Syncope unit in the paediatric population: A single-centre experience

Courtheix, Mathieu; Jalal, Zakaria; Bordachar, Pierre; Iriart, Xavier; Pillois, Xavier; Escobedo, Cécile; Rabot, Catherine; Tribout, Laetitia; Thambo, Jean-Benoît

doi:10.1016/j.acvd.2015.11.009

Cited by 10 publications

(3 citation statements)

References 33 publications

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“…1,14,13 Patients with cardiac syncope had symptoms in the form of palpitation and chest pain. In the patient with complete heart block syncopal event was triggered after exercise There are many studies showing vasovagal syncope as the commonest cause of syncope, consistent with the present study that is Courtheix et al, Schuster et al, Day et al 5,15,16 These findings suggest that every patient who has even one syncopal attack should be promptly investigated since the underlying cause could be a benign one like a vasovagal syncope where symptomatic treatment can bring about sufficient improvement in symptoms.…”

Section: Discussionsupporting

confidence: 87%

Syncope in children clinicoetiological correlation

Fadnis

Prabhu

Venkatesh

et al. 2019

Int J Contemp Pediatr

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Background: Syncope is the abrupt cessation of cerebral blood flow leading to temporary loss of consciousness. Identification of etiology is utmost important as any syncopal event may be life threatening. Aim was to correlate the clinical and etiological causes of syncope in children and to note their investigational profile.Methods: Among 40 patients presenting with syncope and presyncope were studied. History of the event, precipitating factors were noted. They were investigated with the help of blood pressure, Electrocardiogram (ECG), 2D Echocardiogram and Electroencephalogram (EEG).Results: Out of the 40 patients of syncope 65% were above the age of 10 years with male preponderance (60%). Vasovagal syncope (57%) was the most common cause of syncope followed by orthostatic hypotension (15%), neurological (15%), and cardiac etiology (6%). In the neurological etiology the EEG showed diffuse slow background with occasional sharp bursts in right frontal area in 2 patients while in 4 patients sharp bursts were present in the centero-temporal region. 17% were classified as presyncope, 60% as mild and 22% as having severe syncope. There was a significant correlation of etiology of syncope with duration of hospitalization of more than 4 days and with recurrence of syncope. There was significant correlation of Evaluation of Guidelines in Syncope (EGSYS) score >3 with cardiogenic syncope. On follow up, neurological syncope patients had significant decrease in the number of syncopal episodes as they were immediately started on antiepileptics.Conclusions: Electrocardiogram, 2D Echocardiogram and Electroencephalogram are important tools for the early management and treatment of cardiac and neurological etiology of syncope.

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Section: Discussionsupporting

confidence: 87%

Syncope in children clinicoetiological correlation

Fadnis

Prabhu

Venkatesh

et al. 2019

Int J Contemp Pediatr

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“…The syncope guidelines of ACC indicated that psychogenic accounted for 8%−15% of cases ( 12 , 15 ). However, Courtheix et al ( 16 ) described 5.1% of CS in children with syncope in a single center. This may be because the single-center study could not represent the incidence and spectrum of the underlying diseases of syncope.…”

Section: Discussionmentioning

confidence: 99%

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

Liao²,

Zhang³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundSyncope is the primary cause of transient loss of consciousness, which causes severe physical and mental burdens to children and adolescents.ObjectiveThe study was designed to analyze the spectrum of underlying diseases of syncope and treatment options for neurally-mediated syncope (NMS) in Chinese children and adolescents.MethodsMedical records including history, physical examination, blood biochemistry, standing test, head-up tilt (HUTT), sitting-up test, electroencephalogram (EEG), electrocardiogram (ECG), and echocardiography were retrospectively studied in children and adolescents admitted to the National Pediatric Syncope Center, Department of Pediatrics, Peking University First Hospital between 1992 and 2021. All the data were collected from the Beijing Kaihua Medical Management System (Kaihua, Beijing, China). Children who met the syncope diagnostic criteria were enrolled in the study. The spectrum of the underlying diseases of syncope in children and adolescents and the treatment options of NMS were analyzed.ResultsA total of 1,947 children and adolescents with syncope were admitted, including 869 males (44.63%) and 1,078 females (55.37%) aged 1–18 years, with an average age of 11.1 ± 3.1 years. The number of children and adolescents with syncope displayed a gradually increasing trend between 1992 and 2021 except after 2020. NMS proportion increased, and the proportion of unexplained syncope decreased (χ2 = 128.839, P < 0.01). The treatment options of NMS mainly included autonomic nervous function exercise (549, 34.46%), oral rehydration salt (ORS; 445, 27.94%), metoprolol (219, 13.75%), midodrine (120, 7.53%), ORS plus metoprolol (139, 8.73%), ORS plus midodrine (120, 7.53%), and pacemakers (1, 0.06%). Patients with vasovagal syncope (VVS) coexisting with postural orthostatic tachycardia syndrome (POTS) were more likely to take pharmacological treatments than those with VVS or POTS only (χ2 = 41.696, P < 0.01).ConclusionThe number of children with syncope displayed an increasing trend before 2020, and the proportion of unexplained syncope decreased. Autonomic nervous function exercise was the most common treatment for children and adolescents with NMS. Children with VVS coexisting with POTS were more likely to receive pharmacological treatments than those with either.

