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Courtheix M, Jalal Z, Bordachar P, Iriart X, Pillois X, Escobedo C, Rabot C, Tribout L, Thambo JB. Syncope unit in the paediatric population: A single-centre experience. Arch Cardiovasc Dis 2016; 109:199-206. [PMID: 26782626 DOI: 10.1016/j.acvd.2015.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 11/01/2015] [Accepted: 11/05/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Syncopes are frequent in the paediatric population. Most are benign, but rare cases are caused by cardiac life-threatening diseases. Syncope units developed in the adult population have demonstrated improvement in evaluation and treatment, with a reduction in hospitalization. AIMS We report our experience of paediatric syncope management in a dedicated unit, and analyse the value of different elements in the identification of cardiac causes. METHODS This prospective study included 97 consecutive patients (mean age: 12.1±3.3 years) referred between January 2011 and June 2013 to a syncope unit with a paediatric cardiologist, a nurse, a physiotherapist and a psychologist. Patients were classified into diagnostic categories after an initial evaluation that included history, physical examination, electrocardiography, echocardiography and Holter monitoring. RESULTS The most common diagnosis was neurocardiogenic syncope (n=69, 70.4%). Fifty-two cases (81.3%) had no or less recurrence after specific management that included physiotherapy and psychological support (follow-up: 11.5±5.4 months). Psychogenic pseudosyncopes affected 20 children (20.6%). Two patients had epileptic seizures. There were five cases of cardiac syncope (5.1%): two long QT syndromes and a catecholaminergic polymorphic ventricular tachycardia received beta-blockers; two atrioventricular complete blocks required pacemakers. One case was of indeterminate cause and received an insertable loop recorder after exhaustive investigations. Exercise-induced syncopes were significantly associated with cardiac origins (P=0.003), such as electrocardiographic abnormalities (P<0.001), whereas echocardiography was not contributive. CONCLUSION 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.
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Affiliation(s)
- Mathieu Courtheix
- Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France.
| | - Zakaria Jalal
- Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Pierre Bordachar
- Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Xavier Iriart
- Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Xavier Pillois
- Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Cécile Escobedo
- Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Catherine Rabot
- Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Laetitia Tribout
- Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France
| | - Jean-Benoit Thambo
- Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France
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Abstract
This article informs the general pediatrician about the diagnosis, evaluation, and treatment of teenage patients with presyncope and loss of consciousness. The focus is on distinguishing noncardiac fainting from life-threatening syncope. Current treatment strategies of vasovagal syncope and postural orthostatic tachycardia syndrome are also outlined.
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Domenichini G, Diemberger I, Biffi M, Martignani C, Valzania C, Bertini M, Saporito D, Ziacchi M, Branzi A, Boriani G. Long-term follow-up of patients with syncope evaluated by head-up tilt test. Ann Noninvasive Electrocardiol 2010; 15:101-6. [PMID: 20522049 DOI: 10.1111/j.1542-474x.2010.00349.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Clinicians may be tempted to consider a positive head-up tilt test (HUTT) an unfavorable prognostic indicator. We investigated whether results of routine HUTT predict long-term recurrence of syncope. METHODS We analyzed syncope recurrence at long-term among 107 patients (mean age 51 +/- 20 years) receiving HUTT for diagnostic evaluation of unexplained/suspected neurocardiogenic syncope in our Institute. RESULTS HUTT was positive in 76 patients (vasodepressive response, n = 58; cardioinhibitory, n = 5; mixed, n = 13). During a median follow-up of 113 months (range, 7-161), 34 (32%) patients experienced recurrence (24 [32%] with positive HUTT during 110 months (7-159); 10 [32%] with negative HUTT during 120 [22-161] months). Actuarial freedom from recurrence at 10 years did not significantly differ for patients with positive/negative test results (after passive/active phases) or with different positive response patterns (vasodepressive, cardioinhibitory, mixed). By contrast, history of >4 syncopes in the 12 months preceding HUTT stratified risk of recurrence, irrespective of HUTT positivity/negativity. At Cox proportional hazards analysis, history of >4 syncopes in the 12 months preceding HUTT was the single independent risk factor for recurrence both in the overall study population (HR, 1.7; 95% CI, 1.07-2.69) and within the subset of patients who tested positive (HR, 1.83; 95% CI, 1.07-3.17). CONCLUSIONS This long-term follow-up study reinforces the concept that a positive HUTT should not be considered an unfavorable prognostic indicator; frequency of recent occurrences may be a more valid predictor.
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Affiliation(s)
- Giulia Domenichini
- Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Italy
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Lafuente EA, Martínez LC, Moguel JO, David RN, García JD, Tejeda AO, Reyes PH, González VR. Response to treatment during medium-term follow-up in a series of patients with neurocardiogenic syncope. Arch Med Res 2004; 35:416-20. [PMID: 15610912 DOI: 10.1016/j.arcmed.2004.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2003] [Accepted: 06/04/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syncope is a common symptom that has different recurrence ratios. We hypothesized that an individualized treatment regimen including pharmacologic and nonpharmacologic measures considering kind of neurocardiogenic syncope (NCS) and basal characteristics of each patient could allow optimized therapy to avoid recurrences. METHODS We conducted a prospective study to evaluate performance of diverse accepted treatments for NCS. Each patient received specific treatment including general measures such as an increase in salt and water intake, tilt training, specific pharmacologic treatment according to head-up tilt table test (HUTT) result, and patient basal blood pressure and heart rate measurements. RESULTS We followed a group of 127 patients during a main period of 20.8 +/- 9 months (range, 6-38 months). Mean age was 47.8 +/- 19.2 years and 66.9% were females. We had six (4.7%) patients with recurrence of symptoms 4 +/- 0.9 months after diagnostic HUTT. Medications used were atenolol in 20 patients, pindolol in 17, dysopiramide in 50, and fluoxetine in 25. Two patients received fludrocortisone. Tilt training was not indicated initially for patients with recurrences but was indicated later; to date, these patients have not experienced further episodes. CONCLUSIONS Increase in water and salt intake, as well as tilt training, showed great value in prevention of syncope recurrences in this specific set of patients. Pharmacologic treatment has an important role, but there is no single medication associated with significant improvement in symptom control.
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Affiliation(s)
- Enrique Asensio Lafuente
- Departamento de Cardiología, Clínica de Marcapasos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.
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