The problem of underdiagnosis of sudden cardiac death in young patients with high-risk syncope without structural heart disease
The problem of underdiagnosis of sudden cardiac death in young patients with high-risk syncope without structural heart disease
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Original abstract
Aim. To address the problem of underdiagnosis of sudden cardiac death based on the analysis and successful verification of the cause of syncope in young patients with high-risk syncope without structural heart disease after the first syncope. Methods. The study included 128 patients with syncope. Based on inclusion and exclusion criteria, 63 patients were included in the study, aged 18 to 44 years; the average age of the subjects was 25.98 ± 6.69 years. An analysis of the causes of syncope established after the patient's first visit regarding a syncope was performed, and these data were compared with the final clinical diagnosis obtained on the basis of electrophysiological and molecular genetic diagnostic methods. The frequency of recurrence of syncope and SCD episodes from the time of the first syncope was assessed. Results. The study found that only 20 patients (31.7 %) sought medical attention after their first syncopal episode. Only 11 patients (17.7 %) were correctly diagnosed with a cardiac cause after their first syncope. Fifty-two patients (82.3 %) were diagnosed with non-cardiogenic syncope or syncope of unknown etiology. Retrospectively, all 52 (82.5 %) patients experienced a recurrence of syncope within 1–2 years, of which 10 patients (15.9 %) had an episode of SCD with successful cardiopulmonary resuscitation. In 14 patients (22.6 %), a diagnosis of syncope against the background of cardiocerebral syndrome was established at the outpatient stage, in 12 (19.4 %) – vegetative-vascular dystonia, somatoform dysfunction of the autonomic nervous system, in 8 (12.9 %) a diagnosis of anxiety disorder with panic attacks, in 4 – obesity (6.5 %), 3 patients had epilepsy (4.8 %) with the prescription of antiepileptic drugs, 2 patients had migraine without aura (3.2 %), 2 had tension headache (3.2 %), 3 patients had a diagnosis of paroxysmal conditions without specification (4.8 %), 1 had osteochondrosis of the cervical spine (1.6 %) and 2 had closed craniocerebral injury (3.2 %). After using methods of molecular genetic analysis and functional diagnostics (including genome/exome sequencing, implantable cardiac monitor, intracardiac electrophysiological study), the following final diagnoses were made: 12 people were diagnosed with rare diseases – channelopathies, 16 people – sinus node arrest and Short's syndrome, 15 patients – atrioventricular block grade 3 and grade 2 Mobitz 2, 15 patients – ventricular tachycardia, 5 patients – Wolff – Parkinson – White syndrome. Conclusion. High-risk syncope in young patients without structural heart disease should be considered a potential predictor of life-threatening conditions. Early identification of the risk of recurrent syncope and sudden cardiac death, as well as timely verification of the cause of syncope, can prevent a fatal outcome.