Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal Syncope
<b>Background:</b> This study aimed to identify the risk factors associated with malignant vasovagal syncope (VVS), a rare yet clinically significant subtype of VVS. <b>Methods:</b> This single-center case–control study enrolled children diagnosed with malignant VVS, and the...
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2025-05-01
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| author | Wenrui Xu Chunyu Zhang Junbao Du Hongfang Jin Ying Liao |
| author_facet | Wenrui Xu Chunyu Zhang Junbao Du Hongfang Jin Ying Liao |
| author_sort | Wenrui Xu |
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| description | <b>Background:</b> This study aimed to identify the risk factors associated with malignant vasovagal syncope (VVS), a rare yet clinically significant subtype of VVS. <b>Methods:</b> This single-center case–control study enrolled children diagnosed with malignant VVS, and the malignant VVS patients were matched in a 1:4 ratio with non-asystolic VVS children as a control group through age and sex stratification. Clinical characteristics and heart rate variability (HRV) parameters were analyzed. Binary logistic regression analyses were used to identify the risk factors significantly associated with malignant VVS. <b>Results:</b> A total of 10 patients in the malignant group and 40 children in the control group were included. The malignant group exhibited earlier symptom onset (7.0 ± 2.7 vs. 9.7 ± 2.7 years, <i>p</i> < 0.05) than the control group, and children in the malignant group had a higher prevalence of central triggers (60.0% vs. 17.5%, <i>p</i> < 0.05) and convulsive/incontinence episodes (80.0% vs. 17.5%, <i>p</i> < 0.05) than the control group. Additionally, the malignant group demonstrated significantly elevated HRV parameters, including very low frequency (VLF), low frequency (LF), and high frequency (HF), indicating substantial autonomic dysregulation characterized by parasympathetic predominance. Central triggers (OR = 7.16, 95%CI 1.10–46.73) and convulsive/incontinence manifestations (OR = 19.02, 95%CI 2.81–128.64) were independent risk factors of malignant VVS. <b>Conclusions:</b> The age at syncope onset was significantly earlier in children with malignant VVS, and children with malignant VVS exhibited profound autonomic dysregulation characterized by significant parasympathetic predominance. Finally, children with episodes induced by central triggers and accompanied by incontinence or convulsions were at a higher risk of asystole. |
| format | Article |
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| issn | 2227-9067 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Children |
| spelling | doaj-art-a342ff8f1fbb4e2f95c66e8d3563b81a2025-08-20T03:14:46ZengMDPI AGChildren2227-90672025-05-0112563610.3390/children12050636Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal SyncopeWenrui Xu0Chunyu Zhang1Junbao Du2Hongfang Jin3Ying Liao4Department of Pediatrics, Peking University First Hospital, Beijing 100034, ChinaDepartment of Pediatrics, Peking University First Hospital, Beijing 100034, ChinaDepartment of Pediatrics, Peking University First Hospital, Beijing 100034, ChinaDepartment of Pediatrics, Peking University First Hospital, Beijing 100034, ChinaDepartment of Pediatrics, Peking University First Hospital, Beijing 100034, China<b>Background:</b> This study aimed to identify the risk factors associated with malignant vasovagal syncope (VVS), a rare yet clinically significant subtype of VVS. <b>Methods:</b> This single-center case–control study enrolled children diagnosed with malignant VVS, and the malignant VVS patients were matched in a 1:4 ratio with non-asystolic VVS children as a control group through age and sex stratification. Clinical characteristics and heart rate variability (HRV) parameters were analyzed. Binary logistic regression analyses were used to identify the risk factors significantly associated with malignant VVS. <b>Results:</b> A total of 10 patients in the malignant group and 40 children in the control group were included. The malignant group exhibited earlier symptom onset (7.0 ± 2.7 vs. 9.7 ± 2.7 years, <i>p</i> < 0.05) than the control group, and children in the malignant group had a higher prevalence of central triggers (60.0% vs. 17.5%, <i>p</i> < 0.05) and convulsive/incontinence episodes (80.0% vs. 17.5%, <i>p</i> < 0.05) than the control group. Additionally, the malignant group demonstrated significantly elevated HRV parameters, including very low frequency (VLF), low frequency (LF), and high frequency (HF), indicating substantial autonomic dysregulation characterized by parasympathetic predominance. Central triggers (OR = 7.16, 95%CI 1.10–46.73) and convulsive/incontinence manifestations (OR = 19.02, 95%CI 2.81–128.64) were independent risk factors of malignant VVS. <b>Conclusions:</b> The age at syncope onset was significantly earlier in children with malignant VVS, and children with malignant VVS exhibited profound autonomic dysregulation characterized by significant parasympathetic predominance. Finally, children with episodes induced by central triggers and accompanied by incontinence or convulsions were at a higher risk of asystole.https://www.mdpi.com/2227-9067/12/5/636childrenheart rate variabilitymalignant vasovagal syncoperisk factor |
| spellingShingle | Wenrui Xu Chunyu Zhang Junbao Du Hongfang Jin Ying Liao Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal Syncope Children children heart rate variability malignant vasovagal syncope risk factor |
| title | Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal Syncope |
| title_full | Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal Syncope |
| title_fullStr | Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal Syncope |
| title_full_unstemmed | Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal Syncope |
| title_short | Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal Syncope |
| title_sort | features of clinical manifestations and heart rate variability in children with malignant vasovagal syncope |
| topic | children heart rate variability malignant vasovagal syncope risk factor |
| url | https://www.mdpi.com/2227-9067/12/5/636 |
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