Child ; Humans ; Syncope, Vasovagal/therapy* ; Tilt-Table Test

OBJECTIVETo investigate the effect of DDD pacing on vasovagal syncope (VVS).

METHODSEleven patients diagnosed VVS (7 with heart inhibiton type, 4 with combination type)by tilt table test (TTT) in Shanghai Chest Hospital were selected into the study. They all were implanted DDD pacemaker in whom 9 with rate-drop response (RDR) function. All of them were prescribed beta-receptor blocker. The patients were followed-up at 1, 3, 6, 12, 24 months after being discharged.

RESULTSAll the 11 patients with pacemaker implantation were free from syncope, in whom 4 still had pre-syncope discomfort, but the symptoms were slightly. Six patients took TTT again after pacemaker implantation. It was observed that pacing at an elevated rate started immediately when heart rate dropping to the lower threshold, and as a result syncope were prevented.

CONCLUSIONIn the VVS patients with recurrent syncope and severe heart inhibition, DDD pacing with RDR function could prevent from syncope efficiently.

Adult ; Aged ; Cardiac Pacing, Artificial ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Syncope, Vasovagal ; therapy

OBJECTIVETo analyze the impact of attack frequency as well as therapy strategies on outcome of patients with vasovagal syncope (VVS).

METHODSA total of 159 patients (aged from 15 - 59 years old) with VVS were included in this study. Patients were divided into low frequency (< 3) group (n = 95) and high (≥ 3) frequency group (n = 64) according to the attack frequency in the past 5 years at the primary survey. Patients received one of the three therapies: no treatment, physical therapy, and comprehensive treatment. All cases were followed up with telephone or outpatient visit for 24 months.

RESULTSIncidence of syncope was significantly higher in the high frequency group and in the low frequency group [40.6% (26/64) vs. 11.6% (11/95), P < 0.01]. The overall improvement rate was significantly higher in the low frequency group than that of high frequency group (P < 0.01). Improvement rate was significantly higher in the physical therapy subgroup and the comprehensive treatment subgroup than no treatment subgroup for patients with low attack frequency [81.8% (27/33) vs. 47.1% (8/17), P < 0.05; 82.2% (37/45) vs. 47.1% (8/17), P < 0.05], and in comprehensive treatment subgroup than in physical therapy subgroups observed between and [62.2% (28/45) vs. 31.6% (6/19), P < 0.05] for patients with high attack frequency.

CONCLUSIONOutcome is related to previous attack frequency for patients with VVS, physical therapy is effective for reducing the recurrence rate of syncope in VVS patients with low attack frequency while physical therapy combined with pharmacotherapy should be applied for VVS patients with high attack frequency to improve outcome.

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Physical Therapy Modalities ; Prognosis ; Syncope, Vasovagal ; diagnosis ; therapy ; Treatment Outcome ; Young Adult

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Syncope, Vasovagal ; therapy ; Young Adult

BACKGROUND: Vasovagal syncope (VVS) greatly impairs quality of life. The therapeutic efficacy of oral rehydration saline (ORS) for unselected VVS patients is not satisfactory due to the diverse mechanisms of the disease. Body mass index (BMI) was demonstrated to reflect blood volume to a certain extent. Therefore, the present study explored the capability of BMI to predict the therapeutic response of children with VVS to ORS treatment. METHODS: Seventy-four children with VVS who visited the Syncope Unit of Pediatrics at Peking University First Hospital from November 2010 to June 2019 receiving ORS treatment were enrolled for this retrospective case-control study. A comparison of demographic, clinical, and hemodynamic characteristics was performed between responders and non-responders. The correlation between baseline BMI and response time was analyzed. To determine the value of baseline BMI in predicting the therapeutic efficacy of ORS in children with VVS, a receiver operating characteristic curve analysis was performed. RESULTS: Fifty-two children were identified as responders, and the remaining 22 children were identified as non-responders. The baseline BMI of the responders was much lower than that of the non-responders (16.4 [15.5, 17.8] kg/m2vs. 20.7 ±e6 kg/m2, P < 0.001), and baseline BMI was positively correlated with response time in the head-up tilt test after adjusting for sex (r = 0.256, 95% confidence interval [CI]: 0.067-0.439, P = 0.029). The area under the receiver operating characteristic curve of baseline BMI was 0.818 (95% CI: 0.704-0.932, P < 0.001), and an optimal cut-off value of 18.9 kg/m2 yielded a sensitivity of 83% and a specificity of 73% to predict the efficacy of ORS in VVS. CONCLUSION Prior to treatment, baseline BMI is a promising predictor of response to ORS in children with VVS.
Body Mass Index ; Case-Control Studies ; Child ; Fluid Therapy ; Humans ; Quality of Life ; Retrospective Studies ; Syncope, Vasovagal/drug therapy*

