Evaluation of Heart Rate Variability in Children Presenting with Syncope

Bekir Yukcu; Betül Diler Durgut; Emine Tekin; Fidel Ceren Yavuzyilmaz

doi:10.53446/actamednicomedia.1626897

Clinical Research

Evaluation of Heart Rate Variability in Children Presenting with Syncope

Year 2025, Volume: 8 Issue: 2, 217 - 228, 30.06.2025

Bekir Yukcu , Betül Diler Durgut , Emine Tekin , Fidel Ceren Yavuzyilmaz

https://doi.org/10.53446/actamednicomedia.1626897

Abstract

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.

Keywords

heart rate variability, vasovagal syncope, pediatrics, 24-hour Holter monitoring, autonomic dysfunction

Ethical Statement

Ethical approval for this study was obtained from the Clinical Research Ethics Committee of *** University on April 4, 2023 (Decision No: 2). Written informed consent was obtained from all participants' parents before the study.

Thanks

We would like to express our heartfelt gratitude to Mustafa Altun for his invaluable support in data collection for this study.

References

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
2. Johnsrude CL. Current approach to pediatric syncope. Pediatr Cardiol. 2000;21(6):522-531. doi:10.1007/s002460010130
3. Wieling W, Ganzeboom KS, Saul JP. Reflex syncope in children and adolescents. Heart. 2004;90(9):1094-1100. doi:10.1136/hrt.2003.022996
4. Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2017;136(5):e60-e122. doi:10.1161/cir.0000000000000499
5. Longin E, Reinhard J, von Buch C, Gerstner T, Lenz T, König S. Autonomic function in children and adolescents with neurocardiogenic syncope. Pediatr Cardiol. 2008;29(4):763-770. doi:10.1007/s00246-008-9198-z
6. Ng J, Sheldon RS, Ritchie D, Raj V, Raj SR. Reduced quality of life and greater psychological distress in vasovagal syncope patients compared to healthy individuals. Pacing Clin Electrophysiol. 2019;42(2):180-188. doi:10.1111/pace.13559
7. Zhang Q, Sun Y, Zhang C, Qi J, Du J. Vitamin D Deficiency and Vasovagal Syncope in Children and Adolescents. Front Pediatr. 2021;9:575923. doi:10.3389/fped.2021.575923
8. McCraty R, Shaffer F. Heart rate variability: new perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk. Global advances in health and medicine. 2015;4(1):46-61. doi.org/10.7453/gahmj.2014.07
9. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258. doi:10.3389/fpubh.2017.00258
10. Paul HA. Biofeedback: A Practitioner’s Guide. In: Schwartz M, Andrasik F, ed. Child & Family Behavior Therapy. 4th Edition. New York, NY: The Guilford Press; 2016:161-170.
11. Dash RR, Samanta P, Das S, et al. Heart Rate Variability in Unexplained Syncope Patients Versus Healthy Controls: A Comparative Study. Cureus. 2023;15(7):e41370. doi:10.7759/cureus.41370
12. Ernst G. Hidden Signals-The History and Methods of Heart Rate Variability. Front Public Health. 2017;5:265. doi:10.3389/fpubh.2017.00265
13. Bersani I, Piersigilli F, Gazzolo D, et al. Heart rate variability as possible marker of brain damage in neonates with hypoxic ischemic encephalopathy: a systematic review. Eur J Pediatr. 2021;180(5):1335-1345. doi:10.1007/s00431-020-03882-3
14. Kero P. Heart rate variation in infants with the respiratory distress syndrome. Acta Paediatr Scand Suppl. 1974;(250):1-70.
15. Prietsch V, Maier RF, Schmitz L, Obladen M. Long-term variability of heart rate increases with successful closure of patent ductus arteriosus in preterm infants. Neonatology. 1992;61(3):142-149.
16. Griffin MP, Moorman JR. Toward the early diagnosis of neonatal sepsis and sepsis-like illness using novel heart rate analysis. Pediatrics. 2001;107(1):97-104. doi:10.1542/peds.107.1.97
17. Stone ML, Tatum PM, Weitkamp JH, et al. Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis. J Perinatol. 2013;33(11):847-850. doi:10.1038/jp.2013.63
18. Biswas AK, Scott WA, Sommerauer JF, Luckett PM. Heart rate variability after acute traumatic brain injury in children. Crit Care Med. 2000;28(12):3907-3912. doi:10.1097/00003246-200012000-00030
19. Ucak S, Dissanayake HU, Sutherland K, de Chazal P, Cistulli PA. Heart rate variability and obstructive sleep apnea: Current perspectives and novel technologies. J Sleep Res. 2021;30(4):e13274.
