The Prevalence and Predictors of Atrioventricular Blocks in Syrian Patients Reporting to the Emergency Department During the Ongoing Conflict: A Cross-Sectional Study.

Abstract

Background: Atrioventricular block (AVB) is a cardiac conduction disorder that can lead to significant clinical outcomes, particularly in resource-limited and conflict-affected regions. In Syria, healthcare infrastructure has been severely impacted by ongoing conflict, potentially affecting the prevalence and management of AVB.

Methods: We conducted a cross-sectional study at Tishreen University Hospital in Latakia, Syria, with patients > 40 who presented to the emergency department (ED) from June 1 to August 1, 2024. Routine 12-lead ECGs were performed, with AVB diagnoses confirmed by two independent cardiology consultants. Exclusion criteria included pre-existing AVB, pacemaker presence, hemodynamic instability, and ECG diagnostic discrepancies. Patient demographics and comorbidities were assessed, and logistic regression analyses identified predictors of AVB.

Results: The final analysis included 692 patients, of which AVB was detected in 7% of the cohort. Patients with AVB were significantly older (median age 76 vs. 54 years, p < 0.001) and had higher rates of ischemic heart disease (IHD) (62% vs. 14%, p < 0.001) and diabetes (56% vs. 21%, p = 0.01). Logistic regression showed older age (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.6-5.6, p < 0.001), IHD (OR: 1.9, 95% CI: 1.4-4.5, p < 0.001), and DM (OR: 3.9, 95% CI: 2.9-8.3, p < 0.001) were independently associated with AVB.

Conclusion: AVB prevalence in the Syrian ED setting is high, with age, IHD, and diabetes as significant predictors. Routine ECG screening in EDs may facilitate early AVB detection in at-risk populations, especially in conflict-affected regions with limited healthcare resources. This approach could improve outcomes by enabling timely intervention in high-risk patients.