Head-up tilt for the evaluation of syncope of unknown origin in children

Lerman‐Sagie, Tally; Rechavia, Eldad; Strasberg, Boris; Sagie, Alex; Blieden, Leonard C.; Mimouni, Marc

doi:10.1016/s0022-3476(05)80025-3

Cited by 68 publications

(31 citation statements)

References 11 publications

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“…V VS occurs in 33% to 80% of children with syncope. 624,628 Risk factors that raise suspicion of a cardiac etiology include the absence of prodromal symptoms, presence of preceding palpitations within seconds of loss of consciousness, lack of a prolonged upright posture, syncope during exercise or in response to auditory or emotional triggers, family history of SCD, abnormal physical examination, and abnormal ECG, 626,627 although the specificity is modest. 618,627,630,633 It should be remembered that children may not be able to clearly communicate specific symptoms.…”

Section: Pediatric Syncope: Recommendationsmentioning

confidence: 99%

“…641,642 Treatment should emphasize symptom awareness and avoidance of precipitating factors that might worsen the condition, such as dehydration, standing for prolonged periods of time, hot crowded environments, and diuretic intake. 624,629,643,644,647,648,651,652 and the specificity ranges from 83% to 100%. 624,643,652 Pediatric patients with episodes of V VS may exhibit convulsive movements during loss of consciousness that mimic epileptic seizures.…”

Section: Pediatric Syncope: Recommendationsmentioning

confidence: 99%

See 1 more Smart Citation

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Sheldon²,

et al. 2017

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Section: Pediatric Syncope: Recommendationsmentioning

confidence: 99%

Section: Pediatric Syncope: Recommendationsmentioning

confidence: 99%

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Sheldon²,

et al. 2017

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“…Although static cerebral autoregulation testing, using TCD, has been validated and can be performed using pharmacologic intervention to increase MAPe, it may be too invasive for awake, healthy children (6). Tilt testing allows cerebral autoregulation to be studied at the bedside noninvasively, is well tolerated by children, and has been used for many years in the evaluation of children and adults with syncope (24,25). It has also been combined with TCD ultrasonography to evaluate changes in cerebral vascular resistance in patients with dysautonomia (26).…”

Section: Figurementioning

confidence: 99%

Gender Differences in Cerebral Blood Flow Velocity and Autoregulation between the Anterior and Posterior Circulations in Healthy Children

et al. 2005

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There is little information on gender differences in cerebral autoregulation. The purpose of this study was to compare autoregulation of the anterior and posterior circulations using the tilt test method in healthy boys and girls who were 10 -16 y of age. Transcranial Doppler was used to measure middle cerebral artery and basilar artery flow velocities (Vmca and Vbas). Cerebral autoregulation (ARI) of the middle cerebral (ARImca) and basilar arteries (ARIbas) was examined using the tilt test method. An ARI Ͻ0.4 indicates impaired autoregulation. Among the 13 boys and 13 girls, Vmca and Vbas were higher in girls. All children demonstrated intact autoregulation, but boys had higher ARImca than girls, whereas girls had higher ARIbas than boys. Girls demonstrated greater autoregulation in the basilar artery, whereas boys demonstrated greater autoregulation in the middle cerebral artery. Girls had higher flow velocities in both vessels. This study provides normative data on cerebral autoregulation of the poste- Autoregulation of cerebral blood flow (CBF) is a physiologic and homeostatic process that maintains nearly constant CBF over a range of mean arterial pressures (MAPs). Disease states, including traumatic brain injury, can impair cerebral autoregulation, rendering the brain susceptible to inadequate (cerebral ischemia) or excessive (cerebral hyperemia) CBF (1). Despite its critical role in maintaining CBF, there is limited information on cerebral autoregulation in healthy children.Little has been published on pediatric cerebral autoregulation in children outside the clinical arena of neurogenic syncope (2-4). In one study that examined dynamic cerebral autoregulation in awake adolescent study participants, the time to return of middle cerebral artery flow velocity (Vmca) to normal after a transient hypotensive stimulus was reported to be more in healthy adolescents compared with their healthy adult counterparts (5). However, in a subsequent evaluation of cerebral autoregulation in children versus adults during general anesthesia using static autoregulation testing, the investigators reported no age-related differences in autoregulatory capacity and no difference in cerebral autoregulation compared with adults (6). Because both of these studies examined cerebral autoregulation of the anterior circulation only, differences in cerebral autoregulation between the anterior and posterior circulation in children could not be evaluated. In addition, to our knowledge, there is no information regarding cerebral autoregulation of the posterior circulation in children, no information on gender differences in cerebral autoregulation in children, and finally no normative data on cerebral autoregulation using the tilt test method. Therefore, the purpose of this study was to 1) provide normative data on cerebral autoregulation using the tilt test method, 2) describe cerebral autoregulation of the posterior cerebral circulation, and 3) examine gender-related differences in autoregulatory capacity in healthy, awake boys and girl...

