Clinical Features And Treatment Of Cardiac Syncope In Children

Objective: To explore the clinical features and treatment of cardiac syncope(CS)in children and contribute to the diagnosis,treatment and to evaluate the prognosis.Methods: The clinical data and prognosis of 73 cases were collected from January 2013 to December 2017 in children's Hospital of Chongqing Medical University.The clinical features,etiology,treatment,efficacy and prognosis were retrospectively analyzed.Results: 1.73 cases of cardiac syncope were collected.The age ranged from 1 month and 4 days to 15 years and 7 months(7.95±4.09years),0~3 years old accounted for 15.07%.2.In 73 cases,27 cases(37%)in arrhythmia group,among them,10 cases(13.7%)were bradyarrhythmia,mainly high degree and third degree atrioventricular block(AVB),and 17cases(23.3%)were tachyarrhythmia,which was dominated by rapid ventricular arrhythmia.23 cases(31.5%)in organic cardiovascular disease group,with hypertrophic cardiomyopathy(HCM),idiopathic pulmonary hypertension(IPAH)and congenital heart disease.23 cases(31.5%)in mixed group,mainly caused by fulminant myocarditis with third degree AVB,secondly caused by third degree AVB after congenital heart disease surgery.3.In 73 cases,30.1% of CS children with presyncope attacks,the proportion of palpitations was 9.6%.46.6% with predisposing causes,the proportion of strenuous exercise was 37% and the proportion of crying was8.2%.The onset of CS was irregular,and the supine position can also occur;38.4% of the duration of consciousness loss was within 1 minute,78.1% within 5 minutes,the numbers of CS attacks were 0 to 3 times in46.6%,and 52.1% accompanied by symptoms,42.5% accompanied by convulsion,9.6% with incontinence.21.9% had a positive past history,mainly past history was heart disease,especially congenital heart disease and congenital heart disease surgery;21.9% had a positive family history,sudden death 9.6%,syncope 5.5%,heart disease 4.1%;82.2% had positive signs,79.5% had positive heart signs.4.72 patients completed 12-lead ECG,97.2% were positive,the results were positive in arrhythmia group and mixed Group(100%),the positive rate of echocardiography in the organic cardiovascular disease Group was 90.9%.One catecholaminergic polymorphic ventricular tachycardia(CPVT)exercise test was positive for ECG.73 patients completed echocardiography,84.9% were positive.The positive rate of organic cardiovascular disease group was 100%,the positive rate of mixed group was 91.3%,and that of arrhythmia group was18.5%.Five patients completed genetic tests,four cases were positive,two cases were CPVT,one case was long QT syndrome(LQTS),and 1 case was HCM.5.Different causes of CS need different treatments.Follow-up61 cases(83.6%),the average follow-up time were 2.03 years,range from2 month to 5 years.During the follow-up,57 cases(93.4%)had no syncope,there were 4 cases still had syncope,one case was CPVT,one case was dilated cardiomyopathy,one case was congenital third degree AVB,one case was left ventricular non-compaction,and 1 case died,who was a complex congenital heart disease patient and died after surgery.Fulminant myocarditis was mainly treated with glucocorticoid,intravenous immunoglobulin,and pacemaker.After the treatment,their results of ECGs were normal in 62.5% of these children,37.5% of them were installedpermanent pacemakers.In acute phase of tachyarrhythmia,drug treatment was first.Finally,two cases of supraventricular tachycardia and one case of IPAH were treated with radiofrequency catheter ablation.LQTS,CPVT,and HCM were treated with beta-blockers and IPAH was treated with endothelin receptor antagonists.Conclusion: There are obvious clinical features in CS of children,and its etiological composition ratio is different from that of adults.Identifying these features is of great significance in improving diagnosis efficiency of children's CS.The 12-lead electrocardiogram and echocardiography should be used as routine CS examinations.Genetic test has important value for the diagnosis of hereditary ion channel disease.The treatment effect of children's CS is good,especially fulminant myocarditis with third degree AVB.