Syncope in pediatric versus adult patients. Does neuromediated syncope be more prevalent and recurrent in the teen population?

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Rangel I (Author) Other; Freitas J (Author) Other; Correia AS (Author) Other; Sousa A (Author) Other; Lebreiro A (Author) Other; Sousa C (Author) Other; Paiva M (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Journal of Heart Failure Supplements

Initial page: P359

Heart Failure Congress 2012

Belgrade, 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Background: Syncope is a common clinical problem occurring in all ages. Head-up tilt testing (HUTT) is a valuable diagnostic tool to investigate unexplained syncope, but limited data is available in pediatric population. Methods: We retrospectively analyzed clinical records of 250 patients (132 pediatric patients [PP] and 118 adult patients [AP]). Patients performed HUTT from January 1995 through December 2010. Information about their episodes, prodromes, triggers, recovery manifestations, as well as the HUTT outcomes were evaluated. They were subsequently followed-up with a telephone interview, about recurrence of symptoms. Results: From the 132 PP enrolled, 88 (67%) were female, average age 15 ± 3 years (range 5-18). From the 108 AP enrolled, 73 (62%) were female, average age 43 ± 16 years (range 19-79). Children had a significant higher rate of positive HUTT (80% vs 68%; p=0.024). However, there was no significant difference in the type of positive HUTT response in both patient populations (PP: vasodepressor response in 41%, cardioinhibitory in 9%, mixed in 30%; AP: vasodepressor response in 36%, cardioinhibitory in 9%, mixed in 23%). In both populations, there was no significant difference between HUTT outcome (positive versus negative HUTT) regarding prodromes, frequency of recent syncope episodes (in the 12 months preceding HUTT), triggers and recovery symptoms (p > 0,05 for all the variables). Pharmacological therapy, mainly midodrine, was offered less frequently in PP (15% vs 27%; p=0.015), though no differences in syncope characteristics or HUTT response were found between treated and untreated patients. Follow-up data were available in 186 patients (80 PP and 106 AP). During a mean follow-up of 84 months, syncope recurred more in PP than AP (64% vs 46%; p=0.013). There was no relevant difference of recurrence rate between positive and negative HUTT groups (PP: 62% vs 71%; p > 0,05; AP: 48% vs 42%, p > 0,05), as well as between treated and untreated patients (PP: 68% vs 59%, p > 0,05; AP: 59% vs 41%, p > 0,05). In both populations, patients with higher rate of syncope recurrence ( ≥ 3 in the last 12 months of follow-up) reported a higher number of historical syncopal episodes (PP: r=0.570; p < 0.0001; AP: r=0.608; p < 0.0001). Conclusions: HUTT enables the susceptibility to neuromediated reflex of the vast majority of both PP and AP with syncope. In both PP and AP populations, syncope recurrence cannot be predicted by HUTT outcome or pharmacology treatment but is highly correlated with the number of historical syncopal spells.

Language: English

Type (Professor's evaluation): Scientific

Notes: Rangel I, Freitas J, Correia AS, Sousa A, Lebreiro A, Sousa C, Paiva M, Maciel MJ. Syncope in pediatric versus adult patients. Does neuromediated syncope be more prevalent and recurrent in the teen population? Eur J Heart Fail Suppl 2012; 11(Suppl 1): P359. ISSN 1567-4215. Heart Failure Congress 2012, Belgrade, 2012