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Phytotherapy ; Salvia miltiorrhiza ; Syncope, Vasovagal ; drug therapy

OBJECTIVE: To analyze the disease spectrums underlying orthostatic intolerance (OI) and sitting intolerance (SI) in Chinese children, and to understand the clinical empirical treatment options. METHODS: The medical records including history, physical examination, laboratory examination, and imagological examination of children were retrospectively studied in Peking University First Hospital from 2012 to 2021. All the children who met the diagnostic criteria of OI and SI were enrolled in the study. The disease spectrums underlying OI and SI and treatment options during the last 10 years were analyzed. RESULTS: A total of 2 110 cases of OI and SI patients were collected in the last 10 years, including 943 males (44.69%) and 1 167 females (55.31%) aged 4－18 years, with an average of (11.34±2.84) years. The overall case number was in an increasing trend over the year. In the OI spectrum, postural tachycardia syndrome (POTS) accounted for 826 cases (39.15%), followed by vasovagal syncope (VVS) (634 cases, 30.05%). The highest proportion of SI spectrum was sitting tachycardia (STS) (8 cases, 0.38%), followed by sitting hypertension (SHT) (2 cases, 0.09%). The most common comorbidity of OI and SI was POTS coexisting with STS (36 cases, 1.71%). The highest proportion of treatment options was autonomic nerve function exercise (757 cases, 35.88%), followed by oral rehydration salts (ORS) (687 cases, 32.56%), metoprolol (307 cases, 14.55%), midodrine (142 cases, 6.73%), ORS plus metoprolol (138 cases, 6.54%), and ORS plus midodrine (79 cases, 3.74%). The patients with POTS coexisting with VVS were more likely to receive pharmacological intervention than the patients with POTS and the patients with VVS (41.95% vs. 30.51% vs. 28.08%, χ²= 20.319, P < 0.01), but there was no significant difference in the proportion of treatment options between the patients with POTS and the patients with VVS. CONCLUSION POTS and VVS in children are the main underlying diseases of OI, while SI is a new disease discovered recently. The number of children with OI and SI showed an increasing trend. The main treatment methods are autonomic nerve function exercise and ORS. Children with VVS coexisting with POTS were more likely to take pharmacological treatments than those with VVS or POTS only.
Child ; Electrolytes ; Female ; Humans ; Male ; Metoprolol ; Midodrine ; Orthostatic Intolerance/therapy* ; Postural Orthostatic Tachycardia Syndrome/diagnosis* ; Retrospective Studies ; Salts ; Sitting Position ; Syncope, Vasovagal/diagnosis* ; Tilt-Table Test

BACKGROUNDOrthostatic intolerance (OI) is a common disease at pediatric period which has a serious impact on physical and mental health of children. The purpose of this study was to investigate the effect of related factors on the prognosis of children with OI.

METHODSThe subjects were 170 children with OI, including 71 males (41.8%) and 99 females (58.2%) with age from 6 to 17 (12.0±2.6) years. The effect of related factors on the prognosis of children was studied by using univariate analysis. Then, the impact of children's age, symptom score, duration, disease subtype, and treatment on patient's prognosis was studied via analysis of COX proportional conversion model.

RESULTSAmong 170 cases, 48 were diagnosed with vasovagal syncope, including 28 cases of vasoinhibitory type, 16 cases of mixed type, and 4 cases of cardioinhibitory type; 115 cases were diagnosed with postural tachycardia syndrome and 7 cases with orthostatic hypotension. By using univariate analysis of Cox regression, the results showed that symptom score had a marked impact on the time of symptoms improvement of children after taking medication (P < 0.05), while other univariates had no impact (P > 0.05). Multivariate analysis using Cox proportional hazards regression model showed that the symptom score at diagnosis had a significant effect on holding time of symptoms improvement of children after taking medication (P < 0.05). Kaplan-Meier curve showed that symptom-free survival was higher in children with symptom score equal to 1 than children with symptom score equal to or greater than 2 during follow-up (P < 0.05).

CONCLUSIONSymptom score is an important factor affecting the time of symptom improvement after treatment for children with OI.

Adolescent ; Child ; Female ; Humans ; Male ; Metoprolol ; therapeutic use ; Midodrine ; therapeutic use ; Orthostatic Intolerance ; diagnosis ; drug therapy ; mortality ; pathology ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Saline Waters ; therapeutic use ; Syncope, Vasovagal ; diagnosis ; drug therapy ; mortality ; pathology

Adult ; Aged ; Angiotensin II Type 2 Receptor Blockers ; Biphenyl Compounds ; therapeutic use ; Blood Pressure ; drug effects ; Female ; Heart Rate ; drug effects ; Humans ; Male ; Middle Aged ; Syncope, Vasovagal ; drug therapy ; physiopathology ; Tetrazoles ; therapeutic use