Pediatric syncope: a hot issue in focus

Tao, Chunyan; Tang, Chaoshu; Jin, Hongfang; Du, Junbao

doi:10.1016/j.scib.2019.12.026

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…A positive response for POTS in children during the standing test or HUTT was defined as follows: the heart rate is normal at a supine position and increases by ≥ 40 bpm and/or the highest heart rate reaches ≥ 130 bpm in participants aged 6–12 years; or ≥ 125 bpm in adolescents aged 13–18 years, within the first 10 min of the tests. No orthostatic hypotension is noticed during the test ( 2 , 18 , 23 , 24 ).…”

Section: Methodsmentioning

confidence: 92%

“…Pediatric VVS was diagnosed based on the following criteria: (1) presence of inducements, such as postural change from supine to upright position or long-term standing, mental stress or fear, or at a sultry environment; (2) presence of syncope as the main symptom; (3) a positive response in the HUTT; and (4) exclusion of other diseases that may manifest as transient loss of consciousness, for instance, cardiovascular, cerebrovascular, metabolic, and psychogenic diseases. The standards of a positive response during the HUTT include the following conditions: presence of syncope or presyncope with at least one of the following abnormalities: (1) significant reduction in blood pressure (BP) (systolic BP ≤ 80 mmHg or diastolic BP ≤ 50 mmHg, or a decline in mean BP of ≥25%); (2) significant decrease in heart rate (<75 bpm in 4–6-year-old participants; <65 bpm in 7–8-year-old participants; <60 bpm in pediatric patients > 8 years old); (3) electrocardiogram revealing sinus arrest; (4) sudden asystole or atrioventricular block lasting >3 s; and (5) the exclusion of orthostatic hypotension (decline in BP >20/10 mmHg during the first 3 min of the test) ( 2 , 18 , 23 , 24 ). The haemodynamic types of responses during HUTT were classified as vasoinhibitory type, cardioinhibitory type, and mixed type ( 2 ).…”

Section: Methodsmentioning

confidence: 99%

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Poincaré Plot Is Useful for Distinguishing Vasovagal Syncope From Postural Tachycardia Syndrome in Children

et al. 2022

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ObjectivesTo explore the role of the Poincaré plot derived from a 24-hour Holter recording in distinguishing vasovagal syncope (VVS) from postural tachycardia syndrome (POTS) in pediatric patients.Materials and MethodsPediatric patients with VVS or POTS, hospitalized in Peking University First Hospital between January 2012 and December 2018, were included in a derivation study. The transverse axis (T), longitudinal axis (L), T/L ratio, product T × L, distance between the origin and the proximal end of the longitudinal axis (pro-D), and distance between the origin and distal end of the longitudinal axis (dis-D) of the Poincaré plot were compared between the VVS and POTS groups, and the differential diagnostic performance of the above-mentioned graphic parameters was evaluated using receiver operating characteristic curve analysis. A validation study was conducted in pediatric patients hospitalized between January 2019 and December 2020.ResultsIn school-aged children, the T, L, T/L, T × L, and dis-D values of patients with VVS were greater than those of patients with POTS; in adolescents, the T, T/L, T × L, and pro-D values of patients with VVS were greater than those of patients with POTS. Using a T/L cut-off value of 0.3 to distinguish between the two diseases, the sensitivity and specificity were 91.0 and 90.5%, respectively, for the total participants; 91.6 and 88.9%, respectively, for the school-aged children; and 82.1 and 95.7%, respectively, for the adolescents. In the validation study, a T/L cut-off value of 0.3 yielded an accuracy, sensitivity, and specificity of 81.8, 87.2, and 77.6%, respectively, in the total participants; 76.5, 82.6, and 71.4%, respectively, in the school-aged children; and 89.2, 93.8, and 85.7%, respectively, in the adolescents, in distinguishing VVS from POTS validated by clinical diagnosis.ConclusionsThe graphic parameters of the Poincaré plot are significantly different between VVS and POTS in pediatric patients, and the T/L of the Poincaré plot may be a useful measure to help differentiate VVS from POTS in children and adolescents.

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Section: Methodsmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Poincaré Plot Is Useful for Distinguishing Vasovagal Syncope From Postural Tachycardia Syndrome in Children

et al. 2022

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Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024)

Wang,

Liao,

Wang

et al. 2024

World J Pediatr

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Background Significant progress has been made in the diagnosis and treatment of pediatric syncope since the publication of the “2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents” (“2018 Edition Guidelines”). Therefore, we have revised and updated it to assist pediatricians in effectively managing children with syncope. Data sources According to the “2018 Edition Guidelines”, the expert groups collected clinical evidence, evaluated preliminary recommendations, and then organized open-ended discussions to form the recommendations. This guideline was developed by reviewing the literature and studies in databases including PubMed, Cochrane, EMBASE, China Biomedical Database, and Chinese Journal Full-text Database up to April 2024. Search terms included “syncope”, “children”, “adolescents”, “diagnosis”, and “treatment.” Results The guidelines were based on the latest global research progress and were evidence-based. The classification of syncope etiology, diagnostic procedures, postural tests, such as the active standing test, head-up tilt test, and active sitting test, clinical diagnosis, and individualized treatment for neurally mediated syncope in pediatric population were included. Conclusions The guidelines were updated based on the latest literature. The concepts of sitting tachycardia syndrome and sitting hypertension were introduced and the comorbidities of neurally mediated syncope were emphasized. Some biomarkers used for individualized treatment were underlined. Specific suggestions were put forward for non-pharmacological therapies as well as the follow-up process. The new guidelines will provide comprehensive guidance and reference for the diagnosis and treatment of neurally mediated syncope in children and adolescents.

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Vasovagal syncope or psychogenic pseudosyncope: a major issue in the differential diagnosis of apparent transient loss of consciousness in children

Liao

Du²,

Benditt³

et al. 2022

Science Bulletin

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Pediatric syncope: a hot issue in focus

Cited by 4 publications

References 11 publications

Poincaré Plot Is Useful for Distinguishing Vasovagal Syncope From Postural Tachycardia Syndrome in Children

Poincaré Plot Is Useful for Distinguishing Vasovagal Syncope From Postural Tachycardia Syndrome in Children

Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024)

Vasovagal syncope or psychogenic pseudosyncope: a major issue in the differential diagnosis of apparent transient loss of consciousness in children

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