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Updated: Sep 20, 2026
Quantitative Autonomic Testing
Published on: July 19, 2011
[Syncope at pediatric ages: evaluation with head-up tilt]
I Pollini1, S Favilli, L De Simone
1UO di Cardiologia, Azienda Ospedaliera A Meyer, Firenze.
Insights
The head-up tilt test (HUTT) is useful for diagnosing neurocardiogenic syncope in children with recurrent fainting. This study found HUTT identified a lower percentage of positive cases than expected, suggesting its promise in guiding treatment.
Area of Science:
- Pediatric Cardiology
- Autonomic Nervous System Disorders
Background:
- Syncope is common in children, with neurocardiogenic syncope increasingly recognized.
- The head-up tilt test (HUTT) aids in diagnosing neurocardiogenic syncope.
Purpose of the Study:
- To evaluate the clinical utility of HUTT in children with recurrent syncope and normal heart structure.
- To assess HUTT's role in managing pediatric neurocardiogenic syncope.
Main Methods:
- 243 children (100 males, 143 females; mean age 11.4 years) with recurrent unexplained syncope underwent HUTT.
- The test involved a 60-degree tilt for 45 minutes, with positive results defined by syncope, hypotension, or bradycardia.
Main Results:
- 26 patients (10.7%) tested positive for neurocardiogenic syncope.
- Vasodepressive response (61.6%) was most common, followed by cardioinhibitory (19.2%) and mixed (19.2%) responses.
- Positive rates were higher in females (13.3%) than males (7%), and similar across age groups (<10 vs. >10 years).
Conclusions:
- HUTT is a promising method for identifying pediatric syncope patients who may benefit from pharmacotherapy.
- Further research is needed to define prognosis and treatment for children with positive HUTT results.
- Outcomes for children with syncope and negative HUTT require assessment.
Abstract:
Syncope is a common medical problem with multiple potential causes and it is very frequent in pediatric population . Neurocardiogenic syncope has been increasingly recognized with the introduction of head-up tilt test (HUTT). The study investigates the clinical utility of HUTT in the evaluation and management of children with recurrent syncope and structurally normal heart. Two-hundred-forty-three consecutive young patients with recurrent unexplained syncope, 100 males and 143 females (mean age 11.4 years, range 5 to 20) underwent HUTT using a 60 degree tilt for 45 min. The test was considered positive when it provoked symptoms of syncope with hypotension and/or bradycardia. Twenty-six patients (10.7%) were positive for neurocardiogenic syncope. Of the 26 patients with the positive tilt, 5 (19.2%) had cardioinhibitory response, 5 (19.2%) mixed response and 16(61.6%) vasodepressive response. Nineteen of 143 females (13.3%) and 7 of 100 males (7%) resulted positive (NS). Among patients < 10 years of age 3/41 (9.8%) were positive and among > 10 years 22/202 patients (10.9%) resulted positive (NS). The cardioinhibitory response is more frequent in males (p = 0.01), and the vasodepressive in females (p = 0.05). In our study, concerning a non selected pediatric population a positive test resulted in a lower percentage than previously reported; moreover, the tilt test has appeared a promising method of identifying patients requiring pharmacotherapy. Additional randomized controlled studies are necessary to better define the prognosis and treatment of neurocardiogenic syncope in children and adolescents with positive tilt test. Finally, an assessment of the outcome of young patients with syncope and a negative tilt test is needed.
