Syncope in children and adolescents and the congenital long QT syndrome

Syncope in children and adolescents living in north-eastern Poland - scope of causes

PURPOSE

To investigate the diagnostic yield of different tests and asses the scope of causes in children referring to the hospital with a syncope in north-eastern Poland.

METHODS

A review of 386 consecutive patients (age 2-18 years) living in north-eastern Poland presenting to the cardiology department with a new onset syncope (which appeared to be neurally mediated by history) was undertaken. The patients underwent physical examination, laboratory tests, electrocardiography, 24-holter monitoring, head-up tilt-test, exercise test, echocardiography and electroencephalography. All the tests were performed in most of the patients, without ending the diagnostics after finding the first probable cause of loss of consciousness.

RESULTS

229 potential causes of syncope were found in 191 patients (49.4%), with 2 possible causes in 32 patients and 3 potential causes in 3 patients. The top 3 tests with the highest diagnostic yield were: head-up tilt test (41.4%), 24-holter monitoring (14.5%) and echocardiography (8.4%). Electroencephalography was useful in 3 patients (1.5%) and exercise test did not help in any patient.

CONCLUSION

In some children more than one potential cause of syncope was diagnosed. That might confirm multiple factors' causality of syncope. Head-up tilt-test has the highest diagnostic yield in children with syncope. If the diagnostic protocol is not very strict, one might find some crucial conditions in about 8.3% of patients.

Induced pluripotent stem cells as a disease modeling and drug screening platform

Induced pluripotent stem cells (iPSCs) hold great hopes for therapeutic application in various diseases. Although ongoing research is dedicated to achieving clinical translation of iPSCs, further understanding of the mechanisms that underlie complex pathogenic conditions is required. Compared with other classical models for studying diseases, iPSCs provide considerable advantages. A newly emerging application of iPSCs is in vitro disease modeling, which can significantly improve the never-ending search for new pharmacological cures. Here, we will discuss current efforts to create iPSC-dependent patient-specific disease models. Furthermore, we will review the use of iPSCs for development and testing of new therapeutic agents and the implications for high-throughput drug screening.

Seizure versus syncope

One of the most common but difficult management problems in medicine is that of patients who present with a paroxysmal loss of consciousness. All too often the underlying diagnosis remains elusive. This has a cost both in terms of mortality and ongoing morbidity and in terms of the financial burden associated with hospitalisation and repeated investigations. We describe a practical approach to this clinical dilemma, which is rooted in adherence to basic principles of history taking and examination, formulation of a reasonable differential diagnosis, followed by an intelligent use of specific investigations and selection of an appropriate treatment. We also discuss the effect of sudden unexpected death in epilepsy and sudden cardiac death. Despite a careful and thorough approach to the patient with a "seizure versus syncope" problem, many will require repeated assessment before a diagnosis is made.

Advances in pediatric electrophysiology

PURPOSE OF REVIEW

The pediatric electrophysiology literature during the past year has addressed several topics that are particularly relevant for children and other patients with congenital heart disease. This paper reviews selected studies germane to physicians and health care personnel who treat pediatric and adult congenital heart patients with arrhythmias and electrophysiologic disorders.

RECENT FINDINGS

Advances in arrhythmia diagnostics have been reported in pediatrics using loop monitoring, both external and implanted. Diagnostic criteria and risk stratification strategies have been refined for the congenital and inherited rhythm disorders such as cardiomyopathies and long QT syndrome. The use of therapeutic procedures such as catheter ablation for complex arrhythmias in congenital heart disease is discussed. Finally, a summary of articles on implanted devices in pediatrics and congenital heart disease is reviewed, including implantable defibrillators, atrial antitachycardia pacemakers, and cardiac resynchronization therapy in pediatrics.

SUMMARY

Pediatric electrophysiology is a rapidly changing field, with advances seen in diagnostic evaluation of arrhythmia, refinement of risk-stratification testing, and therapeutic options such as catheter ablation and cardiac rhythm management devices. The evolution of pediatric electrophysiology from a diagnostic specialty into a therapeutic and interventional subspecialty has advanced the treatment options for children with cardiac arrhythmias and conduction disorders.