Öz

Objective: The aims of this study were to evaluate the diagnostic yield of 24-hour Holter monitoring (HM) in children referred for chest pain, palpitations, and/or syncope, to identify independent predictors of clinically significant dysrhythmia and of the need for clinical intervention, and to assess the value of repeat HM.

Materials and Methods: Single-center retrospective study of 584 patients aged 6–18 years who underwent 24-hour HM between February 2023 and February 2024, grouped by presenting symptom (isolated palpitations, isolated chest pain, isolated syncope, or combined [≥2 symptoms]). HM findings were classified as normal, clinically non-significant arrhythmia, or severe dysrhythmia. Independent predictors were assessed by multivariable Firth penalized-likelihood logistic regression.

Results: Mean age was 13.4 years; 64.6% were female. HM was normal in 83.4%, non-significant in 12.7%, severe in 3.9%. Findings differed across groups (p=0.007; only chest pain vs syncope, p=0.002). No isolated syncope patient had a severe dysrhythmia or required intervention (0/108). Intervention was most frequent in isolated chest pain (13.2%), but 7 of 12 were empirical beta-blockers for benign ectopy or normal HM. An abnormal ECG was the only independent predictor of intervention (OR 6.78, 95% CI 3.15–14.29; p<0.001) and of severe dysrhythmia (OR 13.32, 95% CI 5.46–33.16; p<0.001); presenting symptom was not independently associated with either. Arrhythmia on the initial HM predicted later actionable arrhythmia (27.1% vs 2.3%). Of those with a normal initial HM, 10.2% underwent repeat HM and 12.0% showed a new finding. Family history of sudden death was not associated with severe dysrhythmia (p=0.406).

Conclusion: The diagnostic yield of HM varies by presenting symptom, but this variation is explained by ECG findings rather than the symptom itself. Arrhythmia on the initial HM strongly predicts subsequent intervention. No patient with isolated syncope had a severe dysrhythmia, although the retrospective single-center design precludes a definitive exclusion of risk.

Kaynakça

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Nasıl atıf yapılır

1.
Urunca A, Karabacak B, Koca S, Gürsu HA, GÜL AEK. Diagnostic yield of 24-hour Holter monitoring in children presenting with chest pain, palpitations, or syncope: A single-center retrospective study. Turk J Pediatr Dis. 2026;Early View:1-8. https://doi.org/10.12956/TJPD.2026.1386