AMBULATORY ARRHYTHMIA SCREENING IN SYMPTOMATIC CHILDREN AND YOUNG-ADULTS - COMPARATIVE EFFECTIVENESS OF HOLTER AND TELEPHONE EVENT RECORDINGS

Effective initial identification of potential cardiac arrhythmias in s ymptomatic children is difficult due to the infrequency, brief duratio n, and vague nature of subjective complaints in the young. Although bo th 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 1 1 days to 26 years, mean 10.2 years) were evaluated for potential card iac arrhythmias with either 24-h Holter (97 patients) or telephone eve nt (105 patients) recorders and grouped according to the presence or a bsence of congenital heart defects, normal or abnormal resting electro cardiogram (ECG), and presence or absence of cardiac surgery. The resu lts showed 30% of all recordings (61% event; 14% Holter) failed to sub stantiate any arrhythmias in spite of subjective symptoms. Event recor dings showed a better correlation of sensed symptoms with arrhythmias (32%) compared to Holters (5%) (p < 0.01) with 73% of Holter recording s performed during both asymptomatic and arrhythmia-free 24-h periods. Holter monitoring was more effective in detecting nonsensed and asymp tomatic events (8% versus 0.5%, (p < 0.01), among high-risk children. This study demonstrates that although both monitoring devices are appl icable to children, each has inherent limitations and usefulness. Thes e must be considered in choosing either device to permit their most op timal and cost-effective application.