Predictive Value of the Index of Cardio-Electrophysiological Balance for Diagnosing and Predicting Recurrence of Pediatric Vasovagal Syncope

<b>Aims/Objective</b> Pediatric vasovagal syncope (VVS) is prone to relapse and affects the quality of patients' lives. The current study aims to assess the predictive value of the index of cardio-electrophysiological balance (iCEB) for both diagnosis and recurrence of pediatric VVS, to enhance precision in clinical management. <b>Methods</b> This retrospective cohort study analysed 199 syncope patients treated at the First Hospital of Jilin University between January 2019 and December 2023. Participants were stratified into VVS (<i>n</i> = 79) and non-VVS (<i>n</i> = 120) groups. Univariate analysis and binary logistic regression were performed to identify predictors for VVS, while correlations between variables were assessed using Spearman/Pearson/point-biserial correlation coefficients. Predictive value was assessed using receiver operating characteristic (ROC) curve analysis. <b>Results</b> Family syncope history, prolonged standing triggers, iCEB, QT interval (QT), and QRS duration (QRS) showed significant differences between the two groups (<i>p</i> < 0.05). iCEB correlated negatively with QRS (r = -0.612, <i>p</i> < 0.001), and positively with QT (r = 0.403) and prolonged standing triggers (r = 0.164) (both <i>p</i> < 0.05). Logistic regression identified iCEB (odds ratio [OR] = 1.251, 95% confidence interval [CI]: 1.136-1.378, per 0.1 units, <i>p</i> < 0.001) and family syncope history (OR = 2.369, 95% CI: 1.192-4.708, <i>p</i> = 0.014) as independent predictors. ROC curve analysis demonstrated that iCEB has superior accuracy in predicting the recurrence of VVS (area under the curve [AUC] = 0.710, 95% CI: 0.634-0.786; sensitivity 65.83%, specificity 70.89% at cutoff 4.086). The high-iCEB patients (≥4.086, <i>n</i> = 56) exhibited a 2.36-fold higher 1-year recurrence rate than their low-iCEB counterparts (41.07% vs. 17.39%, <i>p</i> = 0.044). <b>Conclusion</b> iCEB demonstrates strong predictive value in diagnosing pediatric VVS, and higher iCEB levels are linked to an increased risk of recurrence within one year, making it a useful reference indicator for recurrence.