Electrophysiological study as a predictor of mortality in unexplained syncope

J Arrhythm. 2023 Mar 6;39(2):121-128. doi: 10.1002/joa3.12836. eCollection 2023 Apr.

Abstract

Background: Electrophysiological study can help in the diagnosis of arrhythmic syncope. According to the electrophysiological study finding, the prognosis of patients with syncope is still a matter of study.

Objective: The aim of this study was to assess the survival of patients undergoing electrophysiological study according to their findings and to identify clinical and electrophysiological independent predictors of all-cause mortality.

Methods: A retrospective cohort study included patients with syncope who underwent electrophysiological study from 2009 to 2018. A Cox logistic regression analysis was performed to identify independent prognostic factors for all-cause mortality.

Results: We included 383 patients in our study. During a mean follow-up of 59 months, 84 (21.9%) patients died. The split His group had the worst survival compared with the control group, followed by sustained ventricular tachycardia and HV interval ≥ 70 ms, respectively (p = .001; p < .001; p = .03). The supraventricular tachycardia group showed no differences compared with the control group (p = .87). In the multivariate analysis, independent predictors of all-cause mortality were Age (OR 1.06; 1.03-1.07; p < .001); congestive heart failure (OR 1.82; 1.05-3.15; p = .033); split His (OR 3.7; 1.27-10.80; p = .016); and sustained ventricular tachycardia (OR 1.84; 1.02-3.32; p = .04).

Conclusion: Split His, sustained ventricular tachycardia, and HV interval ≥ 70 ms groups had worse survivals when compared to the control group. Age, congestive heart failure, split His, and sustained ventricular tachycardia were independent predictors for all-cause mortality.

Keywords: electrophysiological study; prognosis; split his; syncope; ventricular tachycardia.