Guidelines for the diagnosis and treatment of neurally mediated syncope in children and adolescents (revised 2024)
Authors: Wang Cheng , Liao Ying , Wang Shuo , Tian Hong , Huang Min , Dong Xiang-Yu , Shi Lin , Li Ya-Qi , Sun Jing-Hui , Du Jun-Bao , Jin Hong-Fang ,   Chinese Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association; Committee of Pediatric Syncope, College of Pediatricians, Chinese Medical Doctor Association; Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association; Committee of Pediatric Cardiology, College of Cardiovascular Physicians, Chinese Medical Doctor Association, An Jin-Dou , An Xin-Jiang , Chen Jie , Chen Li-Qing , Chen Ming-Wu , Chen Shu-Qin , Chen Qi , Chen Yong-Hong , Chen Sun , Chen Zhi , Chau Adolphus Kai-tung , Chu Mao-Ping , Cui Hui-Ying , Dong Xiang-Yu , Du Jun-Bao , Du Shu-Xu , Du Zhong-Dong , Duan Hong-Yu , Duan Jun-Kai , Feng Lin , Fu Li-Jun , Gao Fang , Gao Lu , Gao Wei , Gong Fang-Qi , Gu Li , Gu Hong , Gui Yong-Hao , Han Zhen-Hui , Han Bo , Han Ling , He Bing , He Xue-Hua , He Zhi-Xu , Hu Xiu-Fen , Hu Yao-Fei , Hua Yi-Min , Huang Guo-Ying , Huang Hui-Tao , Huang Min , Huang Ping , Huang Xing-Yuan , Huang Yu-Juan , Jiang Shou-Yuan , Jin Hong-Fang , Jin Mei , Lei Yan-Zhe , Li Bo , Li Fen , Li Li , Li Tao , Li Xiao-Ming , Li Xiao-Hui , Li Yan , Li Yun , Li Zi-Pu , Liang Yong-Mei , Liao Ying , Liu Fang , Liu Wei , Liu Xiao-Yan , Liu Ya-Li , Lu Hui-Ling , Lv Hai-Tao , Lv Tie-Wei , Ma Lu-Yi , Pan Bao-Quan , Pan Xiang-Bin , Pan Si-Lin , Pang Yu-Sheng , Peng Hua , Piao Jin-Hua , Qian Ming-Yang , Qian Wei , Qin Yu-Ming , Shen Jie , Shi Lin , Song Guo-Dong , Sun Jing-Hui , Tian Hong , Tian Jie , Wang Cheng , Wang Cui-Ling , Wang Hong , Wang Lei , Wang Li-Hong , Wang Lin , Wang Qin , Wang Shu-Shui , Wang Wen-Di , Wang Xiao-Ning , Wang Yi-Biao , Wu Jian-Xin , Wu Rong-Zhou , Wu Yu-Rong , Xia Kun , Xiao Ting-Ting , Xiao Yan-Yan , Xie Li-Jian , Xie Yu-Mei , Xie Chun-Hong , Xing Yan-Lin , Xiong Zhen-Yu , Xu Bao-Yuan , Xu Yi , Yan Hui , Yang Jian-Ping , Yang Shi-Wei , Yi Qi-Jian , Yu Xia , Yu Xian-Yi , Yuan Yue , Zhang Du-Fei , Zhang Hong-Yan , Zhang Hui-Li , Zhang Kun , Zhang Li , Zhang Ming-Ming , Zhang Qing-You , Zhang Xi , Zhang Yan-Min , Zhang Yong , Zhang Zhi-Wei , Zhao Cui-Fen , Zhou Bin , Zhou Kai-Yu , Zhu Hua , Zhu Sheng-Dong , Zhuang Jian-Xin 
Published: August 2024

Abstract
Background
Significant progress has been made in the diagnosis and treatment of pediatric syncope since the publication of the “2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents” (“2018 Edition Guidelines”). Therefore, we have revised and updated it to assist pediatricians in effectively managing children with syncope.

Data sources
According to the “2018 Edition Guidelines”, the expert groups collected clinical evidence, evaluated preliminary recommendations, and then organized open-ended discussions to form the recommendations. This guideline was developed by reviewing the literature and studies in databases including PubMed, Cochrane, EMBASE, China Biomedical Database, and Chinese Journal Full-text Database up to April 2024. Search terms included “syncope”, “children”, “adolescents”, “diagnosis”, and “treatment.”

Results
The guidelines were based on the latest global research progress and were evidence-based. The classification of syncope etiology, diagnostic procedures, postural tests, such as the active standing test, head-up tilt test, and active sitting test, clinical diagnosis, and individualized treatment for neurally mediated syncope in pediatric population were included.

Conclusions
The guidelines were updated based on the latest literature. The concepts of sitting tachycardia syndrome and sitting hypertension were introduced and the comorbidities of neurally mediated syncope were emphasized. Some biomarkers used for individualized treatment were underlined. Specific suggestions were put forward for non-pharmacological therapies as well as the follow-up process. The new guidelines will provide comprehensive guidance and reference for the diagnosis and treatment of neurally mediated syncope in children and adolescents.