20. Cheng YC, Su MI, Liu CW, Huang YC, Huang WL. Heart rate variability in patients with anxiety disorders: A systematic review and meta‐analysis. PCN. 2022;76(7):292-302.
21. Correia AT, Lipinska G, Rauch HL, Forshaw PE, Roden LC, Rae DE. Associations between sleep-related heart rate variability and both sleep and symptoms of depression and anxiety: A systematic review. Sleep Med. 2023;101:106-117. doi:10.1016/j.sleep.2022.10.018
22. Stein PK, Domitrovich PP, Hui N, Rautaharju P, Gottdiener J. Sometimes higher heart rate variability is not better heart rate variability: results of graphical and nonlinear analyses. J Cardiovascular Electrophysiol. 2005;16(9):954-959. doi:10.1111/j.1540-8167.2005.40788.x
23. Gąsior JS, Sacha J, Pawłowski M, et al. Normative Values for Heart Rate Variability Parameters in School-Aged Children: Simple Approach Considering Differences in Average Heart Rate. Front Physiol. 2018;9:1495. doi:10.3389/fphys.2018.01495
24. Bobkowski W, Stefaniak ME, Krauze T, et al. Measures of heart rate variability in 24-h ECGs depend on age but not gender of healthy children. Front Physiol. 2017;8:311. doi:10.3389/fphys.2017.00311
25. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Review. Front Public Health. 2017;5:258. doi:10.3389/fpubh.2017.00258
26. Kovalchuk T, Boyarchuk O, Pavlyshyn H, Balatska N, Luchyshyn N. Analysis of heart rate variability in paediatric patients with vasovagal syncope. Pediatria Polska-Polish J Paediat. 2019;94(6):357-367. doi.org/10.5114/polp.2019.92965
27. Sanatani S, Chau V, Fournier A, Dixon A, Blondin R, Sheldon RS. Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient. Canadian J Cardiol. 2017;33(2):189-198. doi:10.1016/j.cjca.2016.09.006
28. Yang J, Zhu L, Chen S, et al. Modified Calgary score in differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in children. Cardiol Young. 2013;23(3):400-404. doi:10.1017/s1047951112001266
29. ELECTROPHYSIOLOGY, Task Force of the European Society of Cardiology the North American Society of Pacing. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation. 1996, 93.5: 1043-1065. doi:10.1161/01.CIR.93.5.1043
30. Boysen A, Lewin MA, Uhlemann F. Common patterns of response to the head-up tilt test in children and adolescents. Cardiol Young. 2006;16(6):537-539. doi:10.1017/s1047951106000886
31. Batra AS, Balaji S. Usefulness of tilt testing in children with syncope: a survey of pediatric electrophysiologists. Indian Pacing Electrophysiol J. 2008;8(4):242-246.
32. Sutton R. Reflex syncope: Diagnosis and treatment. J Arrhythm. 2017;33(6):545-552. doi:10.1016/j.joa.2017.03.007
33. Ernst G. Heart-Rate Variability-More than Heart Beats? Front Public Health. 2017;5:240. doi:10.3389/fpubh.2017.00240
34. Kleiger RE, Miller JP, Bigger JT, Jr., Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59(4):256-262. doi:10.1016/0002-9149(87)90795-8
35. Bakari S, Koca B, Öztunç F, Abuhandan M. Heart rate variability in patients with atrial septal defect and healthy children. J Cardiol. 2013;61(6):436-439. doi:10.1016/j.jjcc.2013.01.014
36. Birch SL, Duncan MJ, Franklin C. Overweight and reduced heart rate variability in British children: an exploratory study. Preventive Medicine. 2012;55(5):430-432. doi:10.1016/j.ypmed.2012.09.015
37. Lazzeri C, La Villa G, Barletta G, Franchi F. 24-hour heart rate variability in patients with vasovagal syncope. Pacing Clin Electrophysiol. 2000;23(4):463-468. doi:10.1111/j.1540-8159.2000.tb00828.x
38. Benditt DG, van Dijk JG, Sutton R, et al. Syncope. Curr Probl Cardiol. 2004;29(4):152-229. doi:10.1016/j.cpcardiol.2003.12.002
39. Kenny RA, Bhangu J, King-Kallimanis BL. Epidemiology of syncope/collapse in younger and older Western patient populations. Prog Cardiovasc Dis. 2013;55(4):357-363. doi:10.1016/j.pcad.2012.11.006
40. Hosaka H, Takase B, Katsushika S, Ohsuzu F, Kurita A. Altered fractal behavior and heart rate variability in daily life in neurally mediated syncope. Biomed Pharmacother. 2003;57:77-82. doi:10.1016/j.biopha.2003.08.009
41. Kochiadakis GE, Kanoupakis EM, Rombola AT, Igoumenidis NE, Chlouverakis GI, Vardas PE. Reproducibility of tilt table testing in patients with vasovagal syncope and its relation to variations in autonomic nervous system activity. Pacing Clin Electrophysiol. 1998;21(5):1069-1076. doi:10.1111/j.1540-8159.1998.tb00152.x

