Joyce James J, Bogarapu Soujanya, Odhiambo Collins, Ferns Sunita J, Kennedy Harold L
Jacksonville Pediatric and Adult Congenital Cardiology Jacksonville FL USA.
Division of Pediatric Cardiology University of Illinois College of Medicine-Peoria Peoria IL USA.
J Am Heart Assoc. 2025 Jun 3;14(11):e039783. doi: 10.1161/JAHA.124.039783. Epub 2025 May 26.
Ambulatory electrocardiography has been in clinical use for 5 decades. However, reference limits for rhythm parameters in healthy infants, children, and adolescents have not been adequately defined. We sought to determine these reference ranges using meta-analysis of existing published studies of 24-hour Holter monitoring in healthy pediatric populations.
Multiple literature databases were searched from 1969 to May 2024 for relevant studies. Data extraction and analysis were completed according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. The prevalence of cardiac ectopy and conduction delays along with mean±SD of heart rates were obtained and grouped by the following age ranges: neonates (birth to 4 weeks), older infants (1-12 months), younger children (1-6 years), older children (7-12 years), and adolescents (13-18 years). Ninety-five percent reference ranges for all rhythm variables were estimated in each age group.
Forty-five studies including 3886 participants were identified and analyzed. Minimum, average, and maximum heart rates during Holter monitoring decreased with age as expected. Prevalence of transient first-degree atrioventricular block and Wenckebach second-degree atrioventricular block increased with age to around 14% in adolescence. Prevalence rates for any premature atrial complexes and premature ventricular complexes were also highest in adolescence at 50% and 29%, respectively. The upper limits for the number of premature atrial complexes per day were 150 in infants and 50 in the older age groups and for premature ventricular complexes were 50 in all age groups.
Holter monitor age-related reference limits for healthy infants, children, and adolescents are proposed.
动态心电图已在临床应用了50年。然而，健康婴儿、儿童和青少年节律参数的参考限值尚未得到充分界定。我们试图通过对已发表的关于健康儿科人群24小时动态心电图监测的现有研究进行荟萃分析来确定这些参考范围。
检索了1969年至2024年5月的多个文献数据库以查找相关研究。根据流行病学观察性研究的荟萃分析指南完成数据提取和分析。获取心脏异位和传导延迟的患病率以及心率的平均值±标准差，并按以下年龄范围分组：新生儿（出生至4周）、较大婴儿（1至12个月）、幼儿（1至6岁）、较大儿童（7至12岁）和青少年（13至18岁）。估计每个年龄组所有节律变量的95%参考范围。
共纳入并分析了45项研究，包括3886名参与者。动态心电图监测期间的最低、平均和最高心率如预期随年龄下降。短暂一度房室传导阻滞和文氏二度房室传导阻滞的患病率随年龄增加，在青少年中增至约14%。任何房性早搏和室性早搏的患病率在青少年中也最高，分别为50%和29%。各年龄组每天房性早搏数量的上限，婴儿为150次，较大年龄组为50次；室性早搏的上限在所有年龄组均为50次。
提出了健康婴儿、儿童和青少年动态心电图与年龄相关的参考限值。
