Abstract 12324: Evaluation of Syncope and its Electrophysiologic Associations in Children and Adolescents: A Pediatric Referral Center Experience
Introduction The primary purpose of evaluation of patient (pt) with syncope (sync), especially exertional (ex) is to determine whether the pt is at increased risk for sudden death, which involves identifying those with underlying cardiac (card) etiology. There is no standardized approach to the evaluation of sync in children and adolescents, with limited data available on its electrophysiologic (EP) associations. The purpose of this study is to review the diagnostic evaluation and EP associations in pts having ex and non-ex sync from a single referral center.
Methods Retrospective analyses from two separate cohorts of pts ≤21 yrs old were performed: (I) Random sampling of pts from outpatient records over 136 months were reviewed for evaluation and findings according to eventual sync type (card vs. non-card); (II) Consecutive EP studies (EPS) from procedural database over 76 months were reviewed for sync association with ex, arrhythmia, and congenital heart disease.
Results Cohort I: Of 5035 pts, 268 had sync (5.3%; 58% female) of which 24 were ex sync (9% of total sync pts). Non-ex and ex sync groups were similar in age (14.8 vs 14.7 yrs). Imaging study, Holter, exercise test, EPS and hemodynamic card catheterization were more commonly performed in ex sync pts vs non-ex pts (p<0.01 for each). Card cause was more common in ex than non-ex sync (33% vs. 5%, p<0.001). Cohort II: Of 619 EPS pts (45% female), 114 had sync (18%; 62% female) including 32 with ex sync. Those with sync were older (median 14 vs 13 yr, p=0.02). All of sync in pts with CSD was non-ex (p=0.03). Table shows significant associations with sync by multivariable analysis.
Conclusion Cardiac abnormalities are more likely associated with exertional than non-exertional syncope. Among patients undergoing EP testing, ventricular tachyarrhythmias and conduction system disease were more likely to be associated with syncope, with syncope occurring mostly unrelated to exercise in those with conduction system disease.
- © 2012 by American Heart Association, Inc.