Causes of Syncope in Children

Lee, Jae Young; Noh, Chung Il; Chun, Eun Jung; Park, Sun Sung; Yun, Myung Ja; Gil, Hong Ryang; Kim, Ho Sung; Choi, Jung Yun; Yun, Yong Su

Abstract

PURPOSE
Syncope is not rare and is caused by various conditions ranging from common physiologic derangements to life-threatening conditions. However, there are limited reports regarding syncope in children. We retrospectively analyzed our experiences of the syncope in children.
METHODS
Retrospective analysis of the medical records of patients with syncopal episodes between October 1985 and June 1996.
RESULTS
Sixty-eight patients (male; 36, female; 32, mean onset age 10.9 +/- 3.7, range 3-18 years) were evaluated. Causes were identified in 67.6% (46/68): neurocardiogenic syncope in 25 (36.8%), cardiac syncope in 21 (30.8%). Among the children with cardiac syncope, rhythm disturbances were major and occurred in 19[complete heart block 1, sinus node dysfunction 3, atrial flutter 2, atrial fibrillation 1, paroxysmal supraventricular tachycardia 2, ventricular tachycardia (VT) 10]. Syncope occurred in two patients with structural defects, one with diffuse coronary arteriopathy and the other with double outlet right ventricle with pulmonary hypertension, although the causes remained uncertain. Among those with VT, associated abnormalities were: TU complex abnormalities in 5, cardiac tumor in 2, cardiomyopathy in 1, unidentified in 2. Various precipitating factors were described in 39 (57.4%); eleven (52.4%) of 21 with cardiac syncope, syncope was exercise related. Among the selected 12 with complicated neurocardiogenic syncope (exercise related, associated with ventricular arrhythmia, or with postoperative congenital heart disease), head-up tilt test with or without isoproterenol infusion reproduced syncope in 10 patients (83.3%). Sudden cardiac death was found in two children; 1 with exercise related polymorphic VT, 1 with VT and cardiac tumor.
CONCLUSION
Various causes can be identified after scrupulous evaluation. Cardiac causes should be considered especially in case of exercise related syncope. Head-up tilt test is an effective diagnostic method in neurocardiogenic syncope.