Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T05:27:03.456Z Has data issue: false hasContentIssue false
  • English
  • Français

Different haemodynamic patterns in head-up tilt test on 400 paediatric cases with unexplained syncope

Published online by Cambridge University Press:  15 July 2014

Yilmaz Yozgat ,
Cem Karadeniz ,
Rahmi Ozdemir ,
Onder Doksoz ,
Mehmet Kucuk ,
Utku Karaarslan ,
Timur Mese  and
Nurettin Unal
Yilmaz Yozgat*
Affiliation:
Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
Cem Karadeniz
Affiliation:
Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
Rahmi Ozdemir
Affiliation:
Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
Onder Doksoz
Affiliation:
Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
Mehmet Kucuk
Affiliation:
Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
Utku Karaarslan
Affiliation:
Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
Timur Mese
Affiliation:
Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
Nurettin Unal
Affiliation:
Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, Izmir, Turkey
*
Correspondence to: Y. Yozgat, Department of Pediatric Cardiology, Dr. Behcet Uz Children’s Hospital, 1374 St. No. 11 Izmir, Turkey. Tel: +905058220788; Fax: +902324892315; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: To assess haemodynamic patterns in head-up tilt testing on 400 paediatric cases with unexplained syncope. Methods: Medical records of 520 children who underwent head-up tilt testing in the preceding year were retrospectively evaluated, and 400 children, 264 (66%) girls and 136 (34%) boys, aged 12.6±2.6 years (median 13; range 5–18), with unexplained syncope were enrolled in the study. Age, sex, baseline heart rate, baseline blood pressure, frequency of symptoms, and/or fainting attacks were recorded. The test protocol consisted of 25 minutes of supine resting followed by 20 minutes of 70° upright positioning. Subjects were divided into nine groups according to their differing haemodynamic patterns. Results: There were no statistically significant differences between the groups with regard to age, gender, baseline blood pressure, and frequency of syncope (p>0.05). The response was compatible with orthostatic intolerance in 28 cases (7.0%), postural orthostatic tachycardia syndrome in 24 cases (6.0%), asymptomatic postural orthostatic tachycardia syndrome in 26 cases (6.5%), orthostatic hypotension in seven cases (1.7%), vasovagal syncope in 38 cases (9.5%), and negative in 274 cases (69.2%). Vasovagal syncope response patterns were of type 3 in nine cases (2.2%), type 2A in 10 cases (2.5%), type 2B in two cases (0.5%), and type 1 (mixed) in 17 cases (4.25%). Conclusions: In the 400 paediatric cases with unexplained syncope, nine different haemodynamic response patterns to head-up tilt testing were discerned. Children with orthostatic intolerance syndromes are increasingly referred to hospitals because of difficulty in daily activities. Therefore, there is need for further clinical trials in these patient groups.

Keywords

Unexplained syncopehead-up tilt testorthostatic intolerance syndromes
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 911 - 917
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Task Force for the Diagnosis and Management of Syncope; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Heart Failure Association (HFA); Heart Rhythm Society (HRS), et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30: 2631–2671.Google Scholar
2. Brignole, M, Alboni, P, Benditt, D, et al. Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope. Task Force on Syncope, European Society of Cardiology. Eur Heart J 2001; 22: 1256–1306.Google Scholar
3. Calkins, H, Zipes, DP. Hypotension and syncope. In: Braunwald E, Zipes DP, Libby P (eds). Heart Disease. A Textbook of Cardiovascular Medicine, 6th edn. WB Saunders Company, Philadelphia, 2001: 932–940.Google Scholar
4. Cooke, J, Carew, S, Costelloe, A, Sheehy, T, Quinn, C, Lyons, D. The changing face of orthostatic and neurocardiogenic syncope with age. QJM 2011; 104: 689–695.CrossRefGoogle ScholarPubMed
5. Seifer, CM, Kenny, RA. Head-up tilt testing in children. Eur Heart J 2001; 22: 1968–1971.Google Scholar
6. Benditt, DG, Ferguson, DW, Grubb, BP, et al. Tilt table testing for assessing syncope. ACC expert consensus document. JACC 1996; 28: 263–275.Google Scholar
7. Kenny, RA, Ingram, A, Bayliss, J, Sutton, R. Head-up tilt: a useful test for investigating unexplained syncope. Lancet 1986; 1: 1352–1355.Google Scholar
8. McLeod, KA. Syncope in childhood. Arch Dis Child 2003; 88: 350–353.Google Scholar
9. Stewart, JM. Chronic orthostatic intolerance and the postural tachycardia syndrome (POTS). J Pediatr 2004; 145: 725–730.Google Scholar
10. Low, PA, Sandroni, P, Joyner, MJ, Shen, WK. Postural tachycardia syndrome. In: Low PA, Benarroch EE (eds). Clinical Autonomic Disorders, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, 2008: 515–533.Google Scholar
11. Skinner, JE, Driscoll, SW, Porter, CB, et al. Orthostatic heart rate and blood pressure in adolescents: reference ranges. J Child Neurol 2010; 25: 1210–1215.Google Scholar
12. Freeman, R, Wieling, W, Axelrod, FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69–72.Google Scholar
13. Singer, W, Sletten, DM, Opfer-Gehrking, TL, Brands, CK, Fischer, PR, Low, PA. Postural tachycardia in children and adolescents: what is abnormal. J Pediatr 2012; 160: 222–226.Google Scholar
14. Park, MK. Pediatric cardiology for practitioners. In: Park MK eds. Syncope, 5th edn. Mosby Elsevier, Philadelphia, 2008: 509–515.Google Scholar
15. Brignole, M, Menozzi, C, Rosso, AD, et al. New classification of heamodynamics of vazovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Europace 2000; 2: 66–76.Google Scholar
16. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. J Neurol Sci 1996; 144: 218–219.Google Scholar
17. Levine, MM. Neurally mediated syncope in children: results of tilt testing, treatment, and long-term follow-up. Pediatr Cardiol 1999; 20: 331–335.Google Scholar
18. Nair, N, Padder, FA, Kantharia, BK. Pathophysiology and management of neurocardiogenic syncope. Am J Manag Care 2003; 9: 327–334.Google ScholarPubMed
19. Lin, J, Wang, Y, Ochs, T, Tang, C, Du, J, Jin, H. Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance. Cardiol Young. 2013; 15: 1–5.Google Scholar
20. Kouakam, C, Vaksmann, G, Lacroix, D, Godart, F, Kacet, S, Rey, C. Value of the tilt-table test in the management of unexplained syncope in children and adolescents. Arch Mal Coeur 1997; 90: 679–686.Google Scholar
21. Van Dijk, JG, Sheldon, R. Is there any point to vasovagal syncope? Clin Auton Res 2008; 18: 167–169.Google Scholar
22. Ulas, UH, McNeeley, K, Zhang, D, Chelimsky, G, Chelimsky, T. Implications of tilt-table induced faint time in patients with reflex syncope. Anadolu Kardiyol Derg 2011; 11: 674–677.Google Scholar
23. Lerman-Sagie, T, Rechavia, E, Strasberg, B, Sagie, A, Blieden, L, Mimouni, M. Head-up tilt for the evaluation of syncope of unknown origin in children. J Pediatr 1991; 118: 676–679.Google Scholar
24. Grubb, BP, Temesy-Armos, P, Moore, J, Wolfe, D, Hahn, H, Elliott, L. The use of head-upright tilt table testing in the evaluation and management of syncope in children and adolescents. Pacing Clin Electrophysiol 1992; 15: 742–748.Google Scholar
25. Fouad, FM, Sitthisook, S, Vanerio, G, et al. Sensitivity and specificity of the tilt table test in young patients with unexplained syncope. Pacing Clin Electrophysiol 1993; 16: 394–400.Google Scholar
26. Huh, TE, Yeom, JS, Kim, YS, Woo, HO, Park, JS, Park, ES. Orthostatic symptoms does not always manifest during tilt-table test in pediatric postural orthostatic tachycardia syndrome patients. Korean J Pediatr 2013; 56: 32–36.Google Scholar
27. Zhang, Q, Du, J, Wang, C, Du, Z, Wang, L, Tang, C. The diagnostic protocol in children and adolescents with syncope: a multi-centre prospective study. Acta Paediatr 2009; 98: 879–884.CrossRefGoogle ScholarPubMed
28. Medow, MS, Stewart, JM. The postural tachycardia syndrome. Cardiol Rev 2007; 15: 67–75.Google Scholar