Frequency Domain Indices of Heart Rate Variability are Useful for Differentiating Vasovagal Syncope and Postural Tachycardia Syndrome in Children

Wang, Yuanyuan; Zhang, Chunyu; Chen, Selena; Li, Xueying; Jin, Hongfang; Du, Junbao

doi:10.1016/j.jpeds.2018.11.054

Cited by 18 publications

(21 citation statements)

References 21 publications

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“…The diagnosis of POTS was mainly based on the following (Sheldon et al, 2015; Wang et al, 2018, 2019): (1) commonly seen in older children; (2) associated with inducements such as quick position change from supine to upright position, or long-term standing before the appearance of OI symptoms; (3) associated with OI symptoms such as dizziness, headache, fatigue, blurred vision, chest tightness, palpitations, hand tremors, and even syncope; (4) HR increased ≥ 40 bpm or the maximum HR ≥ 130 bpm (in children 6–12 years old) or ≥ 125 bpm (in adolescents 13–18 years old) without orthostatic hypotension (BP decrease > 20/10 mmHg) during the first 10 min of the standing test or BHUTT; and (5) exclusion of other diseases that cause OI symptoms such as cardiovascular diseases, metabolic diseases, neurologic diseases, or psychogenic disorders.…”

Section: Methodsmentioning

confidence: 99%

Heart Rate Variability Predicts Therapeutic Response to Metoprolol in Children With Postural Tachycardia Syndrome

et al. 2019

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PurposeTo improve the metoprolol therapeutic effectiveness, we aimed to explore whether baseline heart rate variability (HRV) indicators before metoprolol treatment were useful for predicting its efficacy for postural tachycardia syndrome (POTS).MethodsWe recruited 45 children with POTS who received metoprolol and 17 healthy controls. All children underwent a standing test or basic head-up tilt test and 24-h dynamic electrocardiography before treatment. After 3 months of metoprolol, therapeutic responsiveness was evaluated. The usefulness of baseline HRV parameters in predicting the effectiveness of metoprolol was studied and the long-term cumulative symptom rate was analyzed.ResultsThe baseline HRV frequency domain indicators for power, ultra-low frequency, very-low frequency, low frequency (LF), high frequency (HF), and total power (TP) as well as time domain indicators were significantly lower for responders than non-responders to metoprolol; however, low-frequency normalized units and LF/HF ratio were markedly greater for responders than non-responders. On series-parallel analysis, combined baseline triangular (TR) index ≤ 33.7 and standard deviation of all normal-to-normal intervals (SDNN) index ≤ 79.0 ms as cut-off values yielded sensitivity, specificity and accuracy of 85.3, 81.8, and 84.4%, respectively, to predict therapeutic responsiveness to metoprolol. On long-term follow-up, the cumulative symptom rate was significantly higher with TR index > 33.7 and SDNN index ≤ 79.0 ms, TR index ≤ 33.7 and SDNN index > 79.0 ms or TR index > 33.7 and SDNN index > 79.0 ms than TR index ≤ 33.7 and SDNN index ≤ 79.0 ms (P < 0.05).ConclusionCombined TR index ≤ 33.7 and SDNN index ≤ 79.0 ms were useful preliminary measures to predict therapeutic response to metoprolol in pediatric POTS.

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Section: Methodsmentioning

confidence: 99%

Heart Rate Variability Predicts Therapeutic Response to Metoprolol in Children With Postural Tachycardia Syndrome

et al. 2019

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“…The patient was then asked to stand upright for 10 min for additional monitoring of the HR and BP values. [ 20 ]…”

Section: Methodsmentioning

confidence: 99%

Baseline left ventricular ejection fraction associated with symptom improvements in both children and adolescents with postural tachycardia syndrome under metoprolol therapy

