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Cardiac arrest is rare in pediatric patients with dysautonomia. We are reporting our institutional experience of children with cardiac arrest during HUTT.
Since October 2010 we performed 356 HUTT on children with dysautonomia (age 6–21 years). The studies were performed with continuous monitor of heart rate, BP, stroke volume and sympathetic/parasympathetic activity. We monitor brain perfusion by near infra red regional saturation (NIRS). Study consists of 10 minutes supine, 30 minutes HUTT and 10 minutes of reposition to supine. A positive test was defined by presence of severe symptoms during HUTT. We reviewed the patients who developed cardiac arrest or pause exceeding 3 seconds during HUTT
252 of the 356 patients (71%) were positive. Of those subjects 17 developed cardiac arrest or pause more than 3 seconds (range 3.1 to 34 seconds mean 12.3 seconds). 5 patients showed complete heart block without escape while the remainders had sinus and ventricular arrest. Only one patient required short CPR (5seconds). 8 patients developed convulsions during the arrest and all of them showed a severe sharp drop in their head NIRS. 12 patients showed sharp increase in parasympathetic activity just prior to the arrest (Fig)
Although many investigators consider syncope with dysautonomia as benign, we observed in a significant numbers of patients severe brain anoxia with cardiac standstill leading to more severe symptoms and need for aggressive medical therapy with possible cardiac pacing.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: SCD in Children and Adults
Abstract Category: 6. Arrhythmias: Other
Presentation Number: 1280-58
- 2013 American College of Cardiology Foundation