Disclosure(s): No relevant financial relationship(s) to disclose.
First Author: Ronaldo Pichardo Gonzalez, MD Co-Author: Oghosa Clinton Ibude, MD – Research Fellow, 1. Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States Co-Author: Anushka Deogaonkar, MBBS – Research Fellow, 1. Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States Co-Author: Samantha Camp, BS Co-Author: Quincy K. Tran, MD, PhD – University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center Co-Author: Ali Pourmand, MD MPH – Attending physician, George Washington University school of medicine and Health Sciences
Introduction: Syncope is a frequent cause of emergency department (ED) visits. Ventricular tachycardia (VT) is a serious but often underdiagnosed cause, as transient episodes may be missed without continuous monitoring and are associated with adverse outcomes. This study investigates the relationship between VT-related syncope and the risk of serious clinical outcomes, including organ injury, cardiovascular events, and death.
Methods: Retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network to examine adults (≥18 years) presenting to the ED with syncope between 2015 and 2025. Patients were grouped into two cohorts: Cohort 1 (syncope and VT) versus Cohort 2 (syncope without VT). One-to-one propensity score matching was used to balance demographics and comorbidities including hypertension, diabetes, and dyslipidemia. Primary outcomes were measured within 180 days after the index ED visit and included acute kidney injury (AKI), congestive heart failure (CHF), acute myocardial infarction (AMI), stroke, and all-cause mortality. Risk difference (RD), Kaplan-Meier (KM) survival estimates, and hazard ratios (HR) were performed.
Results: After propensity score matching, 17,708 patients remained per cohort. The mean age was 66.1 (±14.1) years, 33.3% were female, and 41.1% had diabetes. Patients in the VT group had significantly higher risks across all outcomes. The largest risk difference (RD) was observed for death (RD = 10.1%; 95% CI, 9.5%-10.7%; p < 0.001; HR 3.61), followed by CHF (RD = 6.5%; 95% CI, 5.7%-7.3%; p < 0.001; HR 3.07), AKI (RD = 4.0%; 95% CI, 3.4%-4.7%; p < 0.001; HR 2.01), AMI (RD = 2.9%; 95% CI, 2.5%-3.4%; p < 0.001; HR 2.77), and stroke (RD = 0.7%; 95% CI, 0.4%-1.0%; p < 0.001; HR 1.36). Syncope with VT was associated with a 10.6% lower 180-day survival probability and a 3.6-fold higher risk of death at any time point (HR 3.61) compared to syncope without VT.
Conclusions: Syncope with VT is a strong predictor of significantly increased risk for severe outcomes- including major adverse cardiac events, and death- even after adjusting for baseline characteristics. The elevated risks underscore the urgent need for more intensive evaluation and management. These findings have important implications for clinical triage, risk assessment, and individualized care planning.
