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Cited by 118Cardiovascular Syncope and Autonomic DisordersCardiac electrophysiology and arrhythmiasHeart Rate Variability and Autonomic Control

A risk score to predict arrhythmias in patients with unexplained syncope

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Sarasin, François P., Hanusa, Barbara H., Perneger, Thomas, Louis‐Simonet, Martine, Rajeswaran, Anand, Kapoor, Wishwa N.·2003·Academic Emergency Medicine
DOI 10.1197/s1069-6563(03)00535-9
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Abstract

OBJECTIVES: To develop and validate a risk score predicting arrhythmias for patients with syncope remaining unexplained after emergency department (ED) noninvasive evaluation. METHODS: One cohort of 175 patients with unexplained syncope (Geneva, Switzerland) was used to develop and cross-validate the risk score; a second cohort of 269 similar patients (Pittsburgh, PA) was used to validate the system. Arrhythmias as a cause of syncope were diagnosed by cardiac monitoring or electrophysiologic testing. Data from the patient's history and 12-lead emergency electrocardiography (ECG) were used to identify predictors of arrhythmias. Logistic regression was used to identify predictors for the risk-score system. Risk-score performance was measured by comparing the proportions of patients with arrhythmias at various levels of the score and receiver operating characteristic (ROC) curves. RESULTS: The prevalence of arrhythmic syncope was 17% in the derivation cohort and 18% in the validation cohort. Predictors of arrhythmias were abnormal ECG (odds ratio [OR]: 8.1, 95% confidence interval [CI]=3.0 to 22.7), a history of congestive heart failure (OR: 5.3, 95% CI=1.9 to 15.0), and age older than 65 (OR: 5.4, 95% CI=1.1 to 26.0). In the derivation cohort, the risk of arrhythmias ranged from 0% (95% CI=0 to 6) in patients with no risk factors to 6% (95% CI=1 to 15) for patients with one risk factor, 41% (95% CI=26 to 57) for patients with two risk factors, and 60% (95% CI = 32 to 84) for those with three risk factors. In the validation cohort, these proportions varied from 2% (95% CI=0 to 7) with no risk factors to 17% (95% CI=10 to 27) with one risk factor, 35% (95% CI=24 to 46) with two risk factors, and 27% (95% CI=6 to 61) with three risk factors. Areas under the ROC curves ranged from 0.88 (95% CI=0.84 to 0.91) for the derivation cohort to 0.84 (95% CI=0.77 to 0.91) after cross-validation within the same cohort and 0.75 (95% CI=0.68 to 0.81) for the external validation cohort. CONCLUSIONS: In patients with unexplained syncope, a risk score based on clinical and ECG factors available in the ED identifies patients at risk for arrhythmias.

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  • Structural heart disease and primary electrical disease are major risk factors for sudden cardiac death and overall mortality in patients with syncope.

    “Structural heart disease 25-27,31,35,36,45 and primary electrical disease 46 are major risk factors for sudden cardiac death (SCD) and overall mortality in patients with syncope.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [25]

  • Cardiac ischaemia-related syncope is confirmed when syncope presents with evidence of acute myocardial ischaemia with or without myocardial infarction.

    “Cardiac ischaemia-related syncope is confirmed when syncope presents with evidence of acute myocardial ischaemia with or without myocardial infarction. 25-39”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [25]

  • Arrhythmic syncope is highly probable when the ECG shows persistent sinus bradycardia <40 b.p.m. or sinus pauses >3 s in awake state and in absence of physical training; Mobitz II second- and third-degree AV block; alternating left and right BBB; VT or rapid paroxysmal SVT.

    “Arrhythmic syncope is highly probable when the ECG shows 25-39 : • Persistent sinus bradycardia <40 b.p.m. or sinus pauses >3 s in awake state and in absence of physical training; • Mobitz II second- and third-degree AV block; • Alternating left and right BBB; • VT or rapid paroxysmal SVT;”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [25]

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Authors
Sarasin, F. P., Hanusa, B. H., Perneger, T., Louis‐Simonet, M., Rajeswaran, A., & Kapoor, W. N.
Affiliations
  • University of Geneva (CH)
  • University of Pittsburgh (US)
Corresponding author
Sarasin, François P.
ORCID
Venue
Academic Emergency Medicine
Publisher
Wiley
Published
2003-12
Volume
10
Issue
12
Pages
1312-1317
ISSN
  • 1069-6563 (ISSN-L)
  • 1553-2712
DOI
10.1197/s1069-6563(03)00535-9
OpenAlex
W2111333886
Cited by
118
References
23
Citations by year
2026: 4 · 2025: 1 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 1 · 2018: 9 · 2017: 10 · 2016: 3 · 2015: 5 · 2014: 10 · 2013: 9 · 2012: 8
FWCI
2.21
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1671 d)
Locations
  • Academic Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
unexplained syncope, cardiac arrhythmias, risk score, arrhythmic syncope, emergency department evaluation, congestive heart failure, risk factors, cardiac monitoring, electrophysiologic testing, risk prediction model, old age, diagnostic accuracy, sensitivity and specificity, positive predictive value, negative predictive value, cost-effectiveness
MeSH terms
Aged, Aged, 80 and over, Arrhythmias, Cardiac, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Syncope, Cohort Studies, Electrocardiography, Ambulatory

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