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Wang H, Ma W, Jin M, Li B, Sun S. Value of catecholamine levels in the differential diagnosis of vasovagal syncope and psychogenic pseudosyncope in children. Front Pediatr 2024; 12:1281196. [PMID: 38884104 PMCID: PMC11176470 DOI: 10.3389/fped.2024.1281196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Background and purpose Vasovagal syncope (VVS) and psychogenic pseudosyncope (PPS) can be difficult to distinguish, given their similar clinical presentations. This study was conducted to explore the clinical value of catecholamine levels in the differential diagnosis of VVS and PPS in children. Methods This retrospective case-control study was conducted with data from children with VVS and PPS who underwent head-up tilt tests (HUTTs) at the Children's Hospital of Hebei Province between March 2021 and March 2023. The data collected were baseline clinical characteristics, HUTT results, serum catecholamine levels in the supine and upright positions, and 24 h urinary catecholamine concentrations. These variables were compared between the VVS and PPS groups. Results From 328 potentially eligible cases, 54 (16.46%) cases of VVS and 24 (7.32%) cases of PPS were included in the analysis. No significant difference in age, sex, body mass index, or syncope frequency was observed between the VVS and PPS groups. The main predisposing factors for syncope were body position changes in the VSS group (83.33%) and emotional changes in the PPS group (41.67%). The episode duration was significantly shorter in the VSS group than in the PPS group (4.01 ± 1.20 vs. 24.06 ± 5.56 min, p < 0.05). The recovery time was also shorter in the VVS group than in the PPS group (1.91 ± 0.85 vs. 8.62 ± 2.55 min, p < 0.05). Relative to patients with PPS, those with VVS had significantly higher serum epinephrine (EP) levels in the upright position [199.35 (102.88, 575.00) vs. 147.40 (103.55, 227.25), p < 0.05] and lower serum epinephrine levels in the supine position [72.70 (42.92, 122.85) vs. 114.50 (66.57, 227.50), p < 0.05]. Conclusions Serum EP levels have potential value in the differential diagnosis of VVS and PPS.
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Affiliation(s)
- Hua Wang
- Department of Pediatrics, Hebei Medical University, Shijiazhuang, China
- Department of Pediatric Cardiology, Children's Hospital of Hebei Province, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Pediatric Cardiovascular Disease, Shijiazhuang, China
| | - Wandong Ma
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, China
| | - Mei Jin
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Bo Li
- Department of Pediatric Cardiology, Children's Hospital of Hebei Province, Shijiazhuang, China
- Hebei Provincial Key Laboratory of Pediatric Cardiovascular Disease, Shijiazhuang, China
| | - Suzhen Sun
- Department of Pediatrics, Hebei Medical University, Shijiazhuang, China
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Shijiazhuang, China
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Li H, Shao W, Yu X, Gao L, Yuan Y. Efficacy of catheter ablation in ganglionated plexus for malignant vasovagal syncope children. Cardiol Young 2024:1-6. [PMID: 38572563 DOI: 10.1017/s1047951124000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
AIM Malignant vasovagal syncope in children seriously affects their physical and mental health. Our study aimed to explore the efficacy of catheter ablation in ganglionated plexus with malignant vasovagal syncope children. CONCLUSION Catheter ablation of ganglionated plexus was safe and effective in children with malignant vasovagal syncope and can be used as a treatment option for these children. METHODS A total of 20 children diagnosed with malignant vasovagal syncope were enrolled in Beijing Children's Hospital, affiliated with Capital Medical University. All underwent catheter ablation treatment of ganglionated plexus. Ganglionated plexuses of the left atrium were identified by high-frequency stimulation and/or anatomic landmarks being targeted by radiofrequency catheter ablation. The efficacy of the treatment was evaluated by comparing the remission rate of post-operative syncopal symptoms and the rate of negative head-up tilt results. Safety and adverse events were evaluated. RESULTS After follow-up for 2.5 (0.6-5) years, the syncope symptom scores were decreased significantly compared with before treatment [3 (2-4) versus 5 (3-8) scores, P < 0.01]. Eighty-five per cent (17/20) children no longer experienced syncope, whilst 80% (16/20) children showed negative head-up tilt test after treatment. No adverse effects such as cardiac arrhythmia occurred in the children.
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Affiliation(s)
- Hongxia Li
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wei Shao
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xia Yu
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lu Gao
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue Yuan
- Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Yeom JS, Woo HO. Pediatric syncope: pearls and pitfalls in history taking. Clin Exp Pediatr 2023; 66:88-97. [PMID: 36789491 PMCID: PMC9989720 DOI: 10.3345/cep.2022.00451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/06/2022] [Indexed: 02/16/2023] Open
Abstract
Syncope is a heterogeneous syndrome with complex underlying mechanisms, hence, the spectrum of patients presenting with syncope is broad. The diagnosis of syncope begins with history taking, and an accurate diagnosis can be established through correct history taking and interpretation. Building and interpreting patient history are the main factors that cause a diagnostic yield gap between experts and nonexperts. The most frequent source of error is a clinician's misconception rather than an inaccurate account of patient symptoms. Clinicians can have several diagnostic pitfalls while evaluating patient history, which can be avoided by in-depth understanding of the link between syncope pathophysiology and clinical clues. Furthermore, clinicians need to understand the clinical features of diseases that require differentiation from syncope, such as seizures. The use of confusing terms is one of the barriers that prevents accurate diagnosis and communication between doctors and patients. In this review, we address the terms of syncope and its essential history-taking components in connection with the mechanism of syncope.
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Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Gyeongsang Institute of Health Science, Jinju, Korea
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Wang X, Wang S, Xiao H, Zou R, Cai H, Liu L, Li F, Wang Y, Xu Y, Wang C. The value of QT interval in differentiating vasovagal syncope from epilepsy in children. Ital J Pediatr 2022; 48:197. [PMID: 36510267 PMCID: PMC9743691 DOI: 10.1186/s13052-022-01388-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Both vasovagal syncope (VVS) and epilepsy present with transient loss of consciousness and are often difficult to identify. Hence this study aimed to explore the value of QT interval in the differentiation of VVS and epilepsy in children. METHODS One hundred thirteen children with unexplained transient loss of consciousness were selected. 56 children with VVS (VVS group), including 37 males and 19 females, the average age is 9.88 ± 2.55 years old. 57 children with epilepsy (epilepsy group), including 36 males and 21 females, the average age is 8.96 ± 2.67 years old. At the same time, the 60 healthy individuals (control group) were examined according to age and sex. The QT interval of 12-lead electrocardiogram in a basal state of three groups was measured and statistically analyzed by SPSS 24.0 software. RESULTS Compared with the control group, (1) QTcmax, QTcmin and QTcd were significantly longer in VVS group (P < 0.05), QTmax and QTmin were significantly shorter in VVS group (P < 0.05), and there were no significant differences in QTd between the two groups (P > 0.05). (2) The QTmax and QTmin were significantly shorter in epilepsy group (P < 0.05), and there were no significant differences in QTd, QTcmax, QTcmin, QTcd between the two groups (P > 0.05). Compared with the epilepsy group, The QTcmax, QTcmin, QTcd were significantly longer in VVS group (P < 0.05), and there were no significant differences in QTd, QTmax, QTmin between the two groups (P > 0.05). When QTcmax > 479.84 ms, QTcmin > 398.90 ms and QTcd > 53.56 ms, the sensitivity and specificity of diagnosing VVS were 62.5% and 77.19%, 82.14% and 50.88%, 82.14% and 38.60% respectively. CONCLUSION QTcmax, QTcmin and QTcd have certain value in differentiating VVS from epilepsy in children.
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Affiliation(s)
- Xin Wang
- grid.452708.c0000 0004 1803 0208Department of Pediatric Cardiovasology, Children’s Medical Center , The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Hunan 410011 Changsha, China ,grid.12981.330000 0001 2360 039XDepartment of Pediatrics , The Eighth Affiliated Hospital, Sun Yat-sen University, Fu tian, Guangdong 518033 Shenzhen, China
| | - Shuo Wang
- grid.452223.00000 0004 1757 7615Department of Neonatology , Xiangya Hospital, Central South University, Hunan 410008 Changsha, China
| | - Haihui Xiao
- grid.452708.c0000 0004 1803 0208Department of Pediatric Cardiovasology, Children’s Medical Center , The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Hunan 410011 Changsha, China ,grid.508130.fDepartment of Pediatrics, Loudi Central Hospital, 417099 Loudi, China
| | - Runmei Zou
- grid.452708.c0000 0004 1803 0208Department of Pediatric Cardiovasology, Children’s Medical Center , The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Hunan 410011 Changsha, China
| | - Hong Cai
- grid.452708.c0000 0004 1803 0208Department of Pediatric Cardiovasology, Children’s Medical Center , The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Hunan 410011 Changsha, China
| | - Liqun Liu
- grid.452708.c0000 0004 1803 0208Department of Pediatric Neurology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, 410011 Changsha, China
| | - Fang Li
- grid.452708.c0000 0004 1803 0208Department of Pediatric Cardiovasology, Children’s Medical Center , The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Hunan 410011 Changsha, China
| | - Yuwen Wang
- grid.452708.c0000 0004 1803 0208Department of Pediatric Cardiovasology, Children’s Medical Center , The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Hunan 410011 Changsha, China
| | - Yi Xu
- grid.452708.c0000 0004 1803 0208Department of Pediatric Cardiovasology, Children’s Medical Center , The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Hunan 410011 Changsha, China
| | - Cheng Wang
- grid.452708.c0000 0004 1803 0208Department of Pediatric Cardiovasology, Children’s Medical Center , The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Hunan 410011 Changsha, China
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Liao Y, Du J, Benditt DG, Jin H. Vasovagal syncope or psychogenic pseudosyncope: a major issue in the differential diagnosis of apparent transient loss of consciousness in children. Sci Bull (Beijing) 2022; 67:1618-1620. [PMID: 36546036 DOI: 10.1016/j.scib.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - David G Benditt
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis 55455, USA
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
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Li C, Zhang Y, Liao Y, Han L, Zhang Q, Fu J, Zhou D, Long S, Tian H, Jin H, Du J. Differential Diagnosis Between Psychogenic Pseudosyncope and Vasovagal Syncope in Children: A Quantitative Scoring Model Based on Clinical Manifestations. Front Cardiovasc Med 2022; 9:839183. [PMID: 35155640 PMCID: PMC8829042 DOI: 10.3389/fcvm.2022.839183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
The study was designed to explore a clinical manifestation-based quantitative scoring model to assist the differentiation between psychogenic pseudosyncope (PPS) and vasovagal syncope (VVS) in children. In this retrospective case-control study, the training set included 233 pediatric patients aged 5–17 years (183 children with VVS and 50 with PPS) and the validation set consisted of another 138 patients aged 5–15 years (100 children with VVS and 38 with PPS). In the training set study, the demographic characteristics and clinical presentation of patients were compared between PPS and VVS. The independent variables were analyzed by binary logistic regression, and the score for each variable was given according to the approximate values of odds ratio (OR) to develop a scoring model for distinguishing PPS and VVS. The cut-off scores and area under the curve (AUC) for differentiating PPS and VVS cases were calculated using receiver operating characteristic (ROC) curve. Then, the ability of the scoring model to differentiate PPS from VVS was validated by the true clinical diagnosis of PPS and VVS in the validation set. In the training set, there were 7 variables with significant differences between the PPS and VVS groups, including duration of loss of consciousness (DLOC) (p < 0.01), daily frequency of attacks (p < 0.01), BMI (p < 0.01), 24-h average HR (p < 0.01), upright posture (p < 0.01), family history of syncope (p < 0.05) and precursors (p < 0.01). The binary regression analysis showed that upright posture, DLOC, daily frequency of attacks, and BMI were independent variables to distinguish between PPS and VVS. Based on the OR values of each independent variable, a score of 5 as the cut-off point for differentiating PPS from VVS yielded the sensitivity and specificity of 92.0% and 90.7%, respectively, and the AUC value was 0.965 (95% confidence interval: 0.945–0.986, p < 0.01). The sensitivity, specificity, and accuracy of this scoring model in the external validation set to distinguish PPS from VVS were 73.7%, 93.0%, and 87.7%, respectively. Therefore, the clinical manifestation-based scoring model is a simple and efficient measure to distinguish between PPS and VVS.
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Affiliation(s)
- Changjian Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Department of Cardiology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Zhang
- Department of Cardiology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Lu Han
- Cardiovascular Center, Children's Hospital, Fudan University, Shanghai, China
| | - Qingyou Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jia Fu
- Department of Cardiology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Zhou
- Department of Cardiology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Long
- Cardiovascular Center, Children's Hospital, Fudan University, Shanghai, China
| | - Hong Tian
- Cardiovascular Center, Children's Hospital, Fudan University, Shanghai, China
- Hong Tian
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Hongfang Jin
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, The Ministry of China, Beijing, China
- *Correspondence: Junbao Du
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Hassan D, Wehler D, Krones R, Khalaf K, Ahammer H, Jelinek HF. Determination of Heart Rate Changes using Simulated Head Up Tilt Test for Syncope Patient Assessment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4273-4276. [PMID: 34892166 DOI: 10.1109/embc46164.2021.9630983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Home-based self-training can be beneficial to neurocardiogenic patients, particularly for those who experience a decreased heart rate during the clinical head up tilt test (HUT). Many patients, however, may not be able to attend a clinic and/or attend clinics which lack HUT devices. Individualized heart rate prediction based on a simulated HUT (sHUT) model may address this gap in clinical practice. The proposed sHUT model aims to predict whether home-based self-training is an appropriate beneficial intervention based on the calculated decrease in heart rate from the model. The results obtained with the model are in agreement with previous clinical findings with greater than 80% accuracy in identifying patients who could benefit from home training. The predicted home-based training efficacy of syncope against the control group had a corresponding p-value of p<0.0001. Based on these results, physicians may be able to recommend home training as part of online or telemedicine consultation.Clinical Relevance- The simulated Head Up Tilt model predicts the patient-specific efficacy of tilt-training for patients at home diagnosed with syncope.
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Alciati A, Shiffer D, Dipaola F, Barbic F, Furlan R. Psychogenic Pseudosyncope: Clinical Features, Diagnosis and Management. J Atr Fibrillation 2020; 13:2399. [PMID: 33024500 DOI: 10.4022/jafib.2399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/15/2020] [Accepted: 03/18/2020] [Indexed: 12/25/2022]
Abstract
Psychogenic Pseudosyncope (PPS) is the appearance of Transient Loss of Consciousness (TLOC) in which movements are absent, but there are no hemodynamic and electroencephalographic modifications as are induced by gravitational challenges which characterize syncope and true loss of consciousness. For younger and adult populations, a detailed history is crucial for the diagnosis. Clinical clues that should raise the suspicion for PPS include prolonged duration of the LOC, eye closure during the episode, unusual triggers, no recognizable prodromes and the high frequency of attacks. The presence of an established diagnosis of syncope should not deter from the concomitant diagnosis of PPS. The gold standard for a proper diagnosis of PPS is the documentation by a tilt test of normal hemodynamic and electroencephalographic parameters, when recorded during an attack. Treatment of PPS, based on the clear and empathetic communication of the diagnosis, can lead to an immediate reduction of attack frequency and lower the need to call on emergency services. Pharmacological treatment of associated psychiatric disorders and psychological interventions may be beneficial in patients with PPS. Cognitive-behavioural therapy holds the most reliable evidence of efficacy. In the present review, we aimed to address PPS with historical aspects, main clinical features and diagnostic tests, current diagnostic classification, underlying neurobiological abnormalities, management and therapy.
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Affiliation(s)
- Alessandra Alciati
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa S. Benedetto Menni Hospital, Albese con Cassano (CO), Italy
| | - Dana Shiffer
- Internal Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Franca Dipaola
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Internal Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Franca Barbic
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Internal Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Internal Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
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