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“…In the absence of a positive screen result (abnormal history, P/E, and ECG), echocardiogram is most likely normal in children with syncope [ 18 ]. Exercise-induced syncope is highly associated with cardiac origins, mainly with ECG abnormalities with susceptibility to arrhythmia but with normal echocardiography in most cases [ 19 ]. In this study, there was no effect of syncope in the percentage of abnormal Holter results.…”

Section: Discussionmentioning

confidence: 99%

The Value of Continuous Electrocardiographic Monitoring in Pediatric Cardiology: A Local Center Experience

Alotaibi¹,

Alakhfash²,

Alakhfash³

et al. 2022

Cureus

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Objectives This study aims to evaluate the value of Holter monitoring in pediatric cases and look for the best predictor for abnormal Holter monitoring. Methodology All patients referred with cardiac symptoms associated or possibly related to abnormal cardiac rhythm from January 2019 to December 2020 were retrospectively reviewed. The demographic, clinical, 12-lead electrocardiography (ECG), echocardiography, and Holter monitoring results were reviewed. Multinomial logistic regression analysis was used to assess the correlation between gender, age, type of symptoms, ECG, and echo abnormalities, and Holter monitoring results were analyzed. Results During the study period, a total of 189 Holter monitoring was performed for 187 patients. The mean age at the performance of Holter monitoring was 88.6 ± 57 months. The female/male ratio was 1.5:1. The commonest indications for Holter monitoring were abnormal 12-lead ECG (30.7%), palpitations (30.7%), syncopal attacks (12.7%), and chest pain (6.9%). Patients with congenital heart disease (CHD) pre- or post-cardiac intervention constitute 9% of the total Holter monitoring cases. Apart from sinus arrhythmia, 12-lead ECG was abnormal in 57 (30%) patients, with premature atrial complexes (PACs) being the most common abnormality. Echocardiography was abnormal in 67 (35.4%) cases, with secundum atrial septal defect (ASD) (6.3%) and mitral valve prolapse (5.8%) being the commonest abnormalities. The Holter monitoring was completely normal in 89 (47.1%) cases. The commonest Holter abnormalities were PACs (12.7%), supraventricular tachycardia (SVT) (5.8%), and premature ventricular complexes (PVCs) (4.8%). There were 24 patients with SVT, and eight of them had normal Holter monitoring. One patient with SVT had ablation by the electrophysiologist. Using the multinomial logistic regression analysis, significantly abnormal 12-lead ECG, the presence of CHD, and abnormal echocardiography predict the presence of abnormal Holter results with a statistically significant p-value. Conclusion Most pediatric arrhythmias are benign. Holter monitoring provides reassurance for the patient and family. Abnormal Holter monitoring is more often observed in patients with paroxysmal or persistently abnormal 12-lead ECG with or without associated cardiac abnormalities or cardiac interventions. The yield of Holter monitoring is low in children referred because of chest pain, palpitations, or syncope with no other cardiac symptoms and with a structurally and functionally normal heart.

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Syncope unit in the paediatric population: A single-centre experience

Abstract: Syncope units in the paediatric population may be useful in the diagnostic process, to help identify rare cardiac aetiologies, and could decrease recurrence through specific management.

Cited by 10 publications

References 33 publications

Syncope in children clinicoetiological correlation

Syncope in children clinicoetiological correlation

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

The Value of Continuous Electrocardiographic Monitoring in Pediatric Cardiology: A Local Center Experience

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