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

Introduction: Lightheadedness, syncope, dyspnea, chest pain, palpitation, loss of consciousness (LOC) or malaise are a frequent reason 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: To determine the prevalence of baseline ECG abnormalities and those detected in HM in SAC, and to assess the predictive factors of abnormal HM test.

Methods: We conducted a retrospective descriptive study in which we had included all the consecutive SAC (6 to 12 years) presenting: syncope or lightheadedness or palpitation, dyspnea, or chest pain, malaise, 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%), lightheadedness (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 positive 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%) whereas benign abnormalities in 99 patients (86.1%). In the multivariate analysis: Age≥10 years, mean heart rate <94 beats per minute, the presence of syncope, LOC, malaise and the presence of PVCs in 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, which require urgent management.