Department of Pediatric Cardiology, La Rabta Hospital- Tunis- Tunisia.
Department of Cardiology, Mongi Slim hospital, La Marsa- Tunis- Tunisia.
Tunis Med. 2023 Aug-Sep;101(8-9):698-703.
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.
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.
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.
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.
HM has an important diagnostic value in symptomatic SAC. It allows the identification of benign as well as malignant arrhythmias, which require urgent management.
头晕、晕厥、呼吸困难、胸痛、心悸、意识丧失（LOC）或不适是学龄儿童（SAC）就诊的常见原因。鉴于研究较少，在 SAC 中对这些症状进行动态心电图监测（HM）检查的结果仍存在争议。
确定 SAC 基线心电图异常和 HM 中检测到的异常的发生率，并评估 HM 检查异常的预测因素。
我们进行了一项回顾性描述性研究，其中纳入了所有连续的 SAC（6 至 12 岁），这些儿童出现以下症状：晕厥或头晕或心悸、呼吸困难、胸痛、不适、LOC，并转至我们部门进行 HM。
我们纳入了 366 名儿童。平均年龄为 9.7 ± 1.88 岁。患者主要经历的症状有：心悸（50.7%）、胸痛（16.9%）、头晕（11.9%）、晕厥（6.9%）、LOC（5.3%）、心电图异常率为 8.7%。基线心电图最常见的两种异常是室性期前收缩（PVCs）（1.8%）和右束支传导阻滞（1.6%）。101 名（26.6%）患者 HM 阳性。HM 中最常见的异常是 61 名患者（16.1%）出现迷走神经张力过高、29 名患者（7.7%）出现 PVCs、16 名患者（13.9%）出现恶性异常，99 名患者（86.1%）出现良性异常。多变量分析显示：年龄≥10 岁、平均心率<94 次/分钟、存在晕厥、LOC、不适和基线心电图中存在 PVCs 是 HM 异常的独立危险因素。
HM 对有症状的 SAC 具有重要的诊断价值。它可以识别良性和恶性心律失常，这些心律失常需要紧急处理。
