VALUE OF THE TILT TEST IN THE MANAGEMENT OF UNEXPLAINED SYNCOPE IN CHILDREN AND ADOLESCENTS

The value of the tilt test in assessing unexplained syncope in childre n and adolescents was investigated in 79 patients (41 girls and 38 boy s, 12.3 +/- 2.9 years). The test was performed with a tilt of 60 degre es for 45 minutes. A pharmacological provocation with isoprenaline was carried out in negative passive test. The tilt test was considered to be positive in cases of symptomatic falls of the systolic blood press ure with or without bradycardia. Asystole was defined as a ventricular pause greater than or equal to 5 seconds. During the investigation, 5 2 patients (66 %) reproduced symptoms related to vasovagal syncope in 45 patients (57 %) or panic attack in 7 others (9 %). Of the 45 presen ting vasovagal syncope, 7 had a cardio-inhibitory reaction with asysto le of 11.2 +/- 3.3 seconds. The other responses were vasodepressive in 17 patients and mixed in 21 patients. A comparative study did not rev eal any significant difference between patients with a positive or neg ative test including those with panic attacks. Seventy-five patients w ere followed up for an average of 32 +/- 22.3 months. Preventive thera py was prescribed in 34 patients because of the frequency or severity of their symptoms. At the end, 10 patients (13 %) had at least one rec urrence of syncope, 3 in the group with panic attacks, 5 in non-treate d patients (irrespective of the result of the tilt test) and only 1 in the group of 23 patients treated with betablockers. The authors concl ude that with a diagnostic return of 66 % in this series, the tilt tes t seems to be the non-invasive investigation of choice in unexplained syncope in children and adolescents. In addition, true vasovagal synco pe can be differentiated from psychogenic.