Asymptomatic asystole in a child with cardioinhibitory syncope
Abstract
It is frequently difficult to establish the pathogenetic mechanism of faints in patients with sinus node dysfunction due to the similar clinical manifestations of cardioinhibitory reflex syncope and Morgagni—Adams—Stokes syncopal episodes; to the intermittent course of sick sinus syndrome; to no correlation between the clinical manifestations and duration of asystole at the moment of the episode. The described clinical case demonstrates a diagnostic search for the mechanism of syncopal states running with asystole in a teenager with sinus node dysfunction. A long-term (48-month) follow-up in a female patient repeatedly documented asystoles during provoked syncopal and presyncopal states, which could ascertain the reflex genesis of syncope (its cardioinhibitory type with asystole). A 12400-ms asystole episode recorded with ECG loop recorders (REVEAL) was single, accompanied by no clinical manifestations and therefore it had no impact on further treatment policy.
About the Authors
T. M. Shkolenko
Research Clinical Institute of Pediatrics, Moscow
Russian Federation
Russian Federation
T. A. Trofimova
Research Clinical Institute of Pediatrics, Moscow
Russian Federation
Russian Federation
M. A. Shkolnikova
Research Clinical Institute of Pediatrics, Moscow
Russian Federation
Russian Federation
References
1. Школьникова М.А. Жизнеугрожающие аритмии у детей. М1999; 230. (Shkolnikova M.A. Life-threatening arrhythmias in children. Moscow 1999; 230.)
2. Полякова Е.Б. Прогностическое значение синусовой бра-дикардии при различных вариантах течения синдрома слабости синусового узла у детей: Автореф. дис. ... канд. мед наук. М 2007; 30. (Polyakova E.B. Prognostic significance of bradycardia in different variants of sinus node dysfunction: Avtoref. dis. ... kand. med. nauk. Moscow 2007; 30.)
3. Егоров Д. Ф., Адрианов А.В. Диагностика и лечение бради-кардииудетей. Ст-Петербург: Человек 2008; 320. (Egorov D.F., Adrianov A.V. Diagnosis and treatment of bradycardia in children. St-Petersburg: Chelovek2008; 320.)
4. Moya A., Sutton R., Ammirati F. et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J 2009; 30: 21: 2631-2671.
5. Лебедева В.К., Егоров Д.Ф., Воронцов И.М. и др. Электрофизиологические показатели функции синусно-пред-сердного узла и предсердно-желудочкового соединения у детей. Вестн аритмол 2002; 25: 203—206. (Lebedeva V.K., Egorov D.F., Voroncov I. M. et al. Electrophysiological parameters of function of the sinus node the atrio-ventricular node. Vestn aritmol 2002; 25: 203—206.)
6. Fenrich A.L., Denfield S.W., Garson A. Sudden death in children. In: M. Akhtar, R.J. Myerburg, J.N. Ruskin (eds). Sudden Cardiac Death: Prevalence, Mechanisms, and Approaches to Diagnosis and Management. New York: Williams &Wilkins 1994; 258-273.
7. Кушаковский М.С. Аритмии сердца. Екатеринбург: Фолиант 2007; 672. (Kushakovskij M.S. Arrhythmias. Ekaterinburg: Foliant2007; 672.)
8. Школьникова М.А., Вахмистрова Т.А., Кравцова Л.А. и др. Эффективность ревил-диагностики причин потери сознания у детей. Кардиология 2012; 9: 36—43. (Shkolnikova М.А., Vakhmistrova ТА., Kravcova LA. et al. Effectivenes of Reveal Diagnostics in Evalution of Sincope in Children. Kardiologiia2012; 9: 36—43.)
9. Alehan D., UnerA., Ayabakan C. et al. Reproducibility of the head-up tilt test results in children with vasovagal syncope. Int J Cardiol 2003; 88; 1:19-25.
10. Cohen G.A., Lewis D.A., Berger S. Reproducibility of head-up tilt-table testing in pediatric patients with neurocardiogenic syncope. Pediatr Cardiol 2005; 26; 6: 772-77'4.
11. Foglia-Manzillo G., Romano M., Corrado G. et al. Reproducibility of asystole during head-up tilt testing in patients with neurally mediated syncope. Europace 2002; 4; 4: 365-367.
12. Brignole M., Sutton R., Menozzi C. et al. International Study on Syncope of Uncertain Etiology 2 (ISSUE 2) Group. Early application of an implantable loop recorder allows effective specific therapy in patients with recurrent suspected neurally mediated syncope. Eur Heart J 2006; 27: 1085—1092.
13. Epstein A.E., Di Marco J.P., Ellenbogen K.A. et al. ACC/AHA/ HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. Circulation 2008; 117: 350—408.
Review
For citations:
Shkolenko T.M., Trofimova T.A., Shkolnikova M.A. Asymptomatic asystole in a child with cardioinhibitory syncope. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2014;59(3):77-81. (In Russ.)
Views:
1510
Email this article 