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The efficacy of the use of atropine in children with reflex anoxic syncope during pallid breath-holding spells: can cardiac pacemaker implantation be avoided?

Published online by Cambridge University Press:  10 May 2024

Marieke Donné Open the ORCID record for Marieke Donné [Opens in a new window] ,
Kristof Vandekerckhove Open the ORCID record for Kristof Vandekerckhove [Opens in a new window]  and
Hans De Wilde Open the ORCID record for Hans De Wilde [Opens in a new window]
Marieke Donné*
Affiliation:
Department of Pediatric Cardiology, University Hospital of Ghent, Gent, Belgium
Kristof Vandekerckhove
Affiliation:
Department of Pediatric Cardiology, University Hospital of Ghent, Gent, Belgium
Hans De Wilde
Affiliation:
Department of Pediatric Cardiology, University Hospital of Ghent, Gent, Belgium
*
Corresponding author: M. Donné; Email: donne.marieke@gmail.com
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Abstract

Objectives:

Reflex anoxic syncope is the result of an overreaction of the vagal system, resulting in hypotension and bradycardia or brief cardiac arrest. Because of the benign character and the absence of complications in short or long term, treatment is only necessary in case of frequent or severe clinical presentation. Treatment options are anticholinergic drugs or cardiac pacemaker placement. We investigated atropine treatment and aimed to examine if pacemaker placement can be avoided.

Methods:

We retrospectively reviewed patients treated with atropine for severe reflex anoxic syncope in our centre from January 2017 until May 2023, and compared our results to those in the literature.

Results:

The study population consisted of 10 children, 70% female, with an age ranging from 5 months to 3 years (mean 14.5 months) when atropine treatment was started (dose 17–50 microg/kg/day). All patient’s parents reported adequate symptom management during atropine treatment, with complete resolution in 10%. Minor side effects were reported in 60% (dry mucosa in 40%, obstipation in 20%, and nausea or blurry vision in 10%).

Discussion:

We consider atropine a safe and effective treatment to manage reflex anoxic syncope with similar success rate to pacemaker implantation. However, pacemaker implantation entails substantial risk for complications (up to 25%) such as infection or technical problems and morbidity such as scar formation. This might be considered redundant for a benign and temporary condition, certainly given the possibility of other efficient treatment options. Consequently, we recommend atropine treatment over implantation of a cardiac pacemaker in children with severe reflex anoxic syncope.

Keywords

reflex anoxic syncopearrhythmiaatropinepacemaker
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 6
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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