| Value of demographic factors in early identification of pediatric malignant vasovagal syncope in head-up tilt test |
Shuo Wang1 
, Yuwen Wang1
, Hong Cai1
, Ping Liu1
, Fang Li1
, Chuan Wen2
, Liqun Liu3
, Runmei Zou1
, Cheng Wang1
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1Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
2Department of Pediatric Hematological Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
3Department of Pediatric Neurology, Children’s Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China |
Correspondence:
Cheng Wang, Email: wangcheng2nd@csu.edu.cn
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Received: 8 October 2025 • Revised: 27 November 2025 • Accepted: 24 December 2025 |
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| Abstract |
Background
Malignant vasovagal syncope (VVS) is characterized by cardiac arrest lasting more than 3 seconds during a syncope episode or head-up tilt test (HUTT). We aim to conduct a risk assessment for potential malignant VVS before the HUTT by using economic, simple and convenient demographic data, in order to prevent adverse outcomes for pediatric VVS.
Purpose
To explore the correlation between demographic factors and pediatric malignant VVS, and verify the value of these factors in early risk assessment for malignant VVS before HUTT, so as to optimize test safety and reduce adverse events.
Methods
We conducted a retrospective analysis of the clinical data of 3,734 children who were initially diagnosed with VVS due to unexplained syncope and presyncope. Finally, 122 children who met the diagnostic criteria for malignant VVS were included in the malignant VVS group, and 661 children who did not meet the criteria during the same period were matched as the control group. By analyzing demographic data and other factors, we attempted to clarify the association between these factors and malignant VVS.
Results
Linear relationship: age and body mass index (BMI) have independent protective effects on malignant VVS. For every 1-year increase in age and every 1 kg/m2 increase in BMI, the risk of malignant VVS decreases by 12% and 9%, respectively. Nonlinear relationship: When the age is <12.9 years old, for every additional year of age, the risk of malignant VVS decreases by 20%. For ages 12.9 years and above, the efficacy is not significant. There is no significant nonlinear relationship between BMI and malignant VVS.
Conclusion
Age and BMI are independent protective factors for pediatric malignant VVS. Before the age of 12.9 years, the incidence of malignant VVS gradually decreases with the increase in age, and thereafter there is no significant impact. |
| Key Words:
Vasovagal syncope, Malignant, Head-up tilt test, Demographic factor, Child |
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