The Repolarization Period during the Head-Up Tilt Test in Children with Vasovagal Syncope

Abstract

Background: Electrocardiography (ECG) and the head-up tilt test (HUTT) are vital in clinical work-up in children with vasovagal syncope (VVS). Ventricular repolarization parameters (QT) measured during the HUTT can be indicative of electrical instability; however, these parameters are not frequently assessed. This study aimed to investigate if ventricular repolarization parameters measured during the HUTT could be indicative of future ventricular arrhythmias in children with syncope.

Methods: The shape and amplitude of the T-wave and parameters of the repolarization period (QT, QTpeak, Tpeak-Tend) were evaluated in a resting ECG performed on the first day of hospitalization and in ECGs performed during three phases of the HUTT.

Results: In the after-tilt phase of the HUTT, 19/30 children displayed a change in T-wave morphology. QTc was significantly longer in VVS I compared to that in VVS II patients, but not in the controls (p = 0.092).

Conclusions: We need further follow-up studies to establish the clinical importance of abnormal dynamics of the repolarization period in children with VVS and negative HUTT. Therefore, children with abnormal T-wave refraction and prolonged duration of the TpTe should remain under the care of a cardiological outpatient.

Keywords: electrocardiography; neurocardiogenic syncope; tilt test; vasovagal syncope; ventricular repolarization.

Figure 1

The sample electrocardiogram of a child with vasovagal syncope with variable T-wave morphology (VVSI) recorded on admission to the ward and in the three phases of the tilt test: two-humid T-waves are visible in a 2-phase electrocardiogram (after standing) in V4-V6 leads. Source: the medical documentation of a child with children with vasovagal syncope, hospitalized at the Children’s Cardiology Clinic.

Figure 2

The sample electrocardiogram of a child with vasovagal syncope with T-waves normal morphology recorded on admission to the ward and in the three phases of the tilt test: in all electrocardiogram recordings, T-waves did not change after verticalization. Source: the medical documentation of a child with vasovagal syncope, hospitalized at the Children’s Cardiology Clinic.

Figure 3

The sample electrocardiogram of a child from the control group recorded on admission at the branch and in the three phases of the tilt test: all electrocardiogram recordings had normal T-wave morphology. Source: the medical documentation of a child with psychogenic pseudosyncope, hospitalized at the Children’s Cardiology Clinic.