Usefulness of long-term telemetric electrocardiogram monitoring in the diagnosis of tachycardia in children with a medical history of palpitations

Abstract

Background In children, palpitations, which may result from a life-threatening tachyarrhythmia, are one of the most common causes of cardiac visits and hospitalizations. Effective diagnosis is essential in this population of patients. aims This study aimed to assess the usefulness of long-term telemetric electrocardiograms compared with Holter monitoring in the diagnostic workup in children with palpitations. methods A total of 350 children with undocumented palpitations were examined in a multicenter study. In 167 patients (47.7%), the TELE group, month-long continuous telemetric electrocardiogram monitoring (using the PocketECG system) was performed. In 183 patients (52.3%), the HOLT group, 24-hour Holter electrocardiography was carried out and repeated after a month if tachyarrhythmia was not recorded. results A total of 152 children (43.4%) reported palpitations, and 36.2% of them had sinus tachycardia during palpitations. Tachyarrhythmias were recorded in 68 patients (40.7%) in the TELE group and in 7 (3.8%) in the HOLT group after the second examination (P <0.001); the mean time to record tachycardia was 15.8 (8.7) days versus 25.4 (11.1) days (P = 0.004). In the TELE group, we noted a greater number of children with palpitations during recording (62.9% vs 18%), tachycardia with normal QRS complexes (21.6% vs 1.6%), ventricular tachycardia (11.4% vs 0.5%), and asymptomatic arrhythmias than in the HOLT group. conclusions In children, long-term telemetric electrocardiogram monitoring using the PocketECG system is well tolerated and has a high diagnostic efficacy. In young patients with palpitations, telemetric cardiac monitoring lasting up to a month increased the number of patients with recorded tachyarrhythmia by almost 10-fold compared with the analysis of 2 Holter electrocardiograms. We found that a large number of children have asymptomatic cardiac arrhythmias.