Evaluation and treatment of pediatric patients with neurocardiogenic syncope

Neurocardiogenic syncope is the most common form of syncope in children. The most widely accepted mechanism of its etiology is a vigorous contraction of the heart due to relative hypovolemia leading to stimulation of C-fibers and sympathetic withdrawal. Episodes usually occur with an upright position and are preceded by a typical prodrome. A classic history is paramount to the diagnosis. Tilt testing aids in the diagnosis in certain cases. The cornerstone of therapy is maintaining adequate hydration and avoiding situations that may lead to harm with syncopal events. Beta blockers, fludrocortisone, alpha adrenergic agents and disopyramide are commonly used to prevent syncope. Seratonin reuptake inhibitors, pacing with rate drop algorithms and tilt training are relatively new in the armamentarium of therapy.