Senkopla Başvuran Çocuklarda Kalp Hızı Değişkenliğinin Değerlendirilmesi

Year 2025, Volume: 8 Issue: 2, 217 - 228, 30.06.2025

Bekir Yukcu , Betül Diler Durgut , Emine Tekin , Fidel Ceren Yavuzyilmaz

https://doi.org/10.53446/actamednicomedia.1626897

Abstract

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.

Keywords

kalp hızı değişkenliği, vazovagal senkop, pediatri, 24 saat Holter monitörizasyonu, otonom disfonksiyon

References

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
2. Johnsrude CL. Current approach to pediatric syncope. Pediatr Cardiol. 2000;21(6):522-531. doi:10.1007/s002460010130
3. Wieling W, Ganzeboom KS, Saul JP. Reflex syncope in children and adolescents. Heart. 2004;90(9):1094-1100. doi:10.1136/hrt.2003.022996
4. Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2017;136(5):e60-e122. doi:10.1161/cir.0000000000000499
5. Longin E, Reinhard J, von Buch C, Gerstner T, Lenz T, König S. Autonomic function in children and adolescents with neurocardiogenic syncope. Pediatr Cardiol. 2008;29(4):763-770. doi:10.1007/s00246-008-9198-z
6. Ng J, Sheldon RS, Ritchie D, Raj V, Raj SR. Reduced quality of life and greater psychological distress in vasovagal syncope patients compared to healthy individuals. Pacing Clin Electrophysiol. 2019;42(2):180-188. doi:10.1111/pace.13559
7. Zhang Q, Sun Y, Zhang C, Qi J, Du J. Vitamin D Deficiency and Vasovagal Syncope in Children and Adolescents. Front Pediatr. 2021;9:575923. doi:10.3389/fped.2021.575923
8. McCraty R, Shaffer F. Heart rate variability: new perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk. Global advances in health and medicine. 2015;4(1):46-61. doi.org/10.7453/gahmj.2014.07
9. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258. doi:10.3389/fpubh.2017.00258
10. Paul HA. Biofeedback: A Practitioner’s Guide. In: Schwartz M, Andrasik F, ed. Child & Family Behavior Therapy. 4th Edition. New York, NY: The Guilford Press; 2016:161-170.
11. Dash RR, Samanta P, Das S, et al. Heart Rate Variability in Unexplained Syncope Patients Versus Healthy Controls: A Comparative Study. Cureus. 2023;15(7):e41370. doi:10.7759/cureus.41370
12. Ernst G. Hidden Signals-The History and Methods of Heart Rate Variability. Front Public Health. 2017;5:265. doi:10.3389/fpubh.2017.00265
13. Bersani I, Piersigilli F, Gazzolo D, et al. Heart rate variability as possible marker of brain damage in neonates with hypoxic ischemic encephalopathy: a systematic review. Eur J Pediatr. 2021;180(5):1335-1345. doi:10.1007/s00431-020-03882-3
14. Kero P. Heart rate variation in infants with the respiratory distress syndrome. Acta Paediatr Scand Suppl. 1974;(250):1-70.
15. Prietsch V, Maier RF, Schmitz L, Obladen M. Long-term variability of heart rate increases with successful closure of patent ductus arteriosus in preterm infants. Neonatology. 1992;61(3):142-149.
16. Griffin MP, Moorman JR. Toward the early diagnosis of neonatal sepsis and sepsis-like illness using novel heart rate analysis. Pediatrics. 2001;107(1):97-104. doi:10.1542/peds.107.1.97
17. Stone ML, Tatum PM, Weitkamp JH, et al. Abnormal heart rate characteristics before clinical diagnosis of necrotizing enterocolitis. J Perinatol. 2013;33(11):847-850. doi:10.1038/jp.2013.63
18. Biswas AK, Scott WA, Sommerauer JF, Luckett PM. Heart rate variability after acute traumatic brain injury in children. Crit Care Med. 2000;28(12):3907-3912. doi:10.1097/00003246-200012000-00030
19. Ucak S, Dissanayake HU, Sutherland K, de Chazal P, Cistulli PA. Heart rate variability and obstructive sleep apnea: Current perspectives and novel technologies. J Sleep Res. 2021;30(4):e13274.
20. Cheng YC, Su MI, Liu CW, Huang YC, Huang WL. Heart rate variability in patients with anxiety disorders: A systematic review and meta‐analysis. PCN. 2022;76(7):292-302.
21. Correia AT, Lipinska G, Rauch HL, Forshaw PE, Roden LC, Rae DE. Associations between sleep-related heart rate variability and both sleep and symptoms of depression and anxiety: A systematic review. Sleep Med. 2023;101:106-117. doi:10.1016/j.sleep.2022.10.018
22. Stein PK, Domitrovich PP, Hui N, Rautaharju P, Gottdiener J. Sometimes higher heart rate variability is not better heart rate variability: results of graphical and nonlinear analyses. J Cardiovascular Electrophysiol. 2005;16(9):954-959. doi:10.1111/j.1540-8167.2005.40788.x
23. Gąsior JS, Sacha J, Pawłowski M, et al. Normative Values for Heart Rate Variability Parameters in School-Aged Children: Simple Approach Considering Differences in Average Heart Rate. Front Physiol. 2018;9:1495. doi:10.3389/fphys.2018.01495
24. Bobkowski W, Stefaniak ME, Krauze T, et al. Measures of heart rate variability in 24-h ECGs depend on age but not gender of healthy children. Front Physiol. 2017;8:311. doi:10.3389/fphys.2017.00311
25. Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Review. Front Public Health. 2017;5:258. doi:10.3389/fpubh.2017.00258
26. Kovalchuk T, Boyarchuk O, Pavlyshyn H, Balatska N, Luchyshyn N. Analysis of heart rate variability in paediatric patients with vasovagal syncope. Pediatria Polska-Polish J Paediat. 2019;94(6):357-367. doi.org/10.5114/polp.2019.92965
27. Sanatani S, Chau V, Fournier A, Dixon A, Blondin R, Sheldon RS. Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient. Canadian J Cardiol. 2017;33(2):189-198. doi:10.1016/j.cjca.2016.09.006
28. Yang J, Zhu L, Chen S, et al. Modified Calgary score in differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in children. Cardiol Young. 2013;23(3):400-404. doi:10.1017/s1047951112001266
29. ELECTROPHYSIOLOGY, Task Force of the European Society of Cardiology the North American Society of Pacing. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation. 1996, 93.5: 1043-1065. doi:10.1161/01.CIR.93.5.1043
