Clinical features and management of young patients with cardioinhibitory response during orthostatic testing

Neurally mediated syncope is being recognized with increasing frequency in young adults and more recently in children.1–4 Most children undergoing formal orthostatic testing exhibit a vasodepressor or mixed response with a gradual onset of hypotension, often preceded by sinus tachycardia, followed by secondary bradycardia and syncope.1–3 Few of these patients have a dominant cardioinhibitory response exhibiting sudden onset of bradycardia and syncope without prior hypotension or tachycardia.1 Syncopal episodes in this group (unusual in the pediatric experience) may present more risk owing to the rapid onset of syncope, prolonged asystole and seizure activity often exhibited.4 This study reports on the incidence, clinical features, management and outcome of infants and children presenting with dominant Cardioinhibitory syncope.