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“…Amirati et al (26) stated that the cause of syncope could not be determined by routine tests in 49.6% of patients. The HUTT offers a simple, noninvasive diagnostic tool for evaluation of syncope in children (27). HUTT was introduced into clinical evaluation of patients with syncope of unknown origin by Kenny et al (28) in 1986.…”

Section: Discussionmentioning

confidence: 99%

“…A careful history and physical examination, including lying and standing blood pressure (BP) measurement while lying and standing, heart rate (HR) measurements and a routine electrocardiography (ECG) are essential to make an accurate diagnosis (8)(9)(10)(11). Although Head-up tilt test (HUTT) is a practical and useful test for the evaluation of syncope (12)(13)(14), it is still unclear who are under high risk for recurrent syncope.…”

Section: Introductionmentioning

confidence: 99%

Predictors of vasovagal syncope recurrence in children and adolescents and value of head-up tilt table test

Yılmaz¹,

Binnetoğlu²,

Babaoğlu³

et al. 2013

Anadolu Kardiyol Derg

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Objective: The aim of the study was to define predictors of syncope recurrence in children and adolescents with vasovagal syncope and to determine the value of tilt test. Methods: A retrospective observational study performed of prospective cohort of 150 patients aged between 8-18 years who were referred to our clinic because of fainting or who underwent tilt test with the pre-diagnosis of vasovagal syncope. The progress updated by telephone or face-to-face interview. Unpaired t-test, Mann-Whitney U test used for normal and non-normal distributed variables. Logistic regression analysis was used to determine the predictors of recurrence. Results: Tilt test was positive in 97 and negative in 53 patients. Forty-eight patients had mixed, 34 had vasodepressor and 15 had cardioinhibitory type syncope. Recurrence found significantly higher in patients who had syncope in the first 20 minutes of the test (p=0.012). The number of the episodes decreased after the test; 3.86±4.75 vs 0.73±0.44, p<0.001). The recurrence was higher in patients who had more than 4 episodes. The recurrence was similar between positive and negative tilt groups. Age of syncope (OR 1.01, 95% CI 1.002, p=0.027) positive family history (OR 4.47, 95% CI 1.071-1.389, p=0.001) and the number of previous syncopal episodes (OR 1.22, 95% CI 1.882-10.623, p=0.003) were identified as risk factors for recurrence of vasovagal syncope. Original Investigation Özgün Araşt›rma 688ÖZET Amaç: Bu çalışmada vazovagal senkoplu çocuk ve adölesanlarda senkop yinelemesinin öngördürücülerini saptamak ve tilt testinin bu süreçte-ki değerini belirlemek amaçlanmıştır. Yöntemler: Kliniğimize daha önce bayılma nedeniyle başvuran ve senkop nedeni açıklanamayan veya vazovagal senkop düşünülerek tilt testi yapılmış, 8-18 yaş arası 150 hastanın kayıtları ileriye dönük retrospektif gözlemsel olarak değerlendirilerek, son durumları telefon veya yüz yüze görüşülerek güncellendi. Normal ve normal olmayan değişkenler için t-testi ile Mann-Whitney U testi, vazovagal senkop rekürrens öngördürü-cülerinin saptanması için lojistik regresyon kullanıldı. Bulgular: Tilt testi yapılan 150 hastanın 97'sinde tilt testi pozitif, 53'ünde negatif bulunmuştur. Tilt testi 48 hastada mikst, 34 hastada vazodepresör ve 15 hastada kardiyo-inhibitör şeklindeydi. Tilt testi 65 hastada pasif, 32 hastada provokatif fazda pozitifleşti. Testin ilk 20 dakikası içinde senkop görülenlerde anlamlı olarak senkop yinelemesinin daha fazla olduğu gözlendi (p=0,012). Tilt testi yapılana kadar tüm hastalarda senkop sayısı ortalama 3,86±4,75 iken test yapıldıktan sonra senkop sayısı ortalama 0,73±0,44 olarak bulundu (p<0,001). Daha önce dörtten fazla senkop geçi-renlerde yineleme oranı daha yüksek bulundu. Tilt testi pozitif ve negatif olanlarda yineleme oranları arasında istatistiksel olarak fark saptanmadı. Senkop yaşı (OR 1,01, %95 CI 1,002, p=0,027), pozitif aile öyküsü (OR 4,47, %95 CI 1,071-1,389, p=0,001), daha önceden geçirilmiş senkop atak sayısı (OR 1,22, %95 CI 1,623, p=0,003), senkop yinelemesinin bağı...

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Head-up tilt for the evaluation of syncope of unknown origin in children

Cited by 68 publications

References 11 publications

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

Gender Differences in Cerebral Blood Flow Velocity and Autoregulation between the Anterior and Posterior Circulations in Healthy Children

Predictors of vasovagal syncope recurrence in children and adolescents and value of head-up tilt table test

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