Fludrocortisone in Pediatric Vasovagal Syncope: A Retrospective, Single-Center Observational Study.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the effect of fludrocortisone in patients with pediatric vasovagal syncope (VVS).

METHODS: This retrospective observational single-tertiary-center study based on chart reviews included 74 patients who were newly diagnosed with VVS in the head-up tilt-table test (HUTT). Some of the patients had been treated with fludrocortisone. All patients were assessed using a brain and cardiac workup before treatment to rule out the syncope being due to other causes, which resulted in seven of them being excluded: two for epilepsy and five for brain pathologies. The remaining 67 patients were analyzed. The effect of fludrocortisone was evaluated based on the results of a follow-up HUTT, with a response to the treatment considered to be present if there was a negative change at the follow-up HUTT. Univariate logistic regression were used for statistical analyses, with the criterion for significance being p <0.05.

RESULTS: There were no significant differences in the characteristic of the patients between the no-medication ( n =39) and fludrocortisone ( n =28) groups, including age, sex, and duration of treatment. The recurrence rate of syncopal or presyncopal events was significantly lower in the fludrocortisone group (39.3%, 11 of 28) than in the no-medication group (64.1%, 25 of 39) ( p =0.044), as was the rate of negative change at the follow-up HUTT: 57.1% (16 of 28) and 28.2% (11 of 39), respectively ( p =0.017).

CONCLUSIONS: Our findings suggest that fludrocortisone is more effective than no medication in pediatric patients with VVS.