Comments on 2018 CPCS guideline for diagnosis and treatment of syncope in children and adolescents

Tao, Chunyan; Liu, Xueqin; Zhang, Chunyu; Chen, Yonghong; Huang, Yaqian

doi:10.1016/j.scib.2019.01.008

Cited by 12 publications

(14 citation statements)

References 16 publications

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“…It could even be harmful because of its role in decreasing sympathetic activity and increasing peripheral venous volume and cardiac preload (Verheyden et al, 2008;Vallurupalli and Das, 2010;Vyas et al, 2013). Therefore, unselective use of beta-adrenoceptor blockers in VVS patients is not suggested (Tao et al, 2019b;Xu and Wang, 2019). Gielerak and colleagues aimed to predict the efficacy of continuous propranolol (a beta-blocker) by observing tilt test results after intravenous administration of propranolol.…”

Section: Discussionmentioning

confidence: 99%

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Tao

Tang

et al. 2019

Front. Neurosci.

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Objective: To explore the role of baroreflex sensitivity (BRS) in the head-up tilt test (HUTT) in predicting the therapeutic response of vasovagal syncope (VVS) patients to metoprolol. Materials and Methods: Vasovagal syncope patients treated with metoprolol were enrolled in this study and were classified as responders or non-responders according to changes in their symptom scores before and after metoprolol treatment. Values of BRS in the supine position and at positive response occurrence in the HUTT were obtained, and BRS changes from supine to positive response occurrence were calculated. Differences between responders and non-responders were analyzed. Receiver operating characteristic curve analysis was performed to assess the value of BRS for predicting the therapeutic efficacy of metoprolol in pediatric patients with VVS. Results: Forty patients (14 boys; 11.8 ± 2.5 years) diagnosed with VVS were recruited in the study, 28 of whom were verified to be responders to metoprolol and 12 of whom were verified as non-responders. They did not show any differences in baseline characteristics and hemodynamics in the HUTT (p > 0.05). However, the responders had an obviously increased supine BRS value compared to the non-responders (16.9 ± 7.7 ms/mmHg vs. 7.6 ± 3.8 ms/mmHg; p < 0.01). No difference in BRS at positive response occurrence was observed between the two groups (8.9 ± 8.5 ms/mmHg vs. 10.6 ± 9.8 ms/mmHg; p > 0.05). Accordingly, the changes in the BRS of responders were more obvious than in non-responders (8.0 ± 7.8 ms/mmHg vs. −3.0 ± 10.4 ms/mmHg; p < 0.01). The area under the receiver operating characteristic curve for the predictive value of supine BRS was 0.887 (95% CI, 0.779-0.995; p < 0.01). A cutoff value of 10 ms/mmHg yielded a sensitivity and specificity of 82 and 83%, respectively, in predicting the therapeutic efficacy of metoprolol in pediatric VVS patients.

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Section: Discussionmentioning

confidence: 99%

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Tao

Tang

et al. 2019

Front. Neurosci.

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“…Full recovery is possible for POTS in children and adolescents, but it is difficult to treat patients because of inconsistent and poor therapeutic efficacies (95). Thus, collaborative and multidisciplinary therapies are constantly required (5)(6)(7)(8)95). After the diagnosis of POTS, in general, health education is the fundamental strategy above all, and further daily treatment plans should consist of non-pharmacological and pharmacological interventions (5,95,96).…”

Section: Management Strategies For Pots In Children and Adolescentsmentioning

confidence: 99%

“…Health education on POTS is needed for young patients and their guardians who should understand the potential precipitating factors and avoid them (5)(6)(7)(8)96). Owing to frequent incapacitating symptoms of POTS that are closely related to an upright posture especially in stifling conditions (2), patients should avoid long periods of standing, sudden head-up postural changes, and high environmental temperatures (5).…”

Section: Non-pharmacological Interventionsmentioning

confidence: 99%

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Postural Tachycardia Syndrome in Children and Adolescents: Pathophysiology and Clinical Management

Chen

Jin

et al. 2020

Front. Pediatr.

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Postural tachycardia syndrome (POTS), characterized by chronic (≥6 months) orthostatic intolerance symptoms with a sustained and excessive heart rate increase while standing without postural hypotension, is common in children and adolescents. Despite the unclear pathogenesis of POTS, the present opinion is that POTS is a heterogeneous and multifactorial disorder that includes altered central blood volume, abnormal autonomic reflexes, "hyperadrenergic" status, damaged skeletal muscle pump activity, abnormal local vascular tension and vasoactive factor release, mast cell activation, iron insufficiency, and autoimmune dysfunction. A number of pediatric POTS patients are affected by more than one of these pathophysiological mechanisms. Therefore, individualized treatment strategies are initiated in the management of POTS, including basal non-pharmacological approaches (e.g., health education, the avoidance of triggers, exercise, or supplementation with water and salt) and special pharmacological therapies (e.g., oral rehydration salts, midodrine hydrochloride, and metoprolol). As such, the recent progress in the pathogenesis, management strategies, and therapeutic response predictors of pediatric POTS are reviewed here.

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“…To sufferers accompanied by discernible prodromal symptoms before syncopal attack, the preceding period plays an important role in deterring the occurrence of syncope. During this time, counter-pressure manoeuvres, which can increase the venous return to the heart, are recommended to keep adequate cerebral perfusion [4][5][6][7]. These plain and easyto-perform measures are universally acknowledged as the first line interventions.…”

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confidence: 99%

Pediatric syncope: a hot issue in focus

et al. 2020

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Comments on 2018 CPCS guideline for diagnosis and treatment of syncope in children and adolescents

Cited by 12 publications

References 16 publications

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Baroreflex Sensitivity Predicts Response to Metoprolol in Children With Vasovagal Syncope: A Pilot Study

Postural Tachycardia Syndrome in Children and Adolescents: Pathophysiology and Clinical Management

Pediatric syncope: a hot issue in focus

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