Aim: Head injury is the most common trauma occurring in syncope. We aimed to assess whether syncope as cause of head-trauma affects short-and long-term prognosis. Methods: From a database retrospective analysis of 97,014 individuals attending Emergency Department (ED), we selected data of patients with traumatic head injury including age, gender, injury mechanism, brain imaging, multiple traumas, bone fracture, intracranial bleeding, and mortality. Mean follow-up was 6.4 ± 1.8 years. Outcome data were obtained from a digital national population register. The study population included 3,470 ED head injury patients: 117 of them (50.0 ± 23.6 years, 42.7% men) reported syncope as cause of head trauma and 3,315 (32.2 ± 21.1 years, 68.5% men) without syncope preceding head trauma. Results: Thirty-day mortality was low and similar in traumatic head injury with or without syncope. One year and long-term all-cause mortality were both significantly higher in syncopal vs. non-syncopal traumatic head injury (11.1 vs. 2.8% and 32 vs. 10.2%, respectively; both p < 0.001). In adjusted logistic regression analysis, death between 121st-day and 1 year in patients with head-trauma was associated with male gender [odds ratio (OR): 6.48; 95% CI: 2.59-16.25], advancing age (per year) (OR 1.09; 95% CI 1.07-1.11), Glasgow Coma Scale < 13 (OR: 6.18; 95% CI:1.68-22.8), bone fracture (OR 4.72; 95% CI 2.13-10.5), and syncope (OR 3.70; 95% CI: 1;48-9.31). In multivariable Cox regression analysis, syncope was one of the strongest independent predictors of long-term all-cause death (hazard ratio: 1.95; 95% CI 1.37-2.78). Conclusion: In patients with head trauma, history of syncope preceding injury does not increase 30-day all-cause mortality but portends increased 1 year and long-term mortality.

No abstract

Dangerous ventricular arrhythmias leading to sudden cardiac death (SCD) are some of the most diffi-cult diagnostic challenges. They are often mildly symptomatic. Their often self-limiting nature means that they are difficult to capture on ECG. A 75-year old woman with chronic heart failure due to nonis-chemic cardiomyopathy reported to the cardiology clinic for a scheduled routine follow-up of the ICD, implanted three years prior as primary prevention of SCD. The patient reported recent episodes of sud-den weakness and described the episodes as hypotension. The patient associated it with too aggressive treatment of arterial hypertension. During the visit the patient experienced one of these episodes that she had previously described. The monitoring equipment in the clinic revealed ventricular tachycardia (VT). The history of the implanted ICD revealed many similar previous episodes including 5 episodes in the last 24 hours which led to a diagnosis of electrical storm. Dangerous ventricular arrhythmias may be mildly symptomatic and they are often underestimated by the patient. Fainting, especially in situa-tions unusual for the vasovagal reflex or orthostatic hypotension, should always arouse vigilance to-wards life-threatening ventricular arrhythmia.