Pediatric emergency medicine trisk 1520 1520
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defibrillator (ICD) is considered in a subgroup of patients felt to be at high risk
for sudden death, such as those with symptoms before puberty, very long QT
intervals (>500 msec), and those with recurrent syncope. The use of an ICD is
also required in patients with hypertrophic cardiomyopathy and Brugada
syndrome. Adult survivors of congenital heart disease should be cared for by
health providers knowledgeable in the anatomy, repair, and management of these
conditions.
SUMMARY POINTS
Syncope is a common condition in children and is usually benign. Common
causes for syncope include vasovagal syncope, breath-holding spells, and
orthostatic intolerance. Life-threatening causes are usually cardiac in etiology. A
comprehensive medical and family history, a thorough physical examination, and
a 12-lead ECG will help identify most patients with life-threatening causes of
syncope. Routine blood testing and imaging are unnecessary. Since recurrence is
common, education and reassurance are important.
Suggested Readings and Key References
Goldenberg I, Moss AJ, Peterson DR, et al. Risk factors for aborted cardiac arrest
and sudden cardiac death in children with the congenital long-QT syndrome.
Circulation 2008;117:2184–2191.
Morrow W, Berger S, Jenkins K, et al. Pediatric sudden cardiac arrest. Pediatrics
2012;129:e1094–e1102.
Roden DM. Long-QT syndrome. N Eng J Med 2008;358:169–176.
Sheldon RS, Grubb BP 2nd, Olshansky B, et al. 2015 Heart Rhythm Society
expert consensus statement on the diagnosis and treatment of postural
tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope.
Heart Rhythm 2015;12:e41–e63.
Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the
evaluation and management of patients with syncope: a report of the American
College of Cardiology/American Heart Association task force on clinical
practice guidelines and the heart rhythm society. Circulation 2017;136(5):e60–
e122.
