Syncope in children with hypertrophic cardiomyopathy
https://doi.org/10.21508/1027-4065-2014-59-6-35-49
Abstract
Seventy children aged 7 to 17 years with hypertrophic cardiomyopathy (HCM) were examined; among them there were 11 syncope patients and 5 presyncope patients. The screening program included standard electrocardiography (ECG), Doppler echocardiogra-phy, 24-hour Holter ECG monitoring, and an incremental exercise testing (Bruce treadmill test). The markers of myocardial electrical instability were determined. In the children with HCM, syncope was established to be heterogeneous; it had an arrhythmogenic origin and, in most cases, occurred in the presence of tachyarrhythmia (44%) or bradyarrythmia (25%); its vasovagal genesis was probable in one third of the examinees. The children with syncope were typified by the asymmetric, obstructive form of HCM, at the same tone there was most commonly left ventricular hypertrophy concurrent with left atrial enlargement. 24-hour Holter monitoring showed that bradycardia was prevalent in the patients, 3 patients were found to have more than 2-second cardiac rhythm pauses caused by second-degree atrioventricular block in 1 case or by sick sinus syndrome in 2. Nonsustained ventricular tachycardia was noted in two patients. The children with syncope were typified by the signs of myocardial electrical instability as a reduction in the early phase of heart rate turbulence and by impaired QT/RR interval adaptation as hyperadaptation. The paper presents the developed management tactics for children with syncope and indications for the implantation of a cardioverter defibrillator, a pacemaker, or an ECG loop recorder.
About the Authors
I. V. Leontyeva
Research Clinical Institute of Pediatrics, Moscow
Russian Federation
Russian Federation
V. A. Makarova
Research Clinical Institute of Pediatrics, Moscow
Russian Federation
Russian Federation
S. A. Termosesov
Research Clinical Institute of Pediatrics, Moscow
Russian Federation
Russian Federation
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Review
For citations:
Leontyeva I.V., Makarova V.A., Termosesov S.A. Syncope in children with hypertrophic cardiomyopathy. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2014;59(6):57-65. (In Russ.) https://doi.org/10.21508/1027-4065-2014-59-6-35-49
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