4. Syncope Evaluation & Syncope Unit: 4.1 ECG Performance and Interpretation in Patients Admitted to an Emergency Department because of Loss of Consciousness

To assess the performance rate, the clinical interpretation and the findings of baseline EKG performed as initial evaluation in 1428 consecutive patients that attended an emergency department because of an episode of loss of consciousness, in a prospective multicenter study performed in 19 hospitals in Spain. All available EKC tracings were reviewed “a posteriori” by a scientific committee.

EKG was performed in 1342 out of 1428 patients (94%). EKG was initially considered normal in 814 (62%) patients. Tracings of 1081 EKG were available for “a posterior” analysis, with the following findings: atrial fibrillation in 107; ventricular tachycardia in 3; 1^st degree A-V block in 50; 2^nd degree Mobitz II A-V block in 6; 3^rd degree A-V block in 21; isolated right bundle branch block in 62; right bundle branch block with left anterior fascicular block in 25; left bundle branch block in 45; alternating left and right bundle branch block in 1; ventricular preexcitation in 2; “q” waves suggestive of myocardial necrosis in 38; ST segment elevation in 16; ST segment depression in 24; Brugada syndrome in 7; long QT interval in 4. EKG interpretation performed in emergency department was in agreement with “a posteriori” analysis in 93% of the tracings. 52 abnormal EKG tracings were considered initially at emergency department as normal: 1st degree A-V block in 6; 2^nd degree Mobitz II A-V block in 1; right bindle branch block in 12; left bundle branch block in 2; right bundle branch block with left anterior fascicular block in 1; other intraventricular conduction defects in 10; “q” waves suggestive of myocardial necrosis in 3; Brugada syndrome in 2 and long QT in 1; left ventricular hypertrophy in 9; atrial fibrillation in 2.

Baseline EKG in emergency department was performed in a relatively high rate of patients that attended because of loss of consciousness. However it must be considered that it should be performed in all patients. In addition although the interpretation of EKG was adequate in most patients, there were some errors with potential significant impact in risk stratification of these patients.