RT-196
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Neurocardiogenic syncope in
childhood and adolescence: evaluation by tilt-up testing and treatment with beta-blockers
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Mauro Biffi, Giuseppe Boriani,
Gabriele Bronzetti, Nicola De Simone, Romano Zannoli, Angelo Branzi, Bruno Magnani.
Institute of Cardiology, University of Bologna, Italy
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Introduction
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Syncope is a relatively common clinical problem
accounting for almost 6% of all hospital admissions each year, being estimated to occur at
least once in life in up to 20% of the general population1,2.
Although most commonly observed in patients with structural heart disease, it may occur
also in healthy subjects in the absence of any relevant cardiovascular abnormality in up
to 30% of cases (termed "unexplained syncope").
Currently available studies point out that neurocardiogenic syncope is the underlying
cause of nearly 70% of all the patients presenting with "unexplained syncope".
Healthy children and young adolescents represent a subgroup among which the likelihood of
neurocardiogenic syncope is most frequent because of the low incidence of cardiovascular
diseases. Although characterized by a favorable prognosis, young patients with recurrent
episodes due to neurocardiogenic syncope may be significantly harmed by syncopal
recurrences because of traumatic outcome, or may often suffer substantial limitation of
the quality of life. The correct diagnosis of "unexplained syncope" is the key
step for proper patient counseling to abort clinical recurrences and, in selected
patients, to provide tiered therapy. The tilt-up test (HUT) is the most useful diagnostic
tool to evaluate patients with neurocardiogenic syncope and to achieve individually
optimized therapy in the most symptomatic or in high risk patients3,4.
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