title: Syncope unit in the paediatric population: A single-centre experience.
abstract: BACKGROUND
  Syncopes are frequent in the paediatric population. Most are benign, but rare cases are caused by cardiac life-threatening diseases. Syncope units developed in the adult population have demonstrated improvement in evaluation and treatment, with a reduction in hospitalization.
  
  
  OBJECTIVE
  We report our experience of paediatric syncope management in a dedicated unit, and analyse the value of different elements in the identification of cardiac causes.
  
  
  METHODS
  This prospective study included 97 consecutive patients (mean age: 12.1±3.3 years) referred between January 2011 and June 2013 to a syncope unit with a paediatric cardiologist, a nurse, a physiotherapist and a psychologist. Patients were classified into diagnostic categories after an initial evaluation that included history, physical examination, electrocardiography, echocardiography and Holter monitoring.
  
  
  RESULTS
  The most common diagnosis was neurocardiogenic syncope (n=69, 70.4%). Fifty-two cases (81.3%) had no or less recurrence after specific management that included physiotherapy and psychological support (follow-up: 11.5±5.4 months). Psychogenic pseudosyncopes affected 20 children (20.6%). Two patients had epileptic seizures. There were five cases of cardiac syncope (5.1%): two long QT syndromes and a catecholaminergic polymorphic ventricular tachycardia received beta-blockers; two atrioventricular complete blocks required pacemakers. One case was of indeterminate cause and received an insertable loop recorder after exhaustive investigations. Exercise-induced syncopes were significantly associated with cardiac origins (P=0.003), such as electrocardiographic abnormalities (P<0.001), whereas echocardiography was not contributive.
  
  
  CONCLUSIONS
  Syncope units in the paediatric population may be useful in the diagnostic process, to help identify rare cardiac aetiologies, and could decrease recurrence through specific management.
authors.affiliation: Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France. Electronic address: mathieucourtheix@gmail.com.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Courtheix
authors.affiliation: Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Jalal
authors.affiliation: Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.affiliation: Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Iriart
authors.affiliation: Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pillois
authors.affiliation: Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Escobedo
authors.affiliation: Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Rabot
authors.affiliation: Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Tribout
authors.affiliation: Hôpital cardiologique Haut-Lévêque, CHU de Bordeaux, université de Bordeaux, 4, avenue de Magellan, 33604 Bordeaux-Pessac, France.
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Thambo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D005602:France; D006757:Hospital Units; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010372:Pediatrics; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D018667:Tilt-Table Test; D013997:Time Factors; D016896:Treatment Outcome
keywords: Adolescents; Canalopathies; Channelopathies; Children; Enfants; Syncope; Tilt test