USEFULNESS OF 24 HOURS HOLTER MONITORING IN DIAGNOSING PAEDIATRIC ARRHYTHMIAS

Dr.G. Dharmaraj, Dr.G. Ravishankar

Abstract


Pediatric arrhythmias vary in presentation from congestive failure in infants to palpitations and syncope in older children. Our study aims to identify the place and role of continuous electrocardiographic 24 hr ECG monitoring in daily clinical practice of pediatric cardiology.

SUBJECTS AND METHODS:

We enrolled 100 pediatric patients (<12 years age) who were referred during the period of November 2018 to May 2019 to our centre. Among 100, 80 children referred for symptoms of arrhythmia and 20 children asymptomatic with ECG changes. All were evaluated initially with 12 lead electrocardiography (ECG) and trans-thoracic echocardiography. 24-hours holter monitoring was done for further evaluation.

RESULTS: 

Totally there were 100 patients. Out of 100, 55 were males (55%) and 45 were females (45%). Age group varied  from birth to 12 years.11% patients belong to < 2 years old, 32% patients were between 2 to 8yrs and remaining 57% patients were between 8 to 12 years of age group. Out of the 100 patients studied  80 patients who were symptomatic, 35 patients (43.75%) had benign arrhythmias, 10(12.5%) patients had frequent VPCs but none developed ventricular tachycardia, 8(10%) patients had frequent APCs,  3 (3.75%) patients had  2nddegree AV block  and 2(2.5%) patients had CHB and 2(2.5%) had intermittent preexcitation syndrome. Among 20 asymptomatic children 11 had complete heart block and 9 had WPW syndrome but none developed supraventricular tachycardia.

CONCLUSION:

Arrhythmias in pediatric population have varied presentation and diagnosis of pediatric arrhythmias remains challenging. 24 hours Holter monitoring is an important diagnostic tool in patients with suspected symptoms and it helps in risk stratifying pediatric patients for further management.


Keywords


Ventricular premature complex, Atrial premature complex, Complete heart block.

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References


Kennedy H: The History, Science, and Innovation of Holter Technology. Ann Noninvasive Electrocardiol. 2006;11:85–94.

Mason J: Electrophysiological diagnostic procedures. In: Goldman and Bennett (eds) Ceci Textbook of Medicine, 21st ed. 2000 W.B. Saunders pp 230-232.

Kennedy H : Use of long-term (Holter) Electrocardiographic recordings. In: Zipes D and Jalife J (eds). Cardiac Electrophysiology from cell to bedside. 3rd edition. 2000 WB. Saunders pp 717 – 730.

Van Hare G. and Dubin A : Electrocardiogram. In: Allen H., Gutgese II H., Clarck E. and Dricsoll D (eds). Moss and Adams' Heart disease in infants, children and adolescents 6th ed.2001. Lippincott Williams and Wilkins pp 425-443.

Ayabakan C, Ozer S, Celiker A, Ozme S: Analysis of 2017 Holter records in pediatric patients. Turk J Pediatr 2000, 42: 286-93.

Crawford M, Bernstein S, Deedwania P, DiMarco J, Ferrick K, Garson A, Green L, Greene L,Silka M, Stone P , Tracy C: ACC/AHA guidelines for ambulatory electrocardiography. J Am Coll Cardiol 1999. 34: 912-948.

Kilic A, Ozer S, Turanli G, Ayabakan C, Celiker A, Ozme S: Dysrhythmia as a cause of syncope in children without neurological or cardiac morphological abnormalities. Pediatrics International 2002 44, 358-362.

Streiper M: Distinguishing benign syncope from life threatening cardiac causes of syncope Semin Pediatr Neurol.2005; 12:32 9. Steinberg L, Knilans T: Costs and Utility of tests in the evaluation of the pediatric patients with syncope. Prog Pediatr Cardiol 2001; 13; 139-49.

Fitchet A, Stirling M, Burnett G, Goode GK, Garratt CJ, Fitzpatrick AP: Holter monitoring vs tilt testing in the investigation of suspected vasovagal syncope: Pacing Clin Electrophysiol.2003;26:1523-7.

Drago F, Santilli A, Turchetta A, Pompei E, Calzolari A.: Diagnostic usefulness of Holter monitoring in pediatric fainting and syncope. Minerva Pediatr. 1989;41:235-9.

Massin M: Neurocardiogenic syncope in children: Current concepts in diagnosis and management. Pediatr Drugs 2003; 5: 327-34.

Driscoll D, Jacobsen S, Porter C, Wollan P: Syncope in children and adolescents. J Am Coll Cardiol 1997; 29:1039-45.

Baker RL, Koelling TM : Prognostic value of ambulatory electrocardiography monitoring in patients with dilated cardiomyopathy. J Electrocardiol 2005. ;38:64-8.

Kawalec W, Zuk M, Bialkowski J, Pikulska-Orlowska H, Rudzinski A, Siwinska A, Sysa A, Szydlowski L, Werner B, Czarnecki J, Erecinski J, Mackowska K, Olszanowski A.: The significance of cardiac symptoms in patients referred to pediatric cardiology outpatient clinics.Med Wieku Rozwoj. 2005;9:139-51.

Geggel RL.: Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics. 2004;114:e409-17.

Cava JR, Sayger PL.: Chest pain in children and adolescents. Pediatr Clin North Am.2004;51:1553-68.

Lawrence PR, Delaney AE.: Chest pain in children and adolescents: most causes are benign.Adv Nurse Pract. 2004;12:61-66.

Morey S :CC/AHA Guidelines for ambulatory ECG. Am Fam Physician 2000: 61: 884 –888.

Ferreira J, Luis J, Mota P, Anjos R, Meneses I, Bonhorst D, Martins FM.: Holter electrocardiography en pediatric cardiology: preliminary experience. Rev Port Cardiol. 1996;15:27-33.

Miller J, Zipes D: Management of the patient with cardiac arrhythmias. In: Braunwald E,Zipes D and Libby P (eds). Heart disease. A textbook of cardiovascular medicine 6th ed W.B.Saunders 2001; 700 – 763.

Jurkovicova O, Hluchy J, Cagan S.: Electrocardiographic Holter monitoring in patients with ventricular pre-excitation: possibilities of its uses and pitfalls. Vnitr Lek. 1995;41:629-36.

Wolfe R, Driscoll D, Gersony W: Arrhythmias in patients with valve aortic stenosis, valve pulmonary stenosis, and ventricular septal defect: results of 24-hour ECG monitoring.Circulation 1993. 87(2 Suppl): I89-I101.

Kuzevska-Maneva K, Kacarska R, Gurkova B. : Arrhythmias and conduction abnormalities in children after repair of tetralogy of Fallot. Vojnosanit Pregl. 2005;62:97-102.

Guo Y, Zhou AQ, Li F, Huang MR, Yang JP, Li Y, Zhu M, Zhang HY.: Arrhythmia in the long-term follow-up after intracardiac repair of tetralogy of Fallot. Zhonghua Er Ke Za Zhi.2003 ;41:728-31.

Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 7(4): 204-214 (2007) Ranya A. Hegazy, Wael N. Lotfy, “The Value Of Holter Monitoring In The 213


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