Leng Tomas, Aldalati Alaa, Homme James L
Department of Pediatric and Adolescent Medicine, Mayo Clinic, MN, USA.
Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
Am J Emerg Med. 2025 Jul;93:1-6. doi: 10.1016/j.ajem.2025.03.032. Epub 2025 Mar 18.
Pediatric patients presenting to an Emergency Department (ED) with symptoms that may represent cardiac arrhythmia can be challenging due to low prevalence of dysrhythmias and variable ability to detect and report symptoms. We aimed to determine the overall diagnostic yield of Holter monitoring (HM) in this population.
We performed a retrospective cohort study of patients ≤21 years of age presenting to an academic urban tertiary care center with embedded pediatric ED between January 2015-June 2023 with symptoms suggestive of cardiac arrhythmia who were discharged with a HM after ED evaluation. Patients with a known cardiac history or an abnormal electrocardiogram (ECG) at presentation were excluded. Positive diagnostic yield for HM was defined as capturing the patient's reported symptoms, regardless of arrhythmia presence, or detecting a silent arrhythmia.
There were 159 patients included in the study. Thirty-two patients with a known cardiac history and one patient with an abnormal ECG were excluded. The most common chief complaints were palpitations (n = 51, 32 %), followed by syncope/pre-syncope (n = 47, 30 %), and chest pain (n = 33, 21 %). Out of the 91 patients (57 %) reporting symptoms while wearing the HM, only one patient experienced symptomatic arrhythmia. None of the symptomatic patients with a negative HM result had recorded arrhythmia in their medical charts within one year following the initial ED visit. Holter monitoring recorded "silent" arrhythmias in nine (6 %) patients. These included three cases of supraventricular tachycardia, three cases of non-sustained ventricular tachycardia, and three patients with second-degree (Mobitz 1) atrioventricular block. The overall diagnostic yield for HM in our study cohort was 63 %.
Ambulatory HM in low-risk pediatric patients presenting to the ED with symptoms suggestive of cardiac arrhythmia is a useful diagnostic tool in excluding arrhythmias. In addition, a subset of patients will have potentially relevant silent arrhythmia detected.
因可能代表心律失常的症状而前往急诊科（ED）就诊的儿科患者，由于心律失常的患病率较低以及检测和报告症状的能力各异，诊断可能具有挑战性。我们旨在确定动态心电图监测（HM）在该人群中的总体诊断率。
我们对2015年1月至2023年6月期间前往一家设有儿科急诊科的城市学术三级医疗中心就诊、有提示心律失常症状且在急诊科评估后出院时接受动态心电图监测的21岁及以下患者进行了一项回顾性队列研究。就诊时已知有心脏病史或心电图（ECG）异常的患者被排除。动态心电图监测的阳性诊断率定义为捕捉到患者报告的症状（无论是否存在心律失常）或检测到无症状性心律失常。
该研究共纳入159例患者。32例已知有心脏病史的患者和1例心电图异常的患者被排除。最常见的主要症状是心悸（n = 51，32%），其次是晕厥/先兆晕厥（n = 47，30%）和胸痛（n = 33，21%）。在91例（57%）佩戴动态心电图监测仪时报告有症状的患者中，只有1例出现有症状的心律失常。在最初的急诊科就诊后一年内，动态心电图监测结果为阴性的有症状患者在其病历中均未记录到心律失常。动态心电图监测在9例（6%）患者中记录到“无症状性”心律失常。其中包括3例室上性心动过速、3例非持续性室性心动过速和3例二度（莫氏I型）房室传导阻滞患者。我们研究队列中动态心电图监测的总体诊断率为63%。
对于因提示心律失常症状而前往急诊科就诊的低风险儿科患者，动态心电图监测是排除心律失常的有用诊断工具。此外，一部分患者会检测到潜在相关的无症状性心律失常。
