Author/Authors :
Brott، نويسنده , , Thomas G. and Halperin، نويسنده , , Jonathan L. and Abbara، نويسنده , , Suhny and Bacharach، نويسنده , , J. Michael and Barr، نويسنده , , John D. and Bush، نويسنده , , Ruth L. and Cates، نويسنده , , Christopher U. and Creager، نويسنده , , Mark A. and Fowler، نويسنده , , Susan B. and Friday، نويسنده , , Gary and Hertzberg، نويسنده , , Vicki S. and McIff، نويسنده , , E. Bruce and Moore، نويسنده , , Wesley S. and Panagos، نويسنده , , Peter D. and Riles، نويسنده , , Thomas S. and Rosenwasser، نويسنده , , Robert H. and Taylor، نويسنده , , Allen J.، نويسنده ,
Abstract :
Objectives
ed to identify risk factors for recurrent syncope in children and adolescents with congenital long QT syndrome (LQTS).
ound
egarding risk assessment in LQTS after the occurrence of the first syncope episode are limited.
s
entice-Williams-Peterson conditional gap time model was used to identify risk factors for recurrent syncope from birth through age 20 years among 1,648 patients from the International Long QT Syndrome Registry.
s
ariate analysis demonstrated that corrected QT interval (QTc) duration (≥500 ms) was a significant predictor of a first syncope episode (hazard ratio: 2.16), whereas QTc effect was attenuated when the end points of the second, third, and fourth syncope episodes were evaluated (hazard ratios: 1.29, 0.99, 0.90, respectively; p < 0.001 for the null hypothesis that all 4 hazard ratios are identical). A genotype-specific subanalysis showed that during childhood (0 to 12 years), males with LQTS type 1 had the highest rate of a first syncope episode (p = 0.001) but exhibited similar rates of subsequent events as other genotype-sex subsets (p = 0.63). In contrast, in the age range of 13 to 20 years, long QT syndrome type 2 females experienced the highest rate of both first and subsequent syncope events (p < 0.001 and p = 0.01, respectively). Patients who experienced ≥1 episodes of syncope had a 6- to 12-fold (p < 0.001 for all) increase in the risk of subsequent fatal/near-fatal events independently of QTc duration. Beta-blocker therapy was associated with a significant reduction in the risk of recurrent syncope and subsequent fatal/near-fatal events.
sions
en and adolescents who present after an episode of syncope should be considered to be at a high risk of the development of subsequent syncope episodes and fatal/near-fatal events regardless of QTc duration.
Keywords :
Carotid stenosis , Carotid endarterectomy , Carotid stenting , extracranial carotid artery , Revascularization , Stroke , ACCF/AHA Practice Guidelines , vertebral artery disease
