Prevalence of cardiac arrhythmias in pre-hospital tele-cardiology electrocardiograms of emergency medical service patients referred for syncope

Abstract Aim To evaluate the rate of prevalence of significant arrhythmias in emergency medical service (EMS) subjects referred for syncope and screened with pre-hospital tele-cardiology ECG. Methods 2648 consecutive EMS patients referred for syncope were evaluated with tele-cardiology support. Pre-hospital ECGs were sent to a single tele-cardiology “hub”, active 24/7 and serving a region of 4-million inhabitants, and promptly read by a cardiologist. Prevalence of any arrhythmias or conduction disturbances was recorded. Results In more than 55% of cases ECG findings were normal; in 13% ECG showed sinus tachycardia, in 9% sinus bradycardia. Prevalence of ventricular tachycardia was 0.20%, while significant AV-disturbances were present in 1.12% of cases (0.11% second-degree type 2 AV-block, 0.11% advanced AV-block, 0.19% third-degree AV-block, 0.45% junctional rhythm, 0.26% ventricular rhythm). Limited gender differences were detectable. No significant arrhythmias were found in subjects younger than 30 years. Prevalence of several arrhythmias was age related. Conclusions Prevalence of significant arrhythmias among EMS patients referred for syncope and evaluated with pre-hospital tele-cardiology ECG is low, and almost absent in subjects below 30 years. Tele-cardiology pre-hospital screening by a single regional “hub” may be helpful for the prompt diagnosis of arrhythmia related syncope.