Clinical analysis of vasovagal syncope in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the changes in clinical features of vasovagal syncope (VVS) in children.</p><p><b>METHODS</b>From January 2000 to September 2009, 841 children with unexplained syncope or prodromata were enrolled. They were assigned to two groups according to the period of visiting hospital: group A (from January 2000 to December 2004, n=129) and group B (from January 2005 to September 2009, n=712). They were assigned to three age groups: 4-6 years old, 7-10 years old and 11-18 years old. A head-up tilt table test (HUTT) was performed on all the subjects.</p><p><b>RESULTS</b>The total positive rate of HUTT was 45.3% (381/841). Compared with that in group A, the positive rate of HUTT in group B increased significantly (47.5% vs 33.3%; P<0.05). The positive rate of HUTT in female children was significantly higher than that in male children (49.3% vs 37.9%; P<0.05). The positive rate of HUTT increased with age and it was the highest in children at age of 11-18 years (49.2%), followed by in children at age of 7-10 years (44.1%) and 4-6 years (37.1%) (P<0.05). The children at age of 7-10 years and 11-18 years from group B showed significantly higher positive rate of HUTT than those from group A (46.2% vs 27.8%; 54.0% vs 32.6%, P<0.05). Vasodepressor type was the most common response type (70.9%) shown by HUTT compared with mixed type (25.5%) and cardioinhibitory type (3.6%) (P<0.05). The proportion of children with vasodepressor response type in group B was significantly higher than that in group A (72.5% vs 58.1%; P<0.05).</p><p><b>CONCLUSIONS</b>There were obvious changes in the prevalence of VVS and response types before and after five years, suggesting that the development of VVS may be attributed to many factors, such as social factors, mental factor and life style.</p>

Arrhythmia after a positive head-up tilt table test / 中华心血管病杂志

<p><b>OBJECTIVE</b>to study the characteristics of arrhythmia after a positive head-up tilt table test (HUTT).</p><p><b>METHODS</b>head-up tilt table test (BHUT) or sublingual nitroglycerin-provocation head-up tilt table test (SNHUT) were performed in 1374 patients at the Second Xiangya Hospital of Central South University from March of 2001 to August of 2009. Arrhythmias were recorded in 169 patients after a positive HUTT [57 male, age 6 - 65 years, 86 children < 18 years, mean age (23.1 ± 14.8) years].</p><p><b>RESULTS</b>arrhythmias developed in 75 patients (44.38%) post a positive BHUT and in 94 patients (55.62%) post a positive SNHUT. Major types of arrhythmias were sinus bradycardia (143/169, 84.62%), junctional escape rhythm (55/169, 32.54%) and sinus arrest (26/169, 15.38%). Sinus bradycardia was more common in adult (P < 0.01). Occurrence of junctional escape rhythm and sinus arrest was not affected by age, gender and test mode. Arrhythmia and the manifestation of syncope or pre-syncope occurred simultaneously in 77 (45.56%) patients and mainly in BHUT, while arrhythmia appeared later than the syncope manifestation in 92 (54.44%) patients and mainly in SNHUT (P < 0.05). Arrhythmia and blood pressure reduction occurred simultaneously in 84 (53.50%) cases and mainly in BHUT, while arrhythmia appeared later than reduction of blood pressure in 73 (46.50%) cases and mainly in SNHUT (P < 0.01).</p><p><b>CONCLUSIONS</b>(1) the common types of arrhythmia were sinus bradycardia, junctional escape rhythm and sinus arrest after a positive HUTT. Occurrence of sinus arrest was not affected by age, gender and test mode. (2) In BHUT, arrhythmia occurred mostly simultaneously with the manifestation of syncope or pre-syncope and blood pressure reduction, while arrhythmia appeared later in SNHUT.</p>

Clinical characteristics in adults and children with vasovagal syncope / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics in adults and children with vasovagal syncope (VVS).</p><p><b>METHODS</b>Clinical data including head-up tilt table (HUTT) results were analyzed and compared in 136 children (mean age 12.3 +/- 2.7 years, 50 boys, 86 girls) and 119 adults (mean age 36.4 +/- 14.0 years, 29 men, 90 women) with VVS.</p><p><b>RESULTS</b>(1) There were more female VVS patients in adults group than that in children group (male and female ratio: children group 1:1.7 and adults group 1:3.1, P = 0.033) in this cohort. (2) The incidence of chest distress in adults group was significantly higher than that in children group [45.4 (54/119) vs. 27.2% (37/136), P = 0.003] while the incidence of headache [10.9% (13/119) vs. 20.6% (28/136), P = 0.036] and abdominal pain in children group was significantly higher than that in adults group [7.6% (9/119) vs. 19.1% (26/136), P = 0.008]. (3) Incidences of muggy environment [22.8% (26/114) vs. 12.5% (17/136), P = 0.032] and urination VVS [9.7% (11/114) vs. 1.5% (2/136), P = 0.004] were significantly higher in adults group than those in children group. (4) The mean time of mixed response vasogal episode in adults group was significantly longer than that in children group in sublingual nitroglycerin head-up tilt table test (SNHUT) stage (5.04 +/- 2.27 min vs. 3.50 +/- 1.24 min, P = 0.036).</p><p><b>CONCLUSIONS</b>The incidences of chest distress, muggy environment and urination VVS were more often and the mean time of vasogal episode of mixed response in SNHUT stage was longer in adults VVS while the incidence of abdominal pain and headache was higher in children VVS patients compared to adults VVS patients.</p>

Relationship between Unexplained Chest Distress and(or) Chest Pain in Children and Head-Up Tilt Test / 实用儿科临床杂志

0.05).Conclusions Unexplained chest distress and(or)chest pain of children may has close relationship with the autonomic disturbance.As for children with unexplained chest distress and(or)chest pain without organic cardiovascular disease,HUTT in a timely manner will contribute to diagnosis of the cause.J Appl Clin Pediatr,2009,24(1):24-25