30. Boysen A, Lewin MA, Uhlemann F. Common patterns of response to the head-up tilt test in children and adolescents. Cardiol Young. 2006;16(6):537-539. doi:10.1017/s1047951106000886
31. Batra AS, Balaji S. Usefulness of tilt testing in children with syncope: a survey of pediatric electrophysiologists. Indian Pacing Electrophysiol J. 2008;8(4):242-246.
32. Sutton R. Reflex syncope: Diagnosis and treatment. J Arrhythm. 2017;33(6):545-552. doi:10.1016/j.joa.2017.03.007
33. Ernst G. Heart-Rate Variability-More than Heart Beats? Front Public Health. 2017;5:240. doi:10.3389/fpubh.2017.00240
34. Kleiger RE, Miller JP, Bigger JT, Jr., Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59(4):256-262. doi:10.1016/0002-9149(87)90795-8
35. Bakari S, Koca B, Öztunç F, Abuhandan M. Heart rate variability in patients with atrial septal defect and healthy children. J Cardiol. 2013;61(6):436-439. doi:10.1016/j.jjcc.2013.01.014
36. Birch SL, Duncan MJ, Franklin C. Overweight and reduced heart rate variability in British children: an exploratory study. Preventive Medicine. 2012;55(5):430-432. doi:10.1016/j.ypmed.2012.09.015
37. Lazzeri C, La Villa G, Barletta G, Franchi F. 24-hour heart rate variability in patients with vasovagal syncope. Pacing Clin Electrophysiol. 2000;23(4):463-468. doi:10.1111/j.1540-8159.2000.tb00828.x
38. Benditt DG, van Dijk JG, Sutton R, et al. Syncope. Curr Probl Cardiol. 2004;29(4):152-229. doi:10.1016/j.cpcardiol.2003.12.002
39. Kenny RA, Bhangu J, King-Kallimanis BL. Epidemiology of syncope/collapse in younger and older Western patient populations. Prog Cardiovasc Dis. 2013;55(4):357-363. doi:10.1016/j.pcad.2012.11.006
40. Hosaka H, Takase B, Katsushika S, Ohsuzu F, Kurita A. Altered fractal behavior and heart rate variability in daily life in neurally mediated syncope. Biomed Pharmacother. 2003;57:77-82. doi:10.1016/j.biopha.2003.08.009
41. Kochiadakis GE, Kanoupakis EM, Rombola AT, Igoumenidis NE, Chlouverakis GI, Vardas PE. Reproducibility of tilt table testing in patients with vasovagal syncope and its relation to variations in autonomic nervous system activity. Pacing Clin Electrophysiol. 1998;21(5):1069-1076. doi:10.1111/j.1540-8159.1998.tb00152.x

There are 41 citations in total.

Details

Primary Language	English
Subjects	Clinical Sciences (Other)
Journal Section	Research Articles
Authors	Bekir Yukcu 0000-0003-1661-7024 Betül Diler Durgut 0000-0002-0322-2843 Emine Tekin 0000-0002-5115-8890 Fidel Ceren Yavuzyilmaz 0000-0002-9696-1548
Publication Date	June 30, 2025
Submission Date	January 26, 2025
Acceptance Date	March 1, 2025
Published in Issue	Year 2025 Volume: 8 Issue: 2

Cite

AMA	Yukcu B, Diler Durgut B, Tekin E, Yavuzyilmaz FC. Evaluation of Heart Rate Variability in Children Presenting with Syncope. Acta Med Nicomedia. June 2025;8(2):217-228. doi:10.53446/actamednicomedia.1626897

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