Role of holter ECG in diagnosis of pediatric patients with complaints of palpitations

Aim: Palpitations are one of the most common complaints among patients presenting to emergency departments, primary healthcare providers, or cardiologists. Standard resting electrocardiography shows a brief period of heart rhythm and may miss many arrhythmias. Therefore, Holter ECG is an important method in the diagnosis of dysrhythmias. This study aims to evaluate the role of Holter ECG in diagnosing children with palpitations. Materials and Methