Abstract
Objective
To assess the epidemiology of cardiac syncope in children and evaluate the guidelines on its management.
Material and methods
We analyzed the etiology to syncope and diagnostic workup in consecutive pediatric patients presenting with syncope in our emergency departments or cardiac outpatient clinics between 1997 and 2005, and who were subsequently diagnosed as having cardiac syncope.
Results
A primary cardiac cause was identified in 11 syncopal patients presenting to the emergency room and 14 patients to the cardiac clinic: supraventricular tachyarrhythmia in 9, ventricular tachyarrhythmia in 10, pacemaker dysfunction in 2, and isolated cases of sick sinus syndrome, hypoxic spell, hypertrophic cardiomyopathy, and primary pulmonary hypertension. Some elements suggested potential cardiac disease as a cause of syncope in all cases. The resting electrocardiogram and the echocardiogram were interpreted as positive and relevant to the diagnosis in 17 and 3 patients, respectively. Exercise electrocardiogram and Holter recording provided diagnostic information previously not seen on the resting electrocardiogram in six and three patients, respectively. Three children have died and one child has neurological sequelae following resuscitation.
Conclusion
Our data support the premise that careful history taking with special focus on the events leading up to syncope, as well as a complete physical examination, can guide practitioners in discerning which syncopal children need further cardiac investigations. Copyright © 2007 Wiley Periodicals, Inc.
Keywords: syncope/heart, disease/child
Full Text
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REFERENCES
- 1. Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC: Syncope in children and adolescents. J Am Coll Cardiol 1997; 29: 1039–1045. [DOI] [PubMed] [Google Scholar]
- 2. Massin M, Bourguignont A, Coremans C, Comté L, Lepage P, et al.: Syncope in pediatric patients presenting to an emergency room. J Pediatr 2004; 145: 223–228. [DOI] [PubMed] [Google Scholar]
- 3.Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 2001; 22: 1256–1306. [DOI] [PubMed] [Google Scholar]
- 4. Gordon TA, Moodie DS, Passalacqua M, Sterba R, Rothner AD, et al.: A retrospective analysis of the cost‐effective workup of syncope in children. Cleve Clin J Med 1987; 54: 391–394. [DOI] [PubMed] [Google Scholar]
- 5. Johnsrude CL: Current approach to pediatric syncope. Pediatr Cardiol 2000; 21: 522–531. [DOI] [PubMed] [Google Scholar]
- 6. Villain E: Cardiac syncope in children. Arch Pediatr 2004; 11: 169–174. [DOI] [PubMed] [Google Scholar]
- 7. Massin M, Leroy P, Misson JP, Lepage P: Catecholaminergic polymorphic ventricular tachycardia: An often unrecognized diagnosis. Arch Pediatr 2003; 10: 524–526. [DOI] [PubMed] [Google Scholar]
- 8. Massin M, Bourguignont A, Coremans C, Comté L, Lepage P, et al.: Chest pain in pediatric patients presenting to an emergency room or to a cardiac clinic. Clin Pediatr (Phila) 2004; 43: 231–238. [DOI] [PubMed] [Google Scholar]
- 9. Massin M, Coremans C: Recurrent syncope. Postgrad Med J 2005; 81: 200–202. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Clark AL, Coats AJS: Screening for hypertrophic cardiomyopathy. Br Med J 1993; 306: 409–410. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Spirito P, Seidman CE, McKenna WJ, Maron BJ: The management of hypertrophic cardiomyopathy. N Engl J Med 1997; 336: 775–785. [DOI] [PubMed] [Google Scholar]
- 12. Wren C: Cardiac causes for syncope or sudden death in childhood. Arch Dis Child 1999; 81: 289–291. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Silka MJ, Hardy BG, Menashe VD, Morris CD: A population‐based prospective evaluation of risk of sudden cardiac death after operation for common congenital heart defects. J Am Coll Cardiol 1998; 32: 245–251. [DOI] [PubMed] [Google Scholar]
- 14. Garson A Jr, Dick M II, Fournier A, Gillette PC, Hamilton R, et al.: The long QT syndrome children. An international study of 287 patients. Circulation 1993; 87: 1866–1872. [DOI] [PubMed] [Google Scholar]
- 15. Timmermans C, Smeets JL, Rodriguez LM, Vrouchos G, van den Dool A, et al.: Aborted sudden death in the Wolff‐Parkinson‐White syndrome. Am J Cardiol 1995; 115: 492–494. [DOI] [PubMed] [Google Scholar]
- 16. Brugada J, Brugada R, Brugada P: Right bundle‐branch block and ST‐segment elevation in leads V1 through V3. Circulation 1998; 97: 457–460. [DOI] [PubMed] [Google Scholar]
- 17. Leenhardt A, Lucet V, Denjoy I, Grau F, Ngoc DD, et al.: Catecholaminergic polymorphic ventricular tachycardia in children. Circulation 1995; 91: 1512–1519. [DOI] [PubMed] [Google Scholar]
- 18. Ross BA: Congenital complete atrioventricular block. Pediatr Clin North Am 1990; 37: 67–78. [DOI] [PubMed] [Google Scholar]
- 19. Silka MJ, Kron J, Walance CG, Cutler JE, McAnulty JH: Assessment and follow‐up of pediatric survivors of sudden cardiac death. Circulation 1990; 82: 341–349. [DOI] [PubMed] [Google Scholar]