Key result
Cardiologist review of ECGs in a first seizure clinic identified significant abnormalities in 25% of patients, compared to 10% identified by the attending neurologist.
Why the study?
Although an ECG is mandatory for loss of consciousness and many first seizure clinic referrals are syncope-related, the sensitivity of neurologists' ECG reporting for rhythm abnormalities was uncertain.
Does cardiologist interpretation of ECGs improve the detection of significant cardiac abnormalities compared to neurologist interpretation in patients attending a first seizure clinic?
Cohort (n=160)
Cardiologists blinded to patient details
No
Does cardiologist interpretation of ECGs improve the detection of significant cardiac abnormalities compared to neurologist interpretation in patients attending a first seizure clinic?
Effect estimate: Kappa 0.304 (95% CI 0.14-0.47)
Absolute Event Rate: 25% vs 10%
Cardiologist review of ECGs in first seizure clinics significantly increases the detection of potentially life-threatening cardiac abnormalities compared to neurologist interpretation alone.
Neurologists may miss significant ECG abnormalities in first seizure clinics; leaves open whether routine cardiologist review improves diagnostic yield.
BACKGROUND AND AIMS: An electrocardiogram (ECG) is a mandatory test for anyone presenting with loss of consciousness. Many referrals to the first seizure clinic (FSC) are caused by syncope. We assessed the sensitivity of neurologists' ECG reporting in detecting rhythm abnormalities including some potentially life-threatening cardiac conditions. METHODS: We audited patients referred to a FSC in Glasgow over 4 years. All ECGs were interpreted by the attending neurologist as standard practice. Subsequently, two cardiologists reviewed the ECGs independently. RESULTS: Of 160 consecutive patients, 92 patients (58%) were diagnosed as having seizures, 43 (27%) as syncope, and 25 (16%) were unclassified. Twenty eight ECGs thought to be normal by the neurologist were considered abnormal by the cardiologist, including three with long corrected QT interval. The proportion of abnormal ECGs and disparity in reporting between neurologists and cardiologists persisted independent of the underlying diagnosis. CONCLUSION: Reporting of ECGs by non-cardiologists may not be adequately sensitive in picking up potentially life threatening cardiac conditions. Cardiologist input into FSCs is recommended to enhance the diagnostic yield.
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Huang et al. (2021) conducted a cohort in Loss of consciousness / First seizure (n=160). Cardiologist ECG interpretation vs. Neurologist ECG interpretation was evaluated on Detection of significant ECG abnormalities (Kappa 0.304, 95% CI 0.14-0.47). Cardiologist review of ECGs in a first seizure clinic identified significant abnormalities in 25% of patients, compared to 10% identified by the attending neurologist.
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