High-Risk ECG in Syncope: High Risk or Overstated?

Proposed emergency department approach to syncope. After confirming true syncope and excluding immediately apparent diagnoses, assessment focuses on identifying patients at high risk of clinically significant bradyarrhythmia or other specific cardiac conditions requiring hospital admission, while avoiding unnecessary admission for isolated non-specific ECG abnormalities. The proposed recommendations and algorithm reflect the authors' interpretation of the available evidence and are intended to complement current ESC recommendations. Although informed by observational studies, they remain exploratory and have not yet been prospectively validated.