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Analysis of 2017 Holter records in pediatric patients
C Ayabakan1, S Ozer, A Celiker
1Cardiology Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Insights
Holter monitoring (HM) is valuable for diagnosing pediatric arrhythmias, especially in asymptomatic children and those with abnormal hearts. This method aids in evaluating heart rhythm and variability for silent arrhythmia detection.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Diagnostic Monitoring
Background:
- Holter monitoring (HM) is established for adult arrhythmias but understudied in pediatrics.
- Limited data exists on the diagnostic utility of HM in pediatric patients with suspected or known cardiac conditions.
Purpose of the Study:
- To evaluate the diagnostic and therapeutic value of Holter monitoring in pediatric patients.
- To identify the prevalence and types of arrhythmias detected by HM in children.
Main Methods:
- Retrospective analysis of 2,017 Holter monitoring records from 1,500 pediatric patients (0-24 years).
- Indications included symptom screening (palpitations, chest pain, syncope), therapy monitoring, and postoperative/pacemaker checks.
- Correlation of findings with presenting symptoms and cardiac history (e.g., previous cardiac operations).
Main Results:
- Palpitations were the most common symptom, associated with supraventricular extrasystole (SVE), supraventricular tachycardia (SVT), ventricular extrasystole (VE), and complete heart block (CHB).
- Only 5.3% of patients experienced symptoms during monitoring; asymptomatic patients showed higher arrhythmia prevalence.
- SVT, VE, and CHB were more frequent in children with abnormal hearts or prior cardiac surgery.
Conclusions:
- Holter monitoring has a low diagnostic yield for symptomatic pediatric arrhythmias but is crucial for detecting silent arrhythmias.
- HM provides essential cumulative evaluation of heart rhythm and variability, particularly in high-risk pediatric groups.
- The study highlights HM's importance in managing arrhythmias in children, especially those with complex cardiac histories.
Abstract:
Holter monitoring (HM) is widely used in arrhythmic disorders of adult patients; however, studies in the pediatric age group are limited. This study aims to determine the value of HM in diagnosis and treatment of disorders related to arrhythmias in pediatric patients. We examined 2,017 Holter records of 1,500 children who applied to our institution between November 1994 and October 1998. The age ranged from 0-24 years (52% male, 48% female). The indications for HM were screening for arrhythmic symptoms (palpitation, chest pain, syncope) in 67 percent, monitoring dysrhythmic therapy in 17 percent, postoperative control in five percent, and pacemaker control in four percent. Palpitation is the leading presenting symptom, with more frequent findings of supraventricular extrasystole (SVE), supraventricular tachycardia (SVT), ventricular extrasystole (VE) and complete heart block (CHB) when compared to other symptoms. Only 5.3 percent of the patients had arrhythmic symptoms during monitoring and asymptomatic patients had more frequent arrhythmias. SVT, VE, and CHB are more frequent findings in the abnormal heart with previous cardiac operations. The diagnostic yield is low with arrhythmic symptoms in the pediatric age group; however, HM enables cumulative evaluation of heart rhythm and rhythm variability, which is important in diagnosing silent arrhythmias in high risk groups (abnormal heart, postoperative heart).