Optional statement
Syncope is a common symptom in children, particularly in the teenage years. Although most often benign, it can be a symptom of serious underlying conditions and may result in sudden death. It is estimated that approximately 1% to 2% of children presenting with syncope have a serious underlying disorder. Therefore, it is important to assess patients logically and be able to separate those with serious pathology from those without. A good history is the most important step in this regard, and can save a significant amount of anxiety, time, and money for the patient and for the health care system. Most patients can be determined to have vasovagal syncope on the basis of a good history, physical examination, and standard electrocardiogram. Other tests, such as echocardiography and electrocardiogram monitoring (eg, Holter/event monitors, including implantable event monitors), may be reserved for those with abnormalities in the initial workup. Therapy depends on the underlying disorder. Vasovagal syncope may only need reassurance and volume loading with increase in salt and water intake.
Similar content being viewed by others
References and Recommended Reading
Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC: Syncope in children and adolescents. J Am Coll Cardiol 1997, 29:1039–1045.
Benditt DG, Ferguson DW, Grubb BP, et al.: Tilt table testing for assessing syncope. J Am Coll Cardiol 1996, 28:263–275.
Karas B, Grubb BP, Boehm K, Kip K: The postural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents. Pacing Clin Electrophysiol 2000, 2:344–351.
Brugada P, Brugada J: Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 1992, 20:1391–1396.
Kasanuki H, Ohnishi S, Ohtuka M, et al.: Idiopathic ventricular fibrillation induced with vagal activity in patients without obvious heart disease. Circulation 1997, 95:2277–2285.
Nademee K, Veerakul G, Nimmannit S, et al.: Arrhythmogenic marker for the sudden unexplained death syndrome in Thai men. Circulation 1997, 96:2595–2600.
Hess OM, Sigwart U: New treatment strategies for hypertrophic obstructive cardiomyopathy: alcohol ablation of the septum: the new gold standard? J Am Coll Cardiol 2004, 44:2054–2555.
Boriani G, Maron BJ, Shen WK, Spirito P: Prevention of sudden death in hypertrophic cardiomyopathy: but which defibrillator for which patient? Circulation 2004, 110:438–442.
Younozai AK, Franklin WH, Chan DP, et al.: Oral fluid therapy: a promising treatment for vasodepresser syncope. Arch Pediatr Adolesc Med 1998, 152:165–168.
Di Girolamo E, Di Lorio C, Leonzio L, et al.: Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents: a controlled study. Circulation 1999, 100:1798–1801.
Krediet CTP, van Dijk N, Linzer M, et al.: Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 2002, 106:1684–1689. This study represents data from a key study that showed leg crossing combined with tensing muscles at the onset of prodromal symptoms can postpone, and in some subjects prevent, vasovagal syncope.
Almquist A, Goldenberg IF, Milstein S, et al.: Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med 1989, 320:346–351.
Muller G, Deal BJ, Strasburger JF, Benson DW Jr: Usefulness of metoprolol for unexplained syncope and positive response to tilt testing in young persons. Am J Cardiol 1993, 71:592–595.
O’Marcaigh AS, MacLellan-Tobert SG, Porter CJ: Tilttable testing and oral metoprolol therapy in young patients with unexplained syncope. Pediatrics 1994, 93:278–283.
Balaji S, Oslizlok PC, Allen MC, et al.: Neurocardiogenic syncope in children with a normal heart. J Am Coll Cardiol 1994, 23:779–785.
Raviele A, Brignole M, Sutton R, et al.: Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double-blind, randomized, placebo-controlled trial. The Vasovagal Syncope International Study. Circulation 1999, 99:1452–1457.
Brignole M, Menozzi C, Gianfranchi L, et al.: A controlled trial of acute and long-term medical therapy in tiltinduced neurally mediated syncope. Am J Cardiol 1992, 70:339–342.
Madrid AH, Ortega J, Rebollo JG, et al.: Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, double-blind, randomized and placebocontrolled study. J Am Coll Cardiol 2001, 37:554–559.
Ventura R, Maas R, Zeidler D, et al.: A randomized and controlled pilot trial of beta-blockers for the treatment of recurrent syncope in patients with a positive or negative response to head-up tilt test. Pacing Clin Electrophysiol 2002, 25:816–821.
Alegria JR, Gersh BJ, Scott CG, et al.: Comparison of frequency of recurrent syncope after beta-blocker therapy versus conservative management for patients with vasovagal syncope. Am J Cardiol 2003, 92:82–84.
Scott WA, Pongiglione G, Bromberg BI, et al.: Randomized comparison of atenolol and fludrocortisone acetate in the treatment of pediatric neurally mediated syncope. Am J Cardiol 1995, 76:400–402.
Samniah N, Sakaguchi S, Lurie KG, et al.: Efficacy and safety of midodrine hydrochloride in patients with refractory vasovagal syncope. Am J Cardiol 2001, 88:80–83.
Ward CR, Gray JC, Gilroy JJ, Kenny RA: Midodrine: a role in the management of neurocardiogenic syncope. Heart 1998, 79:45–49.
Perez-Lugones A, Schweikert R, Pavia S, et al.: Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study. J Cardiovasc Electrophysiol 2001, 12:935–938.
Di Girolamo E, Di Iorio C, Sabatini P, et al.: Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999, 33:1227–1230.
Grubb BP, Samoil D, Kosinski D, et al.: Use of sertraline hydrochloride in the treatment of refractory neurocardiogenic syncope in children and adolescents. J Am Coll Cardiol 1994, 24:490–494.
Milstein S, Buetikofer J, Dunnigan A, et al.: Usefulness of disopyramide for prevention of upright tiltinduced hypotension-bradycardia. Am J Cardiol 1990, 65:1339–1344.
Morillo CA, Leitch JW, Yee R, Klein GJ: A placebocontrolled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol 1993, 22:1843–1848.
Strieper MJ, Campbell RM: Efficacy of alpha-adrenergic agonist therapy for prevention of pediatric neurocardiogenic syncope. J Am Coll Cardiol 1993, 22:594–597.
Sutton R, Brignole M, Menozzi C, et al.: Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope: pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators. Circulation 2000, 102:294–299.
Ammirati F, Colivicchi F, Santini M: Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 2001, 104:52–57.
Connolly SJ, Sheldon R, Thorpe KE, et al.: Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial. JAMA 2003, 289:2224–2249. In this double-blind randomized trial, pacing therapy did not reduce the risk of recurrent syncope in patients with vasovagal syncope.
Deal BJ, Strieper M, Scagliotti D, et al.: The medical therapy of cardioinhibitory syncope in pediatric patients. Pacing Clin Electrophysiol 1997, 20:1759–1761.
Moss AJ, Zareba W, Hall WJ, et al.: Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation 2000, 101:616–623. This article presents data from a key study that showed a significant reduction in cardiac events with β blockers in patients with long QT syndrome.
Graham TP Jr, Bricker JT, James FW, Strong WB: 26th Bethesda conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Task Force 1: congenital heart disease. J Am Coll Cardiol 1994, 24:867–873.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Batra, A.S., Balaji, S. Management of syncope in pediatric patients. Curr Treat Options Cardio Med 7, 391–398 (2005). https://doi.org/10.1007/s11936-005-0023-1
Issue Date:
DOI: https://doi.org/10.1007/s11936-005-0023-1