The yield of 24-hour ambulatory electrocardiography in the assessment of symptomatic school-age children

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Published Nov 6, 2023
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Vol. 101 No. 8-9 (2023): Tunis med aug-sept 2023

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Khalil Ouaghlani
Department of Pediatric Cardiology , La Rabta Hospital- Tunis- Tunisia
Meriem Drissa
Department of Cardiology, Mongi Slim hospital, La Marsa- Tunis- Tunsia
Rihab Ben Othmen
Department of Pediatric Cardiology. Hôpital la Rabta- Tunis- Tunisia
Hela Msaad
Department of Pediatric Cardiology. Hôpital la Rabta- Tunis- Tunisia
Kaouther Hakim
Department of Pediatric Cardiology. Hôpital la Rabta- Tunis- Tunisia
Fatma Ouarda
Department of Pediatric Cardiology. Hôpital la Rabta- Tunis- Tunisia

Abstract

Introduction:


Light-headedness, syncope, dyspnea, chest pain, palpitation, loss of consciousness (LOC) or malaise are frequent reasons for consultation in school-age children (SAC). The yield of holter monitoring (HM) in the investigation of these symptoms in SAC is still controversial given the scarce studies.


Aim: 1/To determine the prevalence of baseline ECG abnormalities and those detected in HM in SAC and 2/ to assess the predictive factors of abnormal HM test. 


Methods: We conducted a retrospective descriptive study in which we included SAC (6 to 12 years old) presenting with syncope or light-headedness or palpitation, dyspnea, or chest pain, malaise or LOC and referred to our department for HM


Results: We included 366 children. Mean age was 9.7±1.88 years. The major symptoms experienced by the patients were: palpitation (50.7%), chest pain (16.9%), light-headedness (11.9%), syncope (6.9%), LOC (5.3%), ECG was abnormal in 8.7%. The two most common baseline ECG abnormalities were premature ventricular contractions (PVCs) (1.8%) and right bundle branch block (1.6%). HM was abnormal in 101 (26.6%) patients. The most common abnormalities in HM were vagal hypertonia in 61 patients (16.1%), PVCs in 29 patients (7.7%), Malignant abnormalities were encountered in 16 patients (13.9%). In the multivariate analysis: Age≥10 years, mean heart rate <94 beats per minute, syncope, LOC, malaise and PVCs on baseline ECG were identified as independent risk factors of abnormal holter.


Conclusion: HM has an important diagnostic value in symptomatic SAC. It allows the identification of benign as well as malignant arrhythmias.

Keywords:

children, arrhythmia , holter monitoring

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