with palpitations, especially if palpitations are precipitated by exercise or there is a family history of sudden cardiac death under 40 years of age.
• Urgent referral is also warranted if the 12-lead ECG shows second or third degree atrioventricular block, or if there are features suggestive of a serious underlying cardiac cause such as high degree AV block, ventricular tachycardia, persistent supraventricular tachycardia, haemodynamic instability, or high-risk structural heart disease.
• Patients with syncope and palpitations who have chest pain, lightheadedness, or signs/history of structural heart disease, heart failure, or hypertension should be referred routinely to cardiology.
• Referral for specialist cardiovascular assessment should be made urgently (within 24 hours) for any transient loss of consciousness (TLoC) with syncope and any ECG abnormalities including conduction abnormalities, long or short QT interval, or arrhythmias.
• Emergency admission is indicated if the patient has current palpitations with ventricular tachycardia, persistent supraventricular tachycardia, or haemodynamic instability.
• Patients with syncope and palpitations but without red flags (normal ECG, no family history of sudden cardiac death, no exercise-induced symptoms, no structural heart disease) may not require immediate referral but should have appropriate investigations and monitoring arranged.

These criteria ensure timely identification and management of potentially life-threatening cardiac causes of palpitations and syncope.

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