A retrospective analysis of 54 consecutive patients with recurrent syncope, examined with or without tilt table testing, is reported from the Children’s Heart Center, Egleston Children’s Hospital, Emory University, Atlanta, GA. The group of 27 patients without tilt table tests received a greater number of neurology consultations, EEGs, and CTs, but a positive diagnosis (Wolff-Parkinson-White syndrome,1; conversion reaction, 2; hyperventilation, 1; migraine, 1) was made in only 5 (18%). In contrast, a diagnosis was made early in all of 27 patients tested by tilt table; 25 had neurocardiogenic syncope and 2 had conversion reaction. [1]

COMMENT. The extensive workup currently employed, including EEG, CT, MRI, ECG, echocardiogram, blood chemistries, and thyroid function, etc, is not routinely indicated in syncopal pediatric patients with a history consistent with neurocardiogenic syncope. Tilt table testing performed early in the evaluation increases the frequency of a definitive diagnosis, and avoids the inconvenience and expense of further extensive investigations.

Neurocardiogenic syncope, the most common explanation for recurrent syncope in children, is characterized by a prodrome of nausea, pallor, diaphoresis, and blurred vision followed by syncope. Head-up tilt table testing reproduces the effects of gravity during ECG and blood pressure monitoring and uncovers autonomic dysfunction in patients with susceptibility to syncopal episodes.