Application of Head-up Tilt Table Testing in Children

Wei, Lai; Chen, Ming–Ren; Lin, Shan-Miao; Hwang, Haw-Kwei

doi:10.1016/s0929-6646(10)60104-0

Cited by 14 publications

(20 citation statements)

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“…In that study, most of the patients accepted non-pharmacological treatment (education and increasing fluid and salt intake) and only 15.4% accepted short-term pharmacological treatment (β blocker, diphenidol). During follow-up, the overall recurrence rate was 30.8%, but most of the patients experienced less severe syncopal episodes and only had premonitory symptoms (26). Our study indicated that combination of beta-blocker therapy with increasing salt and water intake decreased the recurrence rate of syncope.…”

Section: Discussionmentioning

confidence: 59%

“…Lai et al examined 79 patients below 18 years of age who underwent head up tilt test for evaluation of syncope or presyncope. Among the patients, 69% had mixed type, 28% had cardioinhibitory, 3% had vasodepressor, and 3.7% had asystole syncope attacks (26). Yilmaz et al also performed a study on 150 patients aged between 8 and 18 years who were referred to their clinic due to syncope.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiological Characteristics and Clinical Outcome of Syncope in Children; A Report from Shiraz, Iran

Amoozgar

Homayoon

Ajami

et al. 2016

Int Cardiovasc Res J

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A B S T R A C TBackground: Syncope is a common problem among children. Objectives: This cross-sectional study aimed to determine the epidemiological characteristics of children with syncope and clarify the outcome of managements in Imam Reza Pediatrics Cardiology Clinic affiliated to Shiraz University of Medical Sciences, the main referral center for pediatric patients with syncope in south of Iran. Patents and Methods: This cross-sectional, descriptive-analytical study was conducted on all the children referred with transient loss of consciousness and positive head up tilt test. A total of 243 children (132 girls and 111 boys) were recruited from April 2007 to April 2013. The patients' treatment outcomes were determined through telephone interviews. All the statistical analyses were performed using the SPSS statistical software (version 16.0). Besides, P < 0.05 was considered to be statistically significant. Results: The majority of the patients were female (54.3% vs. 45.7%). In addition, the mean age at the first episode of syncope was 13.02 ± 3.9 years and 14.8% of the patients had positive family history of syncope. The mean duration of follow-up was 4.2 ± 3.41 years. Besides, breath holding spell history was positive in 13.6% of the patients. Medical treatment was done for 76.5% of the patients (96.7% propranolol and 3.3% atenolol). Increase of salt and fluid intake and physical maneuvers were performed for management of syncope in 75.3% and 30.9% of the patients, respectively. During follow-up, 66.7% of the patients did not experience any syncope episodes at all. Among the patients, 33.3% were referred by neurologists, while 66.7% had self-referred or referred by pediatricians or family practitioners. Moreover, 80.2%, 8.6%, and 6.2% of the syncope cases were mixed type, inodeppressive, and choronodeppressive, respectively. Furthermore, 35.8% of the tilt tests were positive with nitroglycerin consumption. Also, 11.1% of the patients had asystole > 3 seconds during syncope. Conclusions: This study indicated that similar to other populations, syncope was more prevalent among girls in our area. Additionally, the most common cause was mixed type of vasovagal syncope. Medical therapy along with offering the patients to increase water and salt intake and do counter pressure physical maneuvers were effective in reduction of the recurrence of syncope.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Epidemiological Characteristics and Clinical Outcome of Syncope in Children; A Report from Shiraz, Iran

Amoozgar

Homayoon

Ajami

et al. 2016

Int Cardiovasc Res J

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“…The POTS diagnosis is more confusing in the case of pediatric patients. However, we considered inclusion criteria of Thieben et al9) to be more reasonable and suited to the actual definition of POTS for the following reasons: Previous studies on orthostatic intolerance have reported that the sensitivity of the tilt-table test is low16). Wieling17) also reported that the initial phase of active standing caused more drastic hemodynamic changes than the tilt-table test, which clearly explains patient's symptoms of orthostatic intolerance.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic symptoms does not always manifest during tilt-table test in pediatric postural orthostatic tachycardia syndrome patients

et al. 2013

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PurposeChronic day-to-day symptoms of orthostatic intolerance are the most notable features of postural orthostatic tachycardia syndrome (POTS). However, we have encountered patients with such symptoms and excessive tachycardia but with no symptoms during the tilt-table test (TTT). We aimed to investigate whether POTS patients with chronic orthostatic intolerance always present orthostatic symptoms during the TTT and analyze the factors underlying symptom manifestation during this test.MethodsWe retrospectively examined patients who presented with POTS at the Gyeongsang National University Hospital between 2008 and 2011. Diagnosis of POTS was based on chronic day-to-day orthostatic intolerance symptoms as well as excessive tachycardia during the TTT. The patients were divided two groups depending on the presentation of orthostatic symptoms during the TTT. Clinical data and the results of the TTT were compared between these groups.ResultsIn 22 patients, 7 patients (31.8%) did not present orthostatic symptoms during the test. Diastolic blood pressure (BP) was significantly lower in the symptom-positive group. The head-up tilt resulted in a significant increase in diastolic BP in the symptom-negative group (P=0.04), while systolic BP had a tendency to decrease in the symptom-positive group (P=0.06).ConclusionSignificant patients with POTS did not present orthostatic symptoms during the TTT despite having chronic daily symptoms. This finding may be important for establishing definitive diagnostic criteria for pediatric POTS. Development of symptoms during TTT might be related to low diastolic BP and abnormal compensatory responses to orthostasis.

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“…Returning the patient quickly to the supine position can sometimes promote consciousness recovery. For children 6-18 years old, HUTT has high specificity, and no severe HUTT-related complications have been found [31]…”

Section: Safety Issue Of Huttmentioning

confidence: 96%

2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents

Wang¹,

Li²,

Liao³

et al. 2018

Science Bulletin

177

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Application of Head-up Tilt Table Testing in Children

Abstract: HUT can be safely performed with a high specificity in children, with the sensitivity of HUT improved by isoproterenol. Therefore, a positive response to treatment is reassuring to the physician and family. NCS is generally a self-limited condition despite a high recurrence rate.

Cited by 14 publications

References 12 publications

Epidemiological Characteristics and Clinical Outcome of Syncope in Children; A Report from Shiraz, Iran

Epidemiological Characteristics and Clinical Outcome of Syncope in Children; A Report from Shiraz, Iran

Orthostatic symptoms does not always manifest during tilt-table test in pediatric postural orthostatic tachycardia syndrome patients

2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents

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