title: Prognostic value of the electrocardiogram in patients with syncope: data from the group for syncope study in the emergency room (GESINUR).
abstract: BACKGROUND
  The Group for Syncope Study in the Emergency Room (GESINUR) was a Spanish 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 ECG abnormality is not well known.
  
  
  OBJECTIVE
  The purpose of this study was to study the association between specific ECG abnormalities and mortality in patients with syncope from the GESINUR study.
  
  
  METHODS
  All patients in the GESINUR study who had syncope and had available, readable ECG and 12-month follow-up data were included in this retrospective observational study (n = 524, age 57 ± 22 years, 50.6% male). ECG abnormalities were analyzed and assessed to evaluate whether an association with all-cause mortality existed at 12 months.
  
  
  RESULTS
  ECGs were classified as abnormal in 344 patients (65.6%). Thirty-three patients died during follow-up (6.3%), but only 1 due to sudden cardiovascular death. Atrial fibrillation (odds ratio [OR] 6.8, 95% confidence interval [CI] 2.8-16.3, P <.001), intraventricular conduction disturbances (OR 3.8, 95% CI 1.7-8.3, P = .001), left ventricular hypertrophy ECG criteria (OR 6.3, 95% CI 1.5-26.3, P = .011), and ventricular pacing (OR 21.8, 95% CI 4.1-115.3, P <.001) were the only independent ECG predictors of all-cause mortality.
  
  
  CONCLUSIONS
  Although an abnormal ECG in patients with syncope is a common finding, only the presence of atrial fibrillation, intraventricular conduction disturbances, left ventricular hypertrophy ECG criteria, and ventricular pacing is associated with 1-year all-cause mortality.
authors.affiliation: Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Spain. Electronic address: jordiperez@vhebron.net.
authors.forename: Jordi
authors.initials: J
authors.lastname: Pérez-Rodon
authors.affiliation: Arrhythmia Unit, Department of Cardiology, Hospital de Basurto, Bilbao, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Martínez-Alday
authors.affiliation: Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Barón-Esquivias
authors.affiliation: Emergency Department, Hospital Universitario Severo Ochoa, Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Martín
authors.affiliation: Arrhythmia Unit, Department of Cardiology, Hospital Clínico Universitario, Valencia, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: García-Civera
authors.affiliation: Emergency Department, Hospital de la Princesa, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Del Arco
authors.affiliation: Medtronic Ibérica S.A., Madrid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Cano-Gonzalez
authors.affiliation: Arrhythmia Unit, Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Moya-Mitjans
mesh_terms: D002423:Cause of Death; D004562:Electrocardiography / Q000145:classification*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D011795:Surveys and Questionnaires; D013575:Syncope / Q000401:mortality / Q000503:physiopathology*
keywords: Abnormality; Atrial fibrillation; Electrocardiogram; Intraventricular conduction disturbances; Left ventricular hypertrophic criteria; Mortality; Prognosis; Syncope; Ventricular pacing