Evaluation of cardiac clues in patients admitted to pediatric cardiology outpatient clinic with syncope

Background: In our study, we aimed to determine the incidence rates of children admitted to the pediatric cardiology outpatient clinic with syncope according to their etiologies; and especially to reveal the clues that distinguish cardiac syncope cases from other cases. Materials and Methods: The study was conducted by obtaining the information of 795 children aged 5-17 years who were diagnosed with syncope in the pediatric cardiology outpatient clinic of our tertiary university hospital between 01.01.2021 and 01.06.2024 from the data in our hospital automation system. Medical history of the patient and his/her family, syncopal event, physical examination findings, 12-lead electrocardiography (ECG), echocardiography, 24-hour rhythm holter and exercise ECG records were analyzed. Results: Cardiac syncope was 14.5% (10.8% arrhythmia and 3.7% structural heart disease) while noncardiac syncope was 85.5% (VVS 60.6%, OH 18.6%, situational 1% and 4.8% idiopathic). The most common conditions associated with cardiac syncope were a history of arrhythmia and heart disease, a family history of sudden death at a young age, and syncope associated with exercise-palpitations-chest pain. Rhythm holter test had a low diagnostic rate, while exercise ECG test had a high diagnostic rate. Conclusion: It is important to diagnose cardiac syncope as it can cause sudden death. Standard 12-lead ECG, echocardiography and rhythm holter examination should be performed in all suspected patients; exercise ECG, head-up tilt test, genetic arrhythmia/cardiomyopathy investigations and electrophysiologic study should be performed in selected cases. In addition, simultaneous ECG monitoring during electroencephalography (EEG) examination in patients presenting with atonic seizures will be very useful in terms of clarifying the etiology.