Spectrum of underlying diseases in syncope and treatment of neurally-mediated syncope in children and adolescents over the past 30 years: A single center study

Cui, Yaxi; Liao, Ying; Zhang, Qingyou; Yan, Hui; Liu, Ping; Wang, Yuli; Sun, Yan; Xu, Wenrui; Liu, Xueqin; Du, Junbao; Jin, Hang

doi:10.3389/fcvm.2022.1017505

Cited by 5 publications

(2 citation statements)

References 36 publications

(50 reference statements)

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“…Syncope is common in adolescents and the underlying cause is often benign. In rare cases, syncope is caused by life‐threatening cardiac disease or arrhythmia induced by a prescribed drug 5 . Sudden cardiac death is rare in adolescents, seldom related to previous cardiac diseases and often preceded by antecedent and/or prodromal symptoms 6,7 …”

Section: Introductionmentioning

confidence: 99%

“…In rare cases, syncope is caused by lifethreatening cardiac disease or arrhythmia induced by a prescribed drug. 5 Sudden cardiac death is rare in adolescents, seldom related to previous cardiac diseases and often preceded by antecedent and/or prodromal symptoms. 6,7 Although one study reported low risks of psychotropic druginduced adverse cardiac events, 8 individual risks cannot be overlooked.…”

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confidence: 99%

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Adolescents on psychotropic treatment displayed longer corrected QT intervals than unmedicated controls when they rose rapidly from the supine position

Berger,

Bromée,

Lindam

et al. 2024

Acta Paediatrica

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AimPsychotropic medication can contribute to arrhythmia and identifying individuals at risk is crucial. This Swedish study compared the corrected QT (QTc) intervals of adolescents on psychotropic medication with unmedicated controls, when supine and after rising rapidly.MethodsThe study was carried out at Östersund County Hospital in March 2022 and February to March 2023. It comprised 16 cases, aged 10–17 years and 28 controls. QTc intervals were measured with electrocardiography and calculated using Bazett's and Fridericia's formulas. Univariate and multiple linear regressions were used to assess differences in QTc intervals between the cases and controls and across sex, age and body mass index.ResultsThe mean QTc interval when supine, calculated with Bazett's formula, was longer for the adolescents on psychotropic medication than the controls (p = 0.046). The same was true for the mean QTc interval after rising rapidly from the supine position, calculated with both Bazett's formula (p = 0.009) and Fridericia's formula (p = 0.007). Mean QTc intervals varied by sex and age groups. Psychotropic medication prolonged QTc intervals, particularly in girls.ConclusionLonger QTc intervals were found in adolescents on psychotropic medication, particularly after rising rapidly from the supine position.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Adolescents on psychotropic treatment displayed longer corrected QT intervals than unmedicated controls when they rose rapidly from the supine position

Berger,

Bromée,

Lindam

et al. 2024

Acta Paediatrica

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Age and mean platelet volume-based nomogram for predicting the therapeutic efficacy of metoprolol in Chinese pediatric patients with vasovagal syncope

Du,

Huang,

et al. 2024

World J Pediatr

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Background Vasovagal syncope (VVS) is the most common type of orthostatic intolerance in children. We investigated whether platelet-related factors related to treatment efficacy in children suffering from VVS treated with metoprolol. Methods Metoprolol-treated VVS patients were recruited. The median duration of therapy was three months. Patients were followed and divided into two groups, treament-effective group and treatment-ineffective group. Logistic and least absolute shrinkage selection operator regressions were used to examine treatment outcome variables. Receiver-operating characteristic (ROC) curves, precision–recall (PR) curves, calibration plots, and decision curve analyses were used to evaluate the nomogram model. Results Among the 72 patients who complete the follow-up, treatment-effective group and treatment-ineffective group included 42 (58.3%) and 30 (41.7%) cases, respectively. The patients in the treatment-effective group exhibited higher mean platelet volume (MPV) [(11.0 ± 1.0) fl vs. (9.8 ± 1.0) fl, P < 0.01] and platelet distribution width [12.7% (12.3%, 14.3%) vs. 11.3% (10.2%, 12.2%), P < 0.01] than those in the treatment-ineffective group. The sex ratio was significantly different (P = 0.046). A fit model comprising age [odds ratio (OR) = 0.766, 95% confidence interval (CI) = 0.594–0.987] and MPV (OR = 5.613, 95% CI = 2.297–13.711) might predict therapeutic efficacy. The area under the curve of the ROC and PR curves was computed to be 0.85 and 0.9, respectively. The P value of the Hosmer–Lemeshow test was 0.27. The decision curve analysis confirmed that managing children with VVS based on the predictive model led to a net advantage ranging from 0.01 to 0.58. The nomogram is convenient for clinical applications. Conclusion A novel nomogram based on age and MPV can predict the therapeutic benefits of metoprolol in children with VVS.

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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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Spectrum of underlying diseases in syncope and treatment of neurally-mediated syncope in children and adolescents over the past 30 years: A single center study

Cited by 5 publications

References 36 publications

Adolescents on psychotropic treatment displayed longer corrected QT intervals than unmedicated controls when they rose rapidly from the supine position

Adolescents on psychotropic treatment displayed longer corrected QT intervals than unmedicated controls when they rose rapidly from the supine position

Age and mean platelet volume-based nomogram for predicting the therapeutic efficacy of metoprolol in Chinese pediatric patients with vasovagal syncope

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

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