As the most common cause of syncope, vasovagal syncope (VVS) is the result of cerebral hypoperfusion caused by sudden-onset bradycardia and mediated by parasympathetic overdrive.1 VVS is generally categorized into three types: cardioinhibitory, vasodepressive and mixed type. Patients with recurrent syncope are first treated with conservative measures such as fluid and salt intake, trigger avoidance, and physical counter-pressure maneuvers. Similar to VVS, parasympathetic overdrive, affecting the sinus node (SAN) and atrioventricular node (AVN), may cause symptomatic sinus nodal dysfunction (SND) and atrioventricular block (AVB).

The issue of the risk of direct current shock in patients with CIEDs is a subject that has been of concern for many years.1–3 As the authors have pointed out, there are case reports of damage to pulse generators and the lead-tissue interface.4 This informed the writing group of the Heart Rhythm Society perioperative management document 10 years ago to recommend that patients who have cardioversion have their CIEDs interrogated before leaving a monitored environment. However, in practice, this does not seem to have occurred very often.

Using data from 5 landmark primary prevention (PP) implantable cardioverter-defibrillator (ICD) trials, Younis et al (Circulation 2023;148:241, PMID 37459413) sought to assess whether there was any racial difference in the risk of ventricular arrhythmias (VAs) and atrial arrhythmias (AAs). All patients self-identified as white or black. All 5 trials defined ischemic cardiomyopathy (ICM) as documented previous myocardial infarction or coronary intervention such as bypass grafting or angioplasty. Nonischemic cardiomyopathy (NICM) was defined as any abnormality in the myocardium capable of producing heart failure (HF) but does not meet criteria for ICM.

A major focus of the Heart Rhythm Society (HRS) has been education of physicians, scientists, allied health professionals, patients, and other stakeholders. Numerous committees and initiatives of the HRS have contributed to the advancement of the education mission. This is epitomized by the HRS annual meeting, the preeminent “touch point” for heart rhythm specialists. The HRS Education Council was formed in 2021 by the HRS Board of Trustees to address the many thus far disconnected educational offerings of HRS committees and to identify opportunities for strategic alignment.