Key result
Exertional syncope or preceding palpitations linked to ~156% higher odds of unexplained syncope.
Why the study?
The study aimed to estimate the prevalence of unexplained syncope and characterize its high-risk features and predictors in children and young adults screened for sudden cardiac death risk factors.
Observational (n=11,878)
In a large cohort of children and young adults, unexplained syncope was common and associated with specific clinical features like exertion and male gender, but not with specific ECG predictors.
Answers are grounded in this paper and cite their sources.
Unexplained syncope features in screened youth may guide risk stratification; leaves open whether ECG screening reduces sudden death incidence.
INTRODUCTION: The Sudden Cardiac Death-Screening of Risk FactOrS survey included a 12-lead electrocardiogram (ECG) plus a digital-based questionnaire and aimed to screen for warning signs of diseases that may course with sudden cardiac death in children and young adults. We aimed to estimate the prevalence of unexplained syncope (US) and characterize its high-risk features and predictors in this cohort. METHODS AND RESULTS: We determined the most probable etiology of transient loss of consciousness (TLOC) episodes based on clinical criteria. US was an exclusion diagnosis and we analyzed its potential clinical and ECG predictors. Among 11 878 individuals, with a mean age of 21 ± 6 (range 6-40) years old, the cumulative incidence of TLOC was 26.5%, 76.2% corresponding to females. Reflex syncope was present in 66.4%, orthostatic hypotension in 8.2%, and 14.8% of the individuals had US. Unexplained syncope was independently associated with age < 18 years old (odds ratio [OR] 1.695; 95% confidence interval [CI] 1.26-2.29, p = .001), male gender (OR 1.642; 95% CI 1.22-2.22, p = .001), participation in competitive sports (OR 1.644; 95% CI 1.01-2.66, p = .043), syncope during exertion and/or palpitations preceding syncope (OR 2.556; 95% CI 1.92-3.40, p < .001), syncope after exertion (OR 2.662; 95% CI 1.73-4.10, p < .001), fever context (OR 9.606; 95% CI 4.13-22.34, p < .001), isolated previous syncopal episode (OR 2.780; 95% CI 0.2.06-3.75, p < .001), and history of palpitations requiring medical care (OR 1.945; 95% CI 1.14-3.31, p = .014). We found no ECG predictors of US in this population. CONCLUSIONS: The cumulative incidence of TLOC in children and young adults is high and remains unexplained in an important proportion of individuals. We identified eight clinical characteristics that may be useful for the risk stratification of individuals evaluated in a nonacute setting.
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Carrington et al. (2021) conducted an observational in Unexplained syncope (n=11,878). Clinical predictors (e.g., syncope during exertion or preceding palpitations) vs. Absence of predictors was evaluated on Unexplained syncope (OR 2.556, 95% CI 1.92-3.40, p=<0.001). Among 11,878 young individuals, unexplained syncope occurred in 14.8% and was strongly predicted by factors such as syncope during exertion or preceding palpitations (OR 2.556; 95% CI 1.92-3.40).
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