{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:21:46Z","timestamp":1785450106229,"version":"3.56.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,11,21]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The aim of this study was to develop a structured 2\u2010step approach, based on noninvasive diagnostic criteria, that led to an electrophysiology study in patients with unexplained syncope.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Two independent cohorts were used: the derivation cohort with 665 patients based on electronic health record data to develop our 2\u2010step diagnostic approach, and the validation cohort based on 160 prospectively screened patients, presenting with unexplained syncope episodes. Noninvasive electrocardiographic and imaging markers and an electrophysiology study\u2013based invasive assessment were combined. A positive diagnostic approach according to our study's prespecified criteria resulted in a decision to proceed with a permanent pacemaker\/implantable cardioverter\u2010defibrillator. The primary end point was the time until the event of recurrent syncope (syncope\u2010free survival). Number needed to treat was calculated for patients with a positive diagnostic approach. The number of patients with unexplained syncope and borderline sinus bradycardia needed to treat was 5, and the number of patients with unexplained syncope and bundle branch block needed to treat was 3 over a mean follow\u2010up of \u22484\u2009years. After the structured 2\u2010step approach, the primary outcome occurred in 14 of 82 (17.1%) with a pacemaker\/implantable cardioverter\u2010defibrillator and 19 of 57 (33%) with a negative approach, with a mean follow\u2010up of \u22482.5\u2009years (29.29\u00b112.58\u2009months,\n              <jats:italic>P<\/jats:italic>\n              =0.03).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The low number needed to treat in the derivation cohort and the low percentage of syncope recurrence in the validation cohort supports the proposed 2\u2010step electrophysiology\u2010inclusive algorithm as a potentially low\u2010cost, 1\u2010day, structured tool for these patients.<\/jats:p>\n          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