The autonomic nervous system dysregulation in response to orthostatic stress in children with neurocardiogenic syncope

Topçu, Burcu; Akalın, Figen

doi:10.1017/s1047951109991211

Cited by 9 publications

(11 citation statements)

References 27 publications

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“…There is one study published in the literature about this subject that was designed by Köse et al18) In this study, Pmax and PWD of HUTT positive patients were significantly greater than those in the HUTT negative and control groups. There are a lot of evidences that increased sympathetic activation might important role in earlier phase of NCS1920). According to earlier studies, β-adrenergic stimulation reduce P wave duration and β-blocker increase P wave duration21).…”

Section: Discussionmentioning

confidence: 99%

P wave dispersion on 12-lead electrocardiography in adolescents with neurocardiogenic syncope

Lee

Yoon

et al. 2016

Korean J Pediatr

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PurposeNeurocardiogenic syncope (NCS) is the most frequent cause of fainting during adolescence. Inappropriate cardiovascular autonomic control may be responsible for this clinical event. The head-up tilt test has been considered a diagnostic standard, but it is cumbersome and has a high false-positive rate. We performed a study to evaluate whether P-wave dispersion (PWD) could be a useful electrocardiographic parameter of cardiac autonomic dysfunction in children with NCS.MethodsFifty-four patients with NCS (28 boys and 26 girls; mean age, 12.3±1.4 years) and 55 age- and sex-matched healthy controls were enrolled. PWD was obtained as the difference between maximum and minimum durations of the P wave on standard 12-lead electrocardiography in all patients and controlsResultsThe value of PWD was significantly higher in the syncope group than in the control group (69.7±19.6 msec vs. 45.5±17.1 msec, respectively; P<0.001). The minimum duration of P wave was shorter in the syncope group than in the control group (43.8±16.8 msec vs. 53.5±10.7 msec, respectively; P<0.001). Left atrial volume was not different between the groups on transthoracic echocardiographyConclusionPWD on echocardiography could be used as a clinical parameter in patients with NCS.

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Section: Discussionmentioning

confidence: 99%

P wave dispersion on 12-lead electrocardiography in adolescents with neurocardiogenic syncope

Lee

Yoon

et al. 2016

Korean J Pediatr

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“…Sympathetic innervation is not capable of sufficiently compensating for parasympathetic hyperactivation. The latter suggests the potential involvement of a neurocardiac reflex in infants' sudden death [10,23]. HM is an atropine-like synthetic quaternary ammonium compound which does not cross the blood-brain barrier, thereby reducing potential atropine-linked neurological side effects.…”

Section: Discussionmentioning

confidence: 99%

An old drug for use in the prevention of sudden infant unexpected death due to vagal hypertonia

Bassareo

Manca

et al. 2011

Eur J Pediatr

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Reflex vagal hypertonia (RVH) has been identified as a possible cause of sudden unexpected death in infants during the first year of life. Homatropine methylbromide (HM) is an anticholinergic drug known to inhibit muscarinic acetylcholine receptors, thus affecting the parasympathetic nervous system. The aim of the present study was to investigate the effects of HM on 24-h Holter electrocardiographic signs of RVH (pre-HM treatment vs post-HM treatment; post-HM treatment vs a control group of healthy infants). A total of 50 patients (mean age, 6.1 ± 2.7 months; 28 males, 22 females; 12 born pre-term) affected by RVH were enrolled in the study. Pre-HM treatment vs post-HM treatment: statistically significant differences were detected for higher heart rate, lower heart rate, mean heart rate, longer sinusal pause, presence of advanced atrio-ventricular blocks, and systolic blood pressure (p < 0.001, p < 0.00001, p < 0.02, p < 0.00001, p < 0.05, and p < 0.04, respectively). A statistically significant correlation was revealed between HM-administered dose and both average heart rate and systolic blood pressure (r = 0.93, p < 0.0001; r = 0.94, p < 0.0001, respectively). No significant differences were detected between post-HM treatment electrocardiographic data and those of the control group. By antagonizing action of the vagus nerve of the parasympathetic system on the heart, thus increasing cardiac frequency, HM treatment appears to feature a good safety profile and be highly effective in preventing transient infantile hypervagotonia, the potential cause of several cases of sudden unexpected death during the first year of life.

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“…It may be difficult to distinguish seizures of patients with atonic, hypotonic epileptic seizures from neurocardiogenic syncope attacks. Head-up tilt test (HUTT) used in diagnosis of neurocardiogenic syncope may give false positive results in the presence of autonomic dysfunction [10].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of autonomic nervous system functions by using tilt table test and heart rate variability in epileptic children

REDJEPOV

USTA

YILDIRIM³

et al. 2023

Marmara Medical Journal

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Objective: The value of head-up tilt test (HUTT) for differential diagnosis of epilepsy and the autonomic nervous system functions in epileptic children using heart rate variability (HRV) are studied. Patients and Methods: The study group consisted of 16 children with idiopatic/criptogenic epilepsy and 12 controls. Heart rate, PR interval, corrected QT (QTc) interval, QT and QTc dispersion were calculated using 12-lead electrocardiogram (ECG), HRV analysis was performed using the Holter recordings obtained both during HUTT and throughout the day. Time domain parameters, standard deviation of all RR intervals (SDNN), the standard deviation of mean NN intervals in five-minutes recording (SDANN), mean standard deviation of NN intervals in five-minutes recordings (SDNNi), root mean square of successive differences (RMSSD), count divided by the total number of all NN intervals (pNN50) and frequency domain parameters low frequency (LF), high frequency (HF), lowfrequency/ high-frequency ratio (LF/HF) were calculated in both and compared between the two groups. Results: Head-up tilt test was positive in 4 epileptic children (25%), none of controls were positive. The heart rate of the patients were higher than the controls (p=0.015). LF/HF ratio in 24-hour Holter recordings, were significantly lower (1.13±0.6, 1.83±0.7 respectively, p=0.002); the SDANN during HUTT (28.7±20.2, 18.2 ± 19.9 respectively, p=0.024) were significantly higher in the patients than the controls. Conclusion: Head-up tilt test positivity is frequent in epileptic children, and cannot be used in differential diagnosis. HRV calculated both from 24 hour Holter recordings and Holter recordings under orthostatic stress were impaired in favour of parasympathetic system in epileptic children.

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The autonomic nervous system dysregulation in response to orthostatic stress in children with neurocardiogenic syncope

Cited by 9 publications

References 27 publications

P wave dispersion on 12-lead electrocardiography in adolescents with neurocardiogenic syncope

P wave dispersion on 12-lead electrocardiography in adolescents with neurocardiogenic syncope

An old drug for use in the prevention of sudden infant unexpected death due to vagal hypertonia

Evaluation of autonomic nervous system functions by using tilt table test and heart rate variability in epileptic children

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