Score indices for predicting electrophysiologic outcomes in patients with unexplained syncope.
BACKGROUND
Our ability to predict a positive electrophysiologic (EP) study in the evaluation of unexplained syncope is suboptimal.


OBJECTIVE
In patients with unexplained syncope, we defined clinical predictors of bradyarrhythmia and ventricular tachycardia (VT) diagnosed during EP study, constructed diagnostic score indices for bradyarrhythmia and VT, and evaluated the predictive power of each score index.


METHODS
All patients evaluated in the Arrhythmia Clinic for unexplained syncope from January 1, 1996, through December 31, 1998, were identified and enrolled in the study. Five hundred eight patients (325 [64%] men; mean+/-SD age, 64+/-17 years) underwent EP testing. We analyzed elements from historical data and noninvasive laboratory findings as predictors of bradyarrhythmia and VT diagnosed on EP study.


RESULTS
Fifty-eight patients (11%) had sinus node dysfunction, 94 (19%) had atrioventricular (AV) node disease, 92 (18%) had His-Purkinje system disease, and 101 (20%) had VT. Models were fit using logistic regression analysis. Predictors were assigned weighted scores, and a score index was formulated. The area under the curve associated with sinus node dysfunction, AV node disease, His-Purkinje system disease, and VT models was 0.64, 0.60, 0.84, and 0.60, respectively.


CONCLUSIONS
We have constructed diagnostic score indices for EP outcomes of bradyarrhythmia and VT in syncope. Of all the score indices, the model for His-Purkinje system disease has the highest predictive power.
Chen
Lin Y
LY
Division of Cardiovascular Diseases, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA, and Department of Internal Medicine, University of Amsterdam, Academic Medical Centre, The Netherlands.
Jahangir
Arshad
A
Decker
Wyatt W
WW
Smars
Peter A
PA
Wieling
Wouter
W
Hodge
David O
DO
Gersh
Bernard J
BJ
Hammill
Stephen C
SC
Shen
Win-Kuang
WK
D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000453:epidemiology*; D001919:Bradycardia / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D004562:Electrocardiography / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology*; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology