Pediatric Syncope: An Examination of Diagnostic Processes, Therapeutic Approaches and the Role of the Tilt Test: Insights from an 18-Year Single-Center Experience
Abstract
:1. Introduction
2. Materials and Methods
- Definite VVS group: patients who were definitively diagnosed with vasovagal syncope based on a comprehensive evaluation, including medical history; physical examination; electrocardiography; and, when necessary, echocardiography, brain MRI, and electroencephalography.
- Suspected VVS group: patients who lack a confident diagnosis of VVS after the initial assessment and required tilt table testing.
2.1. Diagnostic Methods
2.1.1. Electrocardiography (ECG)
2.1.2. Twenty-Four-Hour Holter Monitoring
2.1.3. Tilt Table Test (TTT)
2.1.4. TTT Protocol
2.1.5. Classification of TTT Responses
- Type 1: Mixed Response
- Type 2: Cardioinhibitory Response
- Type 3: Pure Vasodepressor Response
- Postural Orthostatic Tachycardia Syndrome (POTS)
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
NMS | Neurally mediated syncope |
CS | Cardiac syncope |
VVS | Vasovagal syncope |
POTS | Postural orthostatic tachycardia syndrome |
ECG | Electrocardiography |
HR | Heart rate |
AV | Atrioventricular |
TTT | Tilt table test |
ESC | European Society of Cardiology |
ISDN | İsosorbide dinitrate |
SVT | Supraventricular tachycardia |
VT | Ventricular tachycardia |
OR | Odds ratio |
CI | Confidence interval |
BP | Blood pressure |
GTN | Nitroglycerin |
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Variables (n) | Total (283) | Clinically Diagnosed with Vasodepressor Syncope (108) | Undergoing TTT (175) |
---|---|---|---|
Age (years) | 13.5 ± 1.6 | 13.5 ± 1.5 | 13.5 ± 1.6 |
Sex | |||
Female | 196 (69%) | 76 (70%) | 120 (69%) |
Male | 87 (31%) | 32 (30%) | 55 (31%) |
Number of syncope episodes | 3 (1–6) | 2 (1–5) | 3 (1–6) |
Monitoring period (years) | 4 (1–8) | 3 (1–6) | 4 (1–8) |
Variables (n) | Negative TTT (44) | Basal TTT Positive (57) | Positive After ISDN (74) | p-Value |
---|---|---|---|---|
Age (years) | 13.3 ± 1.9 (8–18) | 13.6 ± 1.5 (9–18) | 13.6 ± 1.6 (9–17) | 0.91 |
Male sex | 15 (34%) | 17 (30%) | 23 (31%) | 0.89 |
Initiation of beta-blockers | 0 ab | 46 (80%) ac | 48 (65%) bc | <0.001 |
Initiation of Fludrocortisone | 0 | 0 | 2, (3%) | 0.25 |
Initiation of Midodrine | 0 | 1 (2%) | 0 | 0.35 |
Relapse | 14 (32%) | 11 (19%) | 12 (16%) | 0.12 |
Syncope type | 0.017 | |||
Mixed | 29 (51%) | 39 (53%) | ||
Cardioinhibitory type 2A | 11 (19%) | 4 (5.4%) | ||
Cardioinhibitory type 2B | 7 (12%) | 5 (6.6%) | ||
Vasodepressor | 10 (18%) | 26 (35%) | ||
Monitoring period (years) | 4 ± 1.3 | 4.1 ± 1.2 | 4.1 ± 1.1 | 0.17 |
Number of syncope episodes | 2.7 ± 0.8 ab | 3.1 ± 0.8 a | 3.1 ± 0.9 b | 0.008 |
Duration of medication use (months) | 21.8 ± 5.1 | 21.4 ± 5 | 0.71 | |
Time to positive basal tilt (minutes) | 13 ± 4 | |||
Time to positivity after ISDN (minutes) | 6.8 ± 1.8 |
Variables (n) | Clinically Diagnosed with Vasodepressor Syncope (108) | Undergoing TTT (175) | p-Value |
---|---|---|---|
Age | 13.5 ± 1.5 | 13.5 ± 1.6 | 0.84 |
Male sex | 32 (30%) | 55 (31%) | 0.75 |
Relapse | 16 (15%) | 94 (54%) | <0.001 |
Initiation of beta-blockers | 16 (15%) | 94 (54%) | <0.001 |
Duration of medication use (months) | 23.4 ± 2.7 | 21.6 ± 5 | 0.25 |
Number of syncope episodes | 2.4 ± 0.8 | 3 ± 0.9 | <0.001 |
Monitoring period (years) | 2.9 ± 1.1 | 4.1 ± 1.2 | <0.001 |
(A) | ||||||
---|---|---|---|---|---|---|
Syncope Type (n) | Mixed (68) | Cardioinhibitor Type 2A (15) | Cardioinhibitor Type 2B (12) | Vasodepressor (36) | p-Value | |
Age | 13.5 ± 1.4 | 13.2 ± 1.7 | 13.8 ± 1.6 | 13.9 ± 1.8 | 0.4 | |
Male sex | 21 (31%) | 4 (27%) | 5 (42%) | 10 (28%) | 0.8 | |
Initiation of beta-blockers | 67 (99%) | 15 (100%) | 12 (100%) | 0 | <0.001 | |
Initiation of Fludrocortisone | 0 | 1 (1%) | 1 (1%) | 0 | 0.047 | |
Initiation of Midodrine | 0 | 0 | 1 (1%) | 0 | 0.02 | |
Relapse | 3 (4%) | 2 (1%) | 7 (60%) | 11 (31%) | <0.001 | |
Time to positive basal tilt (minutes) | 12.6 ± 3.9 | 12.3 ± 3.6 | 12.9 ± 3.1 | 15 ± 5 | 0.5 | |
Time to positivity after ISDN (minutes) | 6.6 ± 7.8 | 7.8 ± 2.6 | 7 ± 1 | 6.9 ± 2.2 | 0.6 | |
Monitoring period (years) | 4.1 ± 1 | 4.2 ± 1.8 | 4.3 ± 1.4 | 4 ± 1.1 | 0.9 | |
Number of syncope episodes | 3 ± 0.7 | 3.4 ± 1 | 3.6 ± 1.2 | 3 ± 0.9 | 0.2 | |
Duration of medication use (months) | 21.2 ± 4.7 | 23.1 ± 5.1 | 24.7 ± 4.2 b | 16.7 ± 5.4 | 0.003 | |
(B) | ||||||
Variables | p1 | p2 | p3 | p4 | p5 | p6 |
Initiation of beta-blockers | 1 | 1 | <0.001 | - | <0.001 | <0.001 |
Initiation of Fludrocortisone | 0.12 | 0.068 | - | 1 | 0.46 | 0.32 |
Initiation of Midodrine | - | 0.068 | - | 1 | - | 0.32 |
Relapse | 0.76 | <0.001 | <0.001 | 0.056 | 0.8 | 0.34 |
Duration of medication use (months) | 0.44 | 0.032 | 0.12 | 1 | 0.68 | 0.024 |
Variables | Univariate Regression | Multivariate Regression | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Age | 0.9 | 0.74–1.13 | 0.42 | |||
Sex | 1.4 | 0.68–3 | 0.35 | |||
Initiation of beta-blockers | 0.3 | 0.15–0.71 | 0.004 | |||
Number of syncope episodes | 3.2 | 1.4–7.2 | 0.005 | 1.7 | 1.3–2.5 | 0.03 |
Duration of medication use | 2.2 | 1.5–3.2 | <0.001 | 2.1 | 1.3–3.2 | 0.001 |
Syncope Type | ||||||
Mixed | 0.1 | 0.03–0.35 | <0.001 | |||
Cardioinhibitory type 2A | 0.7 | 0.15–3.3 | 0.65 | |||
Cardioinhibitory type 2B | 9 | 2.5–31.8 | <0.001 | 2.3 | 1.1–4 | 0.01 |
Vasodepressor | 3 | 1.2–7.7 | 0.02 |
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Karaca, S.; Özbingöl, D.; Karaca Özer, P.; Yavuz, M.L.; Nişli, K. Pediatric Syncope: An Examination of Diagnostic Processes, Therapeutic Approaches and the Role of the Tilt Test: Insights from an 18-Year Single-Center Experience. Children 2025, 12, 459. https://doi.org/10.3390/children12040459
Karaca S, Özbingöl D, Karaca Özer P, Yavuz ML, Nişli K. Pediatric Syncope: An Examination of Diagnostic Processes, Therapeutic Approaches and the Role of the Tilt Test: Insights from an 18-Year Single-Center Experience. Children. 2025; 12(4):459. https://doi.org/10.3390/children12040459
Chicago/Turabian StyleKaraca, Serra, Doruk Özbingöl, Pelin Karaca Özer, Mustafa Lütfi Yavuz, and Kemal Nişli. 2025. "Pediatric Syncope: An Examination of Diagnostic Processes, Therapeutic Approaches and the Role of the Tilt Test: Insights from an 18-Year Single-Center Experience" Children 12, no. 4: 459. https://doi.org/10.3390/children12040459
APA StyleKaraca, S., Özbingöl, D., Karaca Özer, P., Yavuz, M. L., & Nişli, K. (2025). Pediatric Syncope: An Examination of Diagnostic Processes, Therapeutic Approaches and the Role of the Tilt Test: Insights from an 18-Year Single-Center Experience. Children, 12(4), 459. https://doi.org/10.3390/children12040459