defibrillator (ICD) is considered in a subgroup of patients felt to be at high risk for sudden death, such as those with symptoms before puberty, very long QT intervals (>500 msec), and those with recurrent syncope The use of an ICD is also required in patients with hypertrophic cardiomyopathy and Brugada syndrome Adult survivors of congenital heart disease should be cared for by health providers knowledgeable in the anatomy, repair, and management of these conditions SUMMARY POINTS Syncope is a common condition in children and is usually benign Common causes for syncope include vasovagal syncope, breath-holding spells, and orthostatic intolerance Life-threatening causes are usually cardiac in etiology A comprehensive medical and family history, a thorough physical examination, and a 12-lead ECG will help identify most patients with life-threatening causes of syncope Routine blood testing and imaging are unnecessary Since recurrence is common, education and reassurance are important Suggested Readings and Key References Goldenberg I, Moss AJ, Peterson DR, et al Risk factors for aborted cardiac arrest and sudden cardiac death in children with the congenital long-QT syndrome Circulation 2008;117:2184–2191 Morrow W, Berger S, Jenkins K, et al Pediatric sudden cardiac arrest Pediatrics 2012;129:e1094–e1102 Roden DM Long-QT syndrome N Eng J Med 2008;358:169–176 Sheldon RS, Grubb BP 2nd, Olshansky B, et al 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope Heart Rhythm 2015;12:e41–e63 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