THE MEDICAL THERAPY OF CARDIOINHIBITORY SYNCOPE IN PEDIATRIC-PATIENTS

A small percentage of pediatric patients with neurally mediated syncop e will have an asystolic response during upright tilt table testing. T he purpose of this study is to evaluate the incidence of asystole duri ng tilt table testing, and to assess the outcome of medical management of such patients. Of 398 patients undergoing evaluation for recurrent syncope between January 1989 and 1994, 18 (4.5%) experienced asystole lasting greater than or equal to 5 seconds during baseline tilt test. Patients had experienced a mean of four episodes of syncope, with a m ean age at the time of tilt test of 11.1 +/- 4.0 years. The median dur ation of asystole was 10 seconds (range 5-40 s). Treatment wets indivi dualized to increased fluids and salt intake (3 patients), metoprolol 18 patients), pseudoephedrine (4 patients), disopyramide (1 patient), or combination therapy with fludro-hydrocortisone (2 patients). During a median duration of follow-up of 31 months, no additional syncope wa s experienced by 78% of patients. Recurrent syncope in 4 patients was associated with either noncompliance or discontinuation of therapy in 3 patients; in 1 patient, increasing the dose of metoprolol was effect ive in preventing recurrences. We conclude that young patients with re current syncope and asystole during tilt test may be safely and effect ively managed with pharmacological therapy, without resorting to pacem aker implantation.