Ambulatory Electrocardiography Modalities in Pediatric Arrhythmia Detection and Management
Yen Teng Hsu, Wei Chieh Tseng, Ying Lun Hsu, Mei Hwan Wu, Chun Wei Lu, Kun Lang Wu, Wei Feng Peng, Shuenn Nan ChiuImportance
The diagnostic efficacy of different ambulatory electrocardiographic monitoring modalities in this patient population remains unclear.
Objective
To compare the diagnostic yield and clinical utility of 3 ambulatory electrocardiographic modalities in pediatric patients.
Design, Setting, and Participants
This single-center study took place at an outpatient clinic and an inpatient ward of National Taiwan University Children’s Hospital. Patients younger than 18 years who underwent ambulatory electrocardiographic monitoring between December 2022 and January 2025 were included. These data were analyzed February 2025 to March 2026.
Exposure
A continuous 7-day Holter device that functioned as an event recorder was used. Recordings from the first 24 hours were defined as the 24-hour Holter results.
Main Outcomes and Measures
Arrhythmias were categorized as major (tachyarrhythmia or bradyarrhythmia) or minor (extrasystolic arrhythmia). All patients were followed up for 1 year; the final arrhythmia diagnosis was used as the reference standard. The primary and secondary outcomes were detection of arrhythmia and a change in clinical management attributable to monitoring findings, respectively.
Results
In total, 435 children (235 female [54%] and 200 male [46%]; mean [SD] age, 12.3 [3.9] years) were included. The mean (SD) duration of analyzable ambulatory electrocardiographic data was 4.9 (1.7) days. Of 411 children who activated the event recorder, 10.7% had symptom-correlated arrhythmias. The 7-day Holter monitoring demonstrated a significantly higher rate of major arrhythmias (6.2%) than the 24-hour Holter or 7-day event recordings (2.3%; rate difference 95% CI, 1.9%-6.0%;
Conclusions and Relevance
In this study of pediatric patients without structural heart disease who underwent electrocardiographic monitoring, 7-day continuous ambulatory electrocardiographic monitoring was associated with a significantly higher diagnostic yield than 24-hour Holter and 7-day event recording. Continuous monitoring may be preferred to detect tachyarrhythmias likely to influence clinical management.