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

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.