Wang

Han

Wang

et al. 2021

Chinese Medical Journal

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Background: Postural tachycardia syndrome (POTS) is a common childhood disease that seriously affects the patient's physical and mental health. This study aimed to investigate whether pre-treatment baseline left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) values were associated with symptom improvement after metoprolol therapy for children and adolescents with POTS. Methods: This retrospective study evaluated 51 children and adolescents with POTS who received metoprolol therapy at the Peking University First Hospital between November 2010 and July 2019. All patients had completed a standing test or basic head-up tilt test and cardiac echocardiography before treatment. Treatment response was evaluated 3 months after starting metoprolol therapy. The pre-treatment baseline LVEF and LVFS values were evaluated for correlations with decreases in the symptom score after treatment (ΔSS). Multivariable analysis was performed using factors with a P value of <0.100 in the univariate analyses and the demographic characteristics. Results: A comparison of responders and non-responders revealed no significant differences in demographic, hemodynamic characteristics, and urine specific gravity (all P > 0.050). However, responders had significantly higher baseline LVEF (71.09% ± 4.44% vs . 67.17% ± 4.88%, t = −2.789, P = 0.008) and LVFS values (40.00 [38.00, 42.00]% vs . 36.79% ± 4.11%, Z = −2.542, P = 0.010) than the non-responders. The baseline LVEF and LVFS were positively correlated with ΔSS ( r = 0.378, P = 0.006; r = 0.363, P = 0.009), respectively. Logistic regression analysis revealed that LVEF was independently associated with the response to metoprolol therapy in children and adolescents with POTS (odds ratio: 1.201, 95% confidence interval: 1.039–1.387, P = 0.013). Conclusions: Pre-treatment baseline LVEF was associated with symptom improvement after metoprolol treatment for children and adolescents with POTS.

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“…100 One study has demonstrated a significant difference in heart rate variability in children with vasovagal syncope when compared with POTS, which may be helpful to differentiate between the 2. 101 Other less common differential diagnoses for anaphylaxis are endocrine or infectious and vaccine responses. The history and physical signs are paramount to ruling out these disorders.…”

Section: Pediatric Considerationsmentioning

confidence: 99%

“…102 Both HATS and alpha-gal syndrome, discussed earlier, are seen in the pediatric population. 101 In children diagnosed with systemic capillary leak syndrome (SCLS), hypotension, vomiting, lethargy, and abdominal pain are common. 103 As seen in adults, the key distinguishing feature between anaphylaxis and SCLS is hemoconcentration and frequent association with an antecedent viral illness.…”

Section: Pediatric Considerationsmentioning

confidence: 99%

Idiopathic anaphylaxis yardstick

Carter

Akin

Castells

et al. 2020

Annals of Allergy, Asthma & Immunology

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Anaphylaxis is considered idiopathic when there is no known trigger. The signs and symptoms of idiopathic anaphylaxis (IA) are identical to those of anaphylaxis because of a known cause and can include cutaneous, circulatory, respiratory, gastrointestinal, and neurologic symptoms. Idiopathic anaphylaxis can be a frustrating disease for patients and health care providers. Episodes are unpredictable, and differential diagnosis is challenging. Current anaphylaxis guidelines have little specific guidance regarding differential diagnosis and long-term management of IA. Therefore, the objective of the Idiopathic Anaphylaxis Yardstick is to use published data and the authors' combined clinical experience to provide practical recommendations for the diagnosis and management of patients with IA.

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Frequency Domain Indices of Heart Rate Variability are Useful for Differentiating Vasovagal Syncope and Postural Tachycardia Syndrome in Children

Cited by 18 publications

References 21 publications

Heart Rate Variability Predicts Therapeutic Response to Metoprolol in Children With Postural Tachycardia Syndrome

Heart Rate Variability Predicts Therapeutic Response to Metoprolol in Children With Postural Tachycardia Syndrome

Baseline left ventricular ejection fraction associated with symptom improvements in both children and adolescents with postural tachycardia syndrome under metoprolol therapy

Idiopathic anaphylaxis yardstick

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