Key result
Abnormal findings on both 12-lead ECG and 24-hour ambulatory monitoring strongly predicted electrophysiology study abnormalities compared to normal noninvasive tests (82.2% vs 9.1%; OR 35.9, P<0.001).
Why the study?
Do abnormal findings on noninvasive electrocardiographic evaluation predict abnormal electrophysiology study results in patients with undiagnosed syncope?
Observational (n=421)
Do abnormal findings on noninvasive electrocardiographic evaluation predict abnormal electrophysiology study results in patients with undiagnosed syncope?
Effect estimate: OR 35.9
Absolute Event Rate: 82.2% vs 9.1%
p-value: p=<0.001
Abnormal findings on 12-lead ECG and 24-hour ambulatory monitoring strongly predict the presence of arrhythmic abnormalities on invasive electrophysiology testing in patients with undiagnosed syncope.
May refine EPS selection in undiagnosed syncope; leaves open need for prospective outcome validation.
BACKGROUND: The evaluation of syncope can be expensive, unfocussed, and unrevealing yet, failure to diagnose an arrhythmic cause of syncope is a major problem. We investigate the utility of noninvasive electrocardiographic evaluation (12-lead ECG and 24-hour ambulatory electrocardiographic recordings) to predict electrophysiology study results in patients with undiagnosed syncope. METHODS: We evaluated 421 patients with undiagnosed syncope who had an electrocardiogram (ECG), an electrophysiology study, and 24-hour ambulatory monitoring. Noninvasive testing was used to predict electrophysiology testing outcomes. Multivariable logistic regression analysis adjusting for age, sex, presence of heart disease, and left ventricular ejection fraction (LVEF) was used to assess independent predictors for sinus node disease, atrioventricular node disease, and induction of ventricular tachyarrhythmias. RESULTS: Patients were divided into four groups: group 1, abnormal ECG and ambulatory monitor; group 2, abnormal ECG only; group 3, abnormal ambulatory monitor; and group 4, normal ECG and ambulatory monitor. The likelihood of finding at least one abnormality during electrophysiologic testing among the four groups was highest in group 1 (82.2%) and lower in groups 2 and 3 (68.1% and 33.7%, respectively). In group 4, any electrophysiology study abnormality was low (9.1%). Odds ratios (OR) were 35.9 (P < 0.001), 17.8 (P < 0.001), and 3.5 (P = 0.064) for abnormal findings on electrophysiology study, respectively (first three groups vs the fourth one). ECG and ambulatory monitor results predicted results of electrophysiology testing. CONCLUSION: Abnormal ECG findings on noninvasive testing are well correlated with potential brady- or/and tachyarrhythmic causes of syncope, in electrophysiology study of patients with undiagnosed syncope.
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Gatzoulis et al. (2009) conducted an observational in Undiagnosed syncope (n=421). Noninvasive electrocardiographic evaluation (12-lead ECG and 24-hour ambulatory monitoring) vs. Normal ECG and ambulatory monitor was evaluated on At least one abnormality during electrophysiologic testing (OR 35.9, p=<0.001). Abnormal findings on both 12-lead ECG and 24-hour ambulatory monitoring strongly predicted electrophysiology study abnormalities compared to normal noninvasive tests (82.2% vs 9.1%; OR 35.9, P<0.001).
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