[Cardiac syncope in children].
BACKGROUND
Syncope are serious problems in paediatrics. Approximately 15% of children and adolescents at the age of 8-18 years experience at least one episode of syncope. Neurocardiogenic syncope are the most common (60-80%). Cardiogenic syncope are rare (6%), although they require special attention due to their background.


OBJECTIVE
Evaluation of incidence, causes, methods of treatment and prognosis in cardiogenic syncope in children and adolescents.


METHODS
Retrospective analysis was made in 18 patients with syncope and different pathology of cardiovascular system. Patients were chosen among 766 children treated in the University Hospital for Children in Cracow from January 2005 to June 2006 due to syncope or pre-syncope. The patients were divided into 2 groups depending on the main cause of syncope: Gr I n = 6 due to arrhythmias without structural heart disorders and Gr II n = 12 due to heart diseases or defects. In all patients physical exam and additional test were analysied carefully (ECG, Holter study, chest X ray, ECHO, angio-TK in 1 patient, and catheterisation with angiography in 3 children).


RESULTS
Cardiogenic syncope appeared more frequently in children with structural abnormalities in the heart (Gr II--12 pts/ 66%), rather than in children with arrhythmias (Gr I--6 pts / 33%). Family history was positive in both groups in 17%. Median age at the moment of first episode was 10.3 y +/- 5.0 in Gr I and 12.8 y +/- 3.0 in Gr II. Syncope in Gr II were frequently (33%) initiated by an effort or stress. In Gr I physical examination did not reveal serious symptoms except for irregularity of heart rate, and general condition of children was good (NYHA I). In 5 pts (58%) in Gr II heart murmur and prominent impulse of the left ventricle were found. Symptoms of congestive heart failure were observed in 4 pts (33%) and their condition was poor (III/IV class according to NYHA). In ECG and/or Holter study in Gr I arrhythmias and/or long QTc were found. Pharmacotherapy was sufficient in treatment of serious arrhythmias and prophylaxy of syncope. In Gr II in most cases hypertrorepolarization abnormalities were found. In these children treatment was multidirectional and included both antiarrhythmic drugs, implantation of cardioverter defibrillator (ICD), operation and even heart transplantation.


CONCLUSIONS
Cardiogenic syncope are rare causes of loss of consciousness and indicate on serious pathology in the cardiovascular system. Heart structural diseases or defects influence severity on clinical course, complex treatment and serious prognosis while in children with arrhythmias pharmacotherapy is effective and prognosis is usually good.
Oko-Lagan
Jolanta
J
Klinika Kardiologii Dzieciecej, Uniwersytet Jagielloński, Collegium Medicum w Krakowie. jokolagan@yahoo.com
Kuzma
Jacek
J
Pietrucha
Beata
B
Olczykowska-Siara
Elzbieta
E
Król-Jawień
Wanda
W
Kordon
Zbigniew
Z
Rudziński
Andrzej
A
Loś-Stolarczyk
Maria
M
Klimeczek
Piotr
P
D000293:Adolescent; D002318:Cardiovascular Diseases / Q000150:complications*; D002648:Child; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013575:Syncope / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology