Ambulatory arrhythmia screening in symptomatic children and young adults: Comparative effectiveness of holter and telephone event recordings

Abstract

Effective initial identification of potential cardiac arrhythmias in symptomatic children is difficult due to the infrequency, brief duration, and vague nature of subjective complaints in the young. Although both telephone event and Holter monitoring are used for this purpose, no comparative studies of the initial screening efficacy of either have been performed. A total of 202 consecutive symptomatic children (age 11 days to 26 years, mean 10.2 years) were evaluated for potential cardiac arrhythmias with either 24-h Holter (97 patients) or telephone event (105 patients) recorders and grouped according to the presence or absence of congenital heart defects, normal or abnormal resting electrocardiogram (ECG), and presence or absence of cardiac surgery. The results showed 30% of all recordings (61% event; 14% Holter) failed to substantiate any arrhythmias in spite of subjective symptoms. Event recordings showed a better correlation of sensed symptoms with arrhythmias (32%) compared to Holters (5%) (p < 0.01) with 73% of Holter recordings performed during both asymptomatic and arrhythmia-free 24-h periods. Holter monitoring was more effective in detecting nonsensed and asymptomatic events (8% versus 0.5%, (p < 0.01), among high-risk children. This study demonstrates that although both monitoring devices are applicable to children, each has inherent limitations and usefulness. These must be considered in choosing either device to permit their most optimal and cost-effective application.

Diagnostic and Cost Effectiveness of Telemonitoring the Pediatric Pacemaker Patient

“…This study confirms previous reports of poor correlation of patient/parent perception of possible cardiac events with actual abnormalities and underscores the need for an efficient, simple technique to screen for possible pacemaker-related problems [7]. The geographic limitation of adequate cardiac centers capable of optimal pacemaker follow-up among pediatric patients may be limited in any given area, necessitating a means to monitor the children effectively between scheduled pacemaker clinic visits.…”

Use of Transesophageal Atrial Pacing for Documentation of Arrhythmias Suspected in Infants and Children

“…However, routine methods often fail to document episodic arrhythmia because the episodes may be brief, infrequent, or both. [1][2][3][4] Transesophageal study is a minimally invasive procedure and atrial stimulation from the esophagus can initiate and terminate tachycardia.…”

2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

“…Arrhythmia correlation during AEGM was noted in 10%-15% of pediatric patients experiencing palpitations. Conversely, sinus tachycardia is identified in nearly 50% of patients with the same symptoms (Dick, McFadden, Crowley, & Rosenthal, 1979;Fyfe, Holmes, Neubauer, & Feldt, 1984;Goldstein, Hesslein, & Dunnigan, 1990;Karpawich, Cavitt, & Sugalski, 1993). In one single-center experience of 495 pediatric patients, transtelephonic electrocardiographic event monitors (TTMs) yielded a useful diagnosis in 48% (Saarel et al, 2004).…”