High-risk features and predictors of unexplained syncope in the young
SCD-SOS cohort
Abstract
Introduction: The Sudden Cardiac Death-Screening of Risk FactOrS survey
included a 12-lead 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 the 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 61.0%, orthostatic hypotension
in 7.9% and 12.6% of the individuals had US. Unexplained syncope was
independently associated with age < 18 years-old (OR1.72;
95%CI 1.27-2.32,p<0.001), male gender (OR1.650; 95%CI
1.22-2.23,p=0.001), participation in competitive sports (OR1.64;95%CI
1.01-2.66,p=0.044), major syncope high-risk features (OR 2.61;95%CI
1.96-3.47,p<0.001), syncope after exertion (OR2.77;95%CI
1.80-4.27,p<0.001), fever context (OR9.58;95%CI
4.12-22.30,p<0.001), lower number of previous syncopal
episodes (OR0.36;95%CI 0.37-0.48,p<0.001) and history of
palpitations requiring medical care (OR1.98;95%CI 1.16-3.38,p=0.012).
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 non-acute setting.