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Published on: March 21, 2013
Application of head-up tilt table testing in children
Wei-Ting Lai1, Ming-Ren Chen, Shan-Miao Lin
1Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Insights
Head-up tilt table testing (HUT) is safe and effective for diagnosing neurocardiogenic syncope (NCS) in children. While NCS recurrence is common, it is generally self-limiting and less severe with treatment.
Area of Science:
- Pediatric Cardiology
- Autonomic Dysfunction
- Diagnostic Testing
Background:
- Limited pediatric studies on head-up tilt table testing (HUT) for neurocardiogenic syncope (NCS).
- Need for effective diagnostic tools in pediatric syncope evaluation.
Purpose of the Study:
- Investigate the application and safety of HUT in children.
- Evaluate the management of NCS in pediatric patients.
Main Methods:
- Seventy-nine pediatric patients (ages 6-18) underwent HUT.
- Clinical diagnosis of NCS or non-NCS based on triggers and symptoms.
- Hemodynamic responses classified into four types.
Main Results:
- NCS diagnosed in 65 patients; non-NCS in 14.
- Isoproterenol increased HUT sensitivity (28% to 45%) with minor specificity decrease.
- No complications reported; 30.8% recurrence rate, generally less severe.
- Recurrence rates similar across HUT results and treatment types.
Conclusions:
- HUT is safe and specific for pediatric syncope evaluation.
- Isoproterenol enhances HUT sensitivity in children.
- NCS is typically self-limiting in children despite high recurrence.
Background/Purpose:
We investigated the application of head-up tilt table testing (HUT) and management of neurocardiogenic syncope (NCS) in children, as pediatric studies are limited.
Methods:
Seventy-nine patients (ages 6-18 years) underwent HUT for evaluation of syncope. Patient triggers and premonitory symptoms allowed the clinical diagnosis of NCS or non-NCS. Results were divided into four hemodynamic types (1, 2A, 2B, and 3) according to patient response to HUT.
Results:
NCS occurred in 65 patients and non-NCS in 14 patients. Isoproterenol infusion significantly increased the sensitivity of the test (from 28% to 45%) and was associated with a slight decrease in the specificity (from 93% to 86%). Subjects in the type 1 group accounted for the majority of responses to the test (69%). There were no complications associated with the test. At follow-up (16.6 ± 9.3 months), the overall recurrence rate was 30.8% but NCS was less severe in most patients. The recurrence rate was similar for patients with a positive or negative HUT and for both pharmacologically and non-pharmacologically treated patients.
Conclusion:
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.
