Meki BİLİCİ, Zübeyde Fidancı DEDEOĞLU, Fikri DEMİR, Alper AKIN, Mehmet TÜRE, Hasan BALIK, İlhan TAN, Sabahattin ERTUĞRUL

Prolonged QT dispersion is associated with pediatric syncope

We aimed to find out whether QT dispersion can be used as a diagnosticmarker in terms of syncope type, and recurrence risk. Fifty-two patients (28male, 53.8%) admitted to the pediatric cardiology clinic with syncope werecompared with 50 healthy controls (28 male, 56%; mean age: 13.8±2.3 years,range: 11-17 years) for QT dispersion (QTd) and other electrocardiographicfindings. Gender, age, echocardiography, blood pressure while standing andsitting, electrolyte levels, liver and kidney function tests, and QTd and QTcd(calculated with corrected QT: QTc) in electrocardiography (ECG) of patientswere all evaluated. Patients’ ages varied between 7-17 years and the meanage at first syncope was 13.9±2.4 years. Mean follow-up duration of thepatients was 10±5 months (range: 5-18 months). Mean number of syncopeattacks was 2.8±2.2. QTd (72±46 ms vs. 34±14 ms) and QTcd (77±45 msvs. 33±14 ms) values of the patients were significantly longer, compared tocontrol group (p

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1. Koca S, Paç AF, Ece İ, Bağrul D, Çay S. Cardiac nodal and cardiac autonomic functions in children with vasovagal syncope. Turk J Pediatr 2016; 58: 498-502.

2. Zhang Q, Du J, Wang C, Du Z, Wang L. Tang C. The diagnostic protocol in children and adolescents with syncope: A multi-centre prospective study. Acta Paediatr 2009; 98: 879-884.

3. DiMario FJ Jr, Wheeler Castillo CS. Clinical categorization of childhood syncope. J Child Neurol 2011; 26: 548-551.

4. Steinberg LA, Knilans TK. Syncope in children: Diagnostic tests have high cost and low yield. J Pediatr 2005; 146: 355-358.

5. Strickberger SA, Benson DW, Biaggioni I, et al; American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke; Quality of Care and Outcomes Research Interdisciplinary Working Group; American College of Cardiology Foundation; Heart Rhythm Society; American Autonomic Society. AHA/ACCF Scientific statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society.. Circulation 2006; 113: 316-327.

6. Cetinkaya M, Semizel E, Bostan O, Cil E. Risk of vasovagal syncope and cardiac arrhythmias in children with mitral valve prolapse. Acta Cardiol 2008; 63: 395-398.

7. Findler M, Birger A, Diamant S, Viskin S. Effects of head-up tilt-table test on the QT interval. Ann Noninvasive Electrocardiol 2010; 15: 245-249.

8. Tanrıverdi Yılmaz S, Binnetoğlu K, Babaoğlu K, Altun G. Predictors of vasovagal syncope recurrence in children and adolescents and value of head-up tilt table test. Anadolu Kardiyol Derg 2013; 13: 688-694.

9. Manolis AS, Linzer M, Salem D, Estes III NAM. Syncope: Current diagnostic evaluation and management. Ann Intern Med 1990; 112: 850-863.

10. Benditt DG, Ferguson DW, Grubb BP, et al. Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol 1996; 28: 263-275.

11. Takahashi N, Nakagawa M, Saikawa T, et al. Regulation of QT indices mediated by autonomic nervous function in patients with type 2 diabetes. Int J Cardiol 2004; 96: 375-379.

12. Akalın F, Turan S, Güran T, Ayabakan C, Yılmaz Y. Increased QT dispersion in breath-holding spells. Acta Paediatr 2004; 93: 770-774.

13. Ross BA, Hughes S, Anderson E, Gillette PC. Abnormal responses to orthostatic testing in children and adolescents with recurrent unexplained syncope. Am Heart J 1991; 122 (3 Pt 1): 748-754.

14. Grubb BP, Temesy-Armos P, Moore J, Wolfe D, Hahn H, Elliott L. The use of head-upright tilt table testing in the evaluation and management of syncope in children and adolescents. Pacing Clin Electrophysiol 1992; 15: 742-748.

15. Pollini I, Favilli S, De Simone L, Romanelli AM, Manetti A. Syncope at paediatric ages: Evaluation with head up tilt. Cardiologia 1998; 43: 499-503.

16. Pongiglione G, Fish FA, Strasburger JF, Benson DW Jr. Heart rate and blood pressure response to upright tilt in young patients with unexplained syncope. J Am Coll Cardiol 1990; 16: 165-170.

17. Lewis DA, Zlotocha J, Henke L, Dhala A. Specificity of head-up tilt testing in adolescents: Effects of various degrees of tilt challenge in normal control subjects. J Am Coll Cardiol 1997; 30: 1057-1060.

18. Lerman-Sagie T, Rechavia E, Strasberg B, Sagie A, Blieden L, Mimouni M. Head-up tilt for the evaluation of syncope of unknown origin in children. J Pediatr 1991; 118: 676-679.

19. Kapoor WN, Brant N. Evaluation of syncope by upright tilt testing with isoproterenol. A nonspecifc test. Ann Intem Med 1992; 116: 358-363.

20. Alehan D, Lenk M, Ozme S, Celiker A, Ozer S. Comparison of sensitivity and specificity of tilt protocols with and without isoproterenol in children with unexplained syncope. Pacing Clin Electrophysiol 1997; 20: 1769-1776.

21. Benditt DG, Ferguson DW, Grubb BP, et al. Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol 1996; 28: 263-275.

22. Kula S, Olgunturk R, Tunaoglu FS, Canter B. Circadian variation of QTc dispersion in children with vasovagal syncope. Int J Cardiol 2004; 97: 407-410.

23. Iacoviello M, Forleo C, Guida P, et al. Independent role of reduced arterial baroreflex sensitivity during head-up tilt testing in predicting vasovagal syncope recurrence. Europace 2010; 12: 1149-1155.

24. Koukam C, Vaksmann G, Pachy E, Lacroix D, Rey C, Kacet S. Long-term follow-up of children and adolescents with syncope; predictor of syncope recurrence. Eur Heart J 2001; 22: 1618-1625.

25. Díaz FJ, Tercedor L, Moreno E, et al. Vasovagal syncope in pediatric patients: A medium-term follow-up analysis. Res Esp Cardiol 2002; 55: 487-492.

26. Zabel M, Woosley RL, Franz MR. Is dispersion of ventricular repolarization rate dependent? Pacing Clin Electrophysiol 1997; 20: 2405-2411.

27. Salim MA, Ware LE, Barnard M, Alpert BS, DiSessa TG. Syncope recurrence in children: Relation to tilttest results. Pediatrics 1998; 102: 924-926.

28. Biffi M, Boriani G, Bronzetti G, Frabetti L, Picchio FM, Branzi A. Neurocardiogenic syncope in selected pediatric patients-natural history during long-term follow-up and effect of prophylactic pharmacological therapy. Cardiovasc Drugs Ther 2001; 15: 161-167.

29. Grimm W, Degenhardt M, Hoffmann J, Menz W, Wirths A, Maisch B. Syncope recurrence can better be predicted by history than by head-up tilt testing in untreated patients with suspected neurally mediated syncope. Eur Heart J 1997; 18: 1465-1469.