Vasovagal syncope in children requiring pacemaker implantation

Area of Science:

• Pediatric Cardiology
• Neurology
• Clinical Electrophysiology

Background:

• Episodic loss of consciousness in children often prompts neurological investigation.
• Distinguishing between neurological and cardiac etiologies is critical for appropriate management.

Observation:

• Four children experienced recurrent episodes of syncope.
• Initial neurological workup, including electroencephalograms (EEGs), ruled out seizures.
• Electrocardiograms (ECGs) revealed atrioventricular (AV) block in two patients.
• Vagal maneuvers, specifically eyeball pressure, induced significant bradycardia in all patients.

Findings:

• The patients presented with syncope attributed to underlying atrioventricular block.
• Normal QT and QTc intervals suggested the absence of congenital long QT syndrome.
• The positive response to vagal stimulation indicated a heightened autonomic response contributing to bradycardia.

Implications:

• This case series underscores the importance of considering cardiac causes, particularly AV block, in pediatric syncope.
• Pacemaker implantation effectively managed symptoms in these patients.
• Early diagnosis and intervention can prevent morbidity and mortality associated with unexplained syncope.