1
|
Cui Y, Liao Y, Zhang Q, Yan H, Liu P, Wang Y, Sun Y, Xu W, Liu X, Du J, Jin H. Spectrum of underlying diseases in syncope and treatment of neurally-mediated syncope in children and adolescents over the past 30 years: A single center study. Front Cardiovasc Med 2022; 9:1017505. [DOI: 10.3389/fcvm.2022.1017505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
BackgroundSyncope is the primary cause of transient loss of consciousness, which causes severe physical and mental burdens to children and adolescents.ObjectiveThe study was designed to analyze the spectrum of underlying diseases of syncope and treatment options for neurally-mediated syncope (NMS) in Chinese children and adolescents.MethodsMedical records including history, physical examination, blood biochemistry, standing test, head-up tilt (HUTT), sitting-up test, electroencephalogram (EEG), electrocardiogram (ECG), and echocardiography were retrospectively studied in children and adolescents admitted to the National Pediatric Syncope Center, Department of Pediatrics, Peking University First Hospital between 1992 and 2021. All the data were collected from the Beijing Kaihua Medical Management System (Kaihua, Beijing, China). Children who met the syncope diagnostic criteria were enrolled in the study. The spectrum of the underlying diseases of syncope in children and adolescents and the treatment options of NMS were analyzed.ResultsA total of 1,947 children and adolescents with syncope were admitted, including 869 males (44.63%) and 1,078 females (55.37%) aged 1–18 years, with an average age of 11.1 ± 3.1 years. The number of children and adolescents with syncope displayed a gradually increasing trend between 1992 and 2021 except after 2020. NMS proportion increased, and the proportion of unexplained syncope decreased (χ2 = 128.839, P < 0.01). The treatment options of NMS mainly included autonomic nervous function exercise (549, 34.46%), oral rehydration salt (ORS; 445, 27.94%), metoprolol (219, 13.75%), midodrine (120, 7.53%), ORS plus metoprolol (139, 8.73%), ORS plus midodrine (120, 7.53%), and pacemakers (1, 0.06%). Patients with vasovagal syncope (VVS) coexisting with postural orthostatic tachycardia syndrome (POTS) were more likely to take pharmacological treatments than those with VVS or POTS only (χ2 = 41.696, P < 0.01).ConclusionThe number of children with syncope displayed an increasing trend before 2020, and the proportion of unexplained syncope decreased. Autonomic nervous function exercise was the most common treatment for children and adolescents with NMS. Children with VVS coexisting with POTS were more likely to receive pharmacological treatments than those with either.
Collapse
|
2
|
Tao C, Cui Y, Zhang C, Liu X, Zhang Q, Liu P, Wang Y, Du J, Jin H. Clinical Efficacy of Empirical Therapy in Children with Vasovagal Syncope. CHILDREN 2022; 9:children9071065. [PMID: 35884049 PMCID: PMC9315970 DOI: 10.3390/children9071065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: This case-control study was designed to assess the efficacy of empiric treatment for vasovagal syncope in children; (2) Methods: We retrospectively enrolled 181 children with vasovagal syncope from the Department of Pediatrics of Peking University First Hospital. The participants were categorized into four groups, based on the empiric treatment received: conventional treatment, including health education and orthostatic training; conventional treatment plus oral rehydration salts; conventional treatment plus metoprolol; conventional treatment plus midodrine hydrochloride. Patients were followed up to evaluate the syncopal or presyncopal recurrence. Kaplan–Meier curves were drawn to explore the syncopal or presyncopal recurrence in children, and the differences were compared among the groups using a log-rank test; (3) Results: Among the 181 children with vasovagal syncope, 11 were lost to follow-up. The median time of follow-up was 20 (8, 42) months. The Kaplan–Meier survival curve showed no significant difference in syncopal or presyncopal recurrence in children treated with different empiric options according to a log-rank test (χ2 = 1.328, p = 0.723); (4) Conclusions: The efficacy of unselected empiric therapy of vasovagal syncope in children was limited, and the individualized therapies merit further studies.
Collapse
Affiliation(s)
- Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
- Department of Genetics and Endocrinology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Yaxi Cui
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Chunyu Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Xueqin Liu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Qingyou Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Ping Liu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Yuli Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing 100191, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; (C.T.); (Y.C.); (C.Z.); (X.L.); (Q.Z.); (P.L.); (Y.W.); (J.D.)
- Correspondence: ; Tel.: +86-10-83573165
| |
Collapse
|
3
|
Tao CY, Chen S, Li XY, Tang CS, Du JB, Jin HF. Body mass index is a promising predictor of response to oral rehydration saline in children with vasovagal syncope. Chin Med J (Engl) 2020; 134:463-468. [PMID: 33617185 PMCID: PMC7909309 DOI: 10.1097/cm9.0000000000001168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Vasovagal syncope (VVS) greatly impairs quality of life. The therapeutic efficacy of oral rehydration saline (ORS) for unselected VVS patients is not satisfactory due to the diverse mechanisms of the disease. Body mass index (BMI) was demonstrated to reflect blood volume to a certain extent. Therefore, the present study explored the capability of BMI to predict the therapeutic response of children with VVS to ORS treatment. METHODS Seventy-four children with VVS who visited the Syncope Unit of Pediatrics at Peking University First Hospital from November 2010 to June 2019 receiving ORS treatment were enrolled for this retrospective case-control study. A comparison of demographic, clinical, and hemodynamic characteristics was performed between responders and non-responders. The correlation between baseline BMI and response time was analyzed. To determine the value of baseline BMI in predicting the therapeutic efficacy of ORS in children with VVS, a receiver operating characteristic curve analysis was performed. RESULTS Fifty-two children were identified as responders, and the remaining 22 children were identified as non-responders. The baseline BMI of the responders was much lower than that of the non-responders (16.4 [15.5, 17.8] kg/m2vs. 20.7 ±e6 kg/m2, P < 0.001), and baseline BMI was positively correlated with response time in the head-up tilt test after adjusting for sex (r = 0.256, 95% confidence interval [CI]: 0.067-0.439, P = 0.029). The area under the receiver operating characteristic curve of baseline BMI was 0.818 (95% CI: 0.704-0.932, P < 0.001), and an optimal cut-off value of 18.9 kg/m2 yielded a sensitivity of 83% and a specificity of 73% to predict the efficacy of ORS in VVS. CONCLUSION Prior to treatment, baseline BMI is a promising predictor of response to ORS in children with VVS.
Collapse
Affiliation(s)
- Chun-Yan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Selena Chen
- Division of Biological Sciences, University of California, San Diego, CA 92093, USA
| | - Xue-Ying Li
- Department of Medical Statistics, Peking University First Hospital, Beijing 100034, China
| | - Chao-Shu Tang
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing 100191, China
| | - Jun-Bao Du
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Hong-Fang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
- Research Unit of Clinical Diagnosis and Treatment of Pediatric Syncope and Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
4
|
Emotional orienting during interoceptive threat in orthostatic intolerance: Dysautonomic contributions to psychological symptomatology in the postural tachycardia syndrome and vasovagal syncope. Auton Neurosci 2018. [DOI: 10.1016/j.autneu.2018.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
5
|
Owens AP, Low DA, Iodice V, Critchley HD, Mathias CJ. The genesis and presentation of anxiety in disorders of autonomic overexcitation. Auton Neurosci 2017; 203:81-87. [DOI: 10.1016/j.autneu.2016.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/13/2016] [Accepted: 10/17/2016] [Indexed: 11/29/2022]
|
6
|
Márquez MF, Gómez-Flores JR, González-Hermosillo JA, Ruíz-Siller TDJ, Cárdenas M. [Role of the sympathetic nervous system in vasovagal syncope and rationale for beta-blockers and norepinephrine transporter inhibitors]. Medwave 2016; 16:e6824. [PMID: 28055999 DOI: 10.5867/medwave.2016.6824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Vasovagal or neurocardiogenic syncope is a common clinical situation and, as with other entities associated with orthostatic intolerance, the underlying condition is a dysfunction of the autonomic nervous system. This article reviews various aspects of vasovagal syncope, including its relationship with orthostatic intolerance and the role of the autonomic nervous system in it. A brief history of the problem is given, as well as a description of how the names and associated concepts have evolved. The response of the sympathetic system to orthostatic stress, the physiology of the baroreflex system and the neurohumoral changes that occur with standing are analyzed. Evidence is presented of the involvement of the autonomic nervous system, including studies of heart rate variability, microneurography, cardiac innervation, and molecular genetic studies. Finally, we describe different studies on the use of beta-blockers and norepinephrine transporter inhibitors (sibutramine, reboxetine) and the rationality of their use to prevent this type of syncope.
Collapse
Affiliation(s)
- Manlio F Márquez
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México. Address: Juan Badiano 1, Colonia Sección XVI, Delegación Tlalpan, Distrito Federal, México.
| | - Jorge Rafael Gómez-Flores
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Jesús A González-Hermosillo
- Departamento de Proyectos de Innovación y Desarrollo, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | | | - Manuel Cárdenas
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| |
Collapse
|