Prognostic value of the ECG in syncope: data from GESINUR study

Background: The GESINUR is a multicenter prospective observational study that evaluated the clinical presentation and acute management of loss of consciousness in Spain. Several studies have shown that an abnormal ECG is a poor prognostic factor in patients with syncope. However the prognostic significance of each of the ECG abnormalities (EA) is unknown, which is the objective of this study. Methods: We included all patients in the GESINUR study with syncope, readable ECG and one year follow-up, n = 582 (56±22 years, 51% female). EA were analyzed and assessed whether there was an association with overall mortality at 12 months. Results: The ECG was classified as abnormal in 375 patients (65%). Thirty-four patients died during follow-up (5.84%). Although several EA were associated with a worse prognosis in univariate analysis (see table), multivariate analysis showed that only a QRS ≥ 120ms (OR 8.75, p = 0.012), the presence of ventricular pacing (p <0.001), advanced age (OR 1.1 per year of age, p <0.001) and elevated heart rate (OR 1.03 per each heartbeat, p = 0.006) were independently associated with higher mortality. There was also a strong tendency of left ventricular hypertrophy criteria to be associated with increased mortality (OR 9.15, p = 0.053) in multivariate analysis. View this table: ECG Mortality Predictors. Univariate an Conclusions: Although an abnormal ECG in patients with syncope is a common finding, only the presence of a wide QRS complex, ventricular pacing and elevated heart rate worsen its prognosis.