What Is the Yield of Screening Echocardiography in Pediatric Syncope?

Ritter, Saskia; Tani, Lloyd Y.; Etheridge, Susan P.; Williams, Richard V.; Craig, Janet E.; Minich, L. LuAnn

doi:10.1542/peds.105.5.e58

Cited by 83 publications

(62 citation statements)

References 16 publications

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“…Holter monitoring has a low diagnostic yield, providing a symptom-rhythm correlation in Ͻ10% of patients. 4 The use of an ELR increases the likelihood of capturing the rhythm at the time of symptoms, but up to 35% to 50% of pediatric patients will not have a symptom-rhythm correlation. 5,6 Although ELR allows for prolonged ambulatory monitoring for approximately 1 month, its use is sometimes confounded by a high rate of noncompliance.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Implantable Loop Recorders in Establishing Symptom-Rhythm Correlation in Young Patients With Syncope and Palpitations

et al. 2003

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ABSTRACT. Objective. To evaluate efficacy of the recently introduced implantable loop recorder (ILR) in establishing symptom-rhythm correlation in young patients with syncope, near syncope, palpitations, and acute life-threatening events (ALTEs).Methods. A retrospective study was conducted with patients with ILR from 3 pediatric centers. Inclusion criteria were age <25 years and a minimum follow-up of 1 month. All ILR-stored events were analyzed regularly for the presence or absence of an arrhythmia at the time of the symptomatic event.Results. Twenty-one patients (12 male, 9 female) with an average age of 12.3 ؎ 5.3 years (range: 0.8 -22 years) were included in the study. Five (24%) patients had structural heart disease, 2 (10%) had a family history of sudden cardiac death, 3 (14%) had QT prolongation on electrocardiogram, and 11 had no cardiovascular disease. Indications for ILR were recurrent syncope and near syncope (n ‫؍‬ 15), palpitations (n ‫؍‬ 2), and ALTE (n ‫؍‬ 2). Fourteen (67%) patients continued to have symptoms, and 7 (33%) had no symptoms after ILR over a follow-up period of 8.4 ؎ 4.7 months (range: 1.9 -16 months). Symptom-rhythm correlation was possible in all 14 patients who continued to have symptoms (supraventricular tachycardia in 4, ventricular tachycardia in 2, torsades de points in 1, asystole in 1, junctional bradycardia in 1, and sinus rhythm in 5).Conclusions. ILR is useful in determining the presence or absence of an arrhythmia during symptoms of syncope, near syncope, and palpitations as well as ALTEs in patients with and without structural heart disease when conventional diagnostic testing, such as electrocardiogram, Holter monitoring, and/or external loop recording, is inconclusive. Pediatrics 2003;112:e228 -e233. URL: http://www.pediatrics.org/cgi/content/full/112/3/e228; implantable loop recorder, arrhythmias, syncope, palpitations.

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Section: Discussionmentioning

confidence: 99%

“…An echocardiogram is performed when structural heart disease is suspected. 4 An electrophysiology study (EPS) is rarely needed in a child with syncope. Unfortunately, conventional cardiovascular tests have a low diagnostic yield.…”

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confidence: 99%

Efficacy of Implantable Loop Recorders in Establishing Symptom-Rhythm Correlation in Young Patients With Syncope and Palpitations

et al. 2003

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“…Routine testing with ECG is recommended during the initial evaluation of any child or young adult with syncope. Ritter et al 23 reviewed the records of 480 pediatric patients (median age, 13 years) who presented with syncope. A cardiac etiology for syncope was identified in 22 patients (5%), including long QT syndrome (n ϭ 14), arrhythmias (n ϭ 6), and cardiomyopathies (n ϭ 2).…”

Section: Discussionmentioning

confidence: 99%

“…An abnormal history (exercise-induced syncope or family history of sudden death), physical examination, or ECG identified 21 of the 22 patients with a cardiac cause of syncope (96% sensitivity; 99% negative predictive value). 23 If the history and physical examination are typical for neurocardiogenic syncope and the ECG is normal, further testing generally is not needed.…”

Section: Discussionmentioning

confidence: 99%

Warning Symptoms and Family History in Children and Young Adults with Sudden Cardiac Arrest

Drezner¹,

Fudge²,

Harmon³

et al. 2012

The Journal of the American Board of Family Medicine

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Background: Children and young adults with undiagnosed cardiovascular disorders at risk for sudden death may have warning symptoms or significant family history that is detectable through screening. The objective of this study was to determine the prevalence of warning symptoms and family history in a cohort of children and young adults who suffered sudden cardiac arrest (SCA).Methods: A retrospective survey investigating warning symptoms and family history of cardiovascular disease was completed by families with a child or young adult who suffered SCA.Results: Eighty-seven of 146 families (60%) returned a completed survey. The SCA victims were an average age of 16 years (range, <5-29 years), 69% male, and 68% white. Seventy-two percent of SCA victims were reported by their parents to have at least one cardiovascular symptom before SCA, with fatigue (44%) and near-syncope/lightheadedness (30%) the two most common. Twenty-four percent of SCA victims had one or more (average 2.6; range, 1 to 10) events of syncope or unexplained seizure that remained undiagnosed as a cardiac disorder before SCA. Parents reported that cardiovascular symptoms first occurred, on average, 30 months (range, 19 to 71 months) before SCA; a symptom was brought to the attention of the child's physician in 41% of cases. Twenty-seven percent of families reported a family member had suffered sudden death before age 50 because of a heart condition.

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“…The evaluation of these patients can be extensive, expending considerable time and resources 2, 3, 4. Previous reports on syncope have been mostly observational 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Paris

Toro‐Salazar

Gauthier

et al. 2016

JAHA

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BackgroundPediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs).Methods and ResultsAmbulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5‐year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise‐related or more problematic symptoms. Guideline‐defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow‐up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.Conclusions SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low‐severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.

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What Is the Yield of Screening Echocardiography in Pediatric Syncope?

Cited by 83 publications

References 16 publications

Efficacy of Implantable Loop Recorders in Establishing Symptom-Rhythm Correlation in Young Patients With Syncope and Palpitations

Efficacy of Implantable Loop Recorders in Establishing Symptom-Rhythm Correlation in Young Patients With Syncope and Palpitations

Warning Symptoms and Family History in Children and Young Adults with Sudden Cardiac Arrest

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

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