TY - JOUR T1 - EVALUATION OF HEART RATE VARIABILITY IN CHILDREN PRESENTING WITH SYNCOPE TT - SENKOP İLE BAŞVURAN ÇOCUKLARDA KALP HIZI DEĞİŞKENLİĞİNİN DEĞERLENDİRİLMESİ AU - Yukcu, Bekir AU - Diler Durgut, Betül AU - Tekin, Emine AU - Yavuzyilmaz, Fidel Ceren PY - 2025 DA - October Y2 - 2025 JF - Acta Medica Nicomedia JO - Acta Med Nicomedia PB - Kocaeli Üniversitesi WT - DergiPark SN - 2717-8994 SP - 409 EP - 421 VL - 8 IS - 3 LA - en AB - Objective: This study evaluated the diagnostic value of heart rate variability (HRV) parameters obtained from 24-hour Holter monitoring in pediatric patients with vasovagal syncope (VVS) and compared them to a control group. The study also analyzed time-domain and frequency-domain HRV parameters to explore the autonomic mechanisms underlying VVS and the diagnostic potential of HRV.Methods: This retrospective study was conducted at *** Women’s and Children’s Health Training and Research Hospital. Forty-one children with VVS and 36 healthy controls undergoing 24-hour Holter monitoring for ventricular extrasystoles were included. Comprehensive cardiac, neurological, and demographic evaluations were performed for all participants. HRV parameters were analyzed from 24-hour Holter recordings, and group comparisons were performed using the Mann–Whitney U test. Spearman correlation and Receiver Operating Characteristic analyses were also conducted.Results: Time-domain HRV parameters were significantly lower in the syncope group compared to those in the control group (p < 0.05). No significant differences were observed in frequency-domain parameters. The standard deviation of normal-to-normal RR intervals (SDNN) demonstrated the highest diagnostic accuracy, with a cut-off value of <163 ms (Area Under the Curve: 0.753, sensitivity: 72.2%, specificity: 75.6%).Conclusion: HRV parameters obtained from 24-hour Holter monitoring provide valuable insights into autonomic dysfunction in pediatric VVS. SDNN emerged as a strong diagnostic marker in this regard. Further studies with larger, more homogeneous populations are needed to establish normative HRV values and refine diagnostic criteria in pediatric populations. KW - heart rate variability KW - vasovagal syncope KW - pediatrics KW - 24-hour Holter monitoring KW - autonomic dysfunction N2 - Amaç: Bu çalışmada, pediatrik vazovagal senkop (VVS) hastalarında 24 saatlik Holter monitörizasyonu ile elde edilen kalp hızı değişkenliği (HRV) parametrelerinin tanısal değerinin değerlendirilmesi ve kontrol grubu ile karşılaştırılması amaçlanmıştır. Zaman alanı ve frekans alanı HRV parametreleri incelenerek VVS’nin altta yatan otonom mekanizmaları ve HRV’nin tanısal potansiyeli araştırılmıştır.Yöntemler: Retrospektif tasarlanan bu çalışma, *** Kadın Doğum ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi’nde gerçekleştirildi. Çalışmaya, senkop şikayeti ile başvuran 41 çocuk hasta ve Ventriküler ekstrasistol nedeniyle 24 saatlik Holter elektrokardiyografi (EKG) monitorizasyonu yapılan 36 sağlıklı kontrol dahil edildi. Tüm hastalar kapsamlı kardiyak, nörolojik ve demografik değerlendirmelere tabi tutuldu. HRV parametreleri 24 saatlik Holter EKG kayıtlarından analiz edildi ve gruplar arası farklar Mann-Whitney U testi ile değerlendirildi. Ayrıca, Spearman korelasyon ve Alıcı Çalışma Karakteristiği (ROC) analizi yapıldı.Bulgular: Zaman alanı HRV parametreleri, senkop grubunda kontrol grubuna göre anlamlı olarak düşük bulundu (p<0,05). Frekans alanı parametreleri açısından gruplar arasında anlamlı fark tespit edilmedi. Ardışık normal sinüs kalp atımları arasındaki sürenin standart sapmasının (SDNN) 163 ms altındaki değerler, vasovagal senkopu öngörmede en yüksek tanısal doğruluğu gösterdi (Eğrinin Altındaki Alan (AUC): 0,753, duyarlılık: %72,2, özgüllük: %75,6).Sonuç: Yirmidört saatlik Holter monitörizasyonu ile elde edilen HRV parametreleri, pediatrik VVS hastalarında otonom disfonksiyonu değerlendirmede etkili bilgiler sağlayabilir. SDNN, güçlü bir tanısal belirteç olarak öne çıkmaktadır. Normatif HRV değerlerinin oluşturulması için daha geniş ve homojen popülasyonlarla yapılacak çalışmalara ihtiyaç vardır. CR - 1. Shim SH, Park S-Y, Moon SN, et al. Baseline heart rate variability in children and adolescents with vasovagal syncope. Korean J Pediatr. 2014;57(4):193. doi:10.3345/kjp.2014.57.4.193 CR - 2. Johnsrude CL. Current approach to pediatric syncope. Pediatr Cardiol. 2000;21(6):522-531. doi:10.1007/s002460010130 CR - 3. Wieling W, Ganzeboom KS, Saul JP. 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