Summary
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.
Similar content being viewed by others
References
David D, Mitchelson EL (1988) Transtelephonic electrocardiographic monitoring for the detection and treatment of cardiac arrhythmias.Cardiovasc Clin 18:73–82
Dewey RC, Capeless MA, Levy AM (1987) Use of ambulatory electrocardiographic monitoring to identify high-risk patients with congenital complete heart block.N Engl J Med 316:835–839
Dick M, McFadden D, Crowley D, et al. (1979) Diagnosis and management of cardiac rhythm disorders by transtelephonic electrocardiography in infants and children.J Pediatrics 94:612–615
Fyfe DA, Holmes DR, Neubauer SA, et al. (1984) Transtelephonic monitoring in pediatric patients with clinically suspected arrhythmias.Clin Pediatr 23:139–143
Goldstein MA, Hesslein P, Dunnigan A (1990) Efficacy of transtelephonic electrocardiographic monitoring in pediatric patients.Am J Dis Child 144:178–182
Grodman RS, Capone RJ, Most AS (1979) Arrhythmia surveillance by transtelephonic monitoring: comparison with Holter monitoring in symptomatic ambulatory patients.Am Heart J 98:459–464
Hasin Y, David D, Rogel S (1976) Diagnostic and therapeunic assessment by telephone electrocardiographic monitoring of ambulatory patients.Br Heart J 2:609–612
Judson P, Holmes DR, Baker WP (1979) Evaluation of outpatient arrhythmias utilizing transtelephonic monitoring.Am Heart J 97:759–761
Karpawich PP, Antillon JR, Cappola PR, et al. (1985) Preand postoperative electrophysiologic assessment of children with secundum atrial septal defect.Am J Cardiol 55:519–521
Karpawich PP, Gillette PC, Garson A, et al. (1985) Congenital complete atrioventricular block: clinical and electrophysiologic predictors of need for pacemaker insertion.Am J Cardiol 48:1098–1102
Kennedy HL, Caralis DG (1977) Ambulatory electrocardiography—a clinical perspective.Ann Intern Med 87:729–739
Kugler JD, Danford DA, Gumbiner CH (1991) Ventricular fibrillation during transesophageal atrial pacing in an infant with Wolff-Parkinson-White syndrome.Pediatr Cardiol 12:36–38
Lipski J, Cohen L, Espenoza J, et al. (1976) Value of Holter monitoring in assessing cardiac arrhythmias in symptomatic patients.Am J Cardiol 37:102–107
Selbst SM, Ruddy RM, Clark BJ, et al. (1988) Pediatric chest pain: a prospective study.Pediatrics 82:319–323
Southall DP, Johnston F, Shinebourne EA, et al. (1981) 24-Hour electrocardiographic study of heart rate and rhythm patterns in population of healthy children.Br Heart J 45:281–286
Vetter VL, Horowitz LH (1982) Electrophysiologic residua and sequelae of surgery for congenital heart defects.Am J Cardiol 50:588–604
Williams RL (1978) Use of transtelephonic electrocardiography in patients with symptoms suggesting cardiac arrhythmia.Pediatrics 61:493–495
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Karpawich, P.P., Cavitt, D.L. & Sugalski, J.S. Ambulatory arrhythmia screening in symptomatic children and young adults: Comparative effectiveness of holter and telephone event recordings. Pediatr Cardiol 14, 147–150 (1993). https://doi.org/10.1007/BF00795642
Issue Date:
DOI: https://doi.org/10.1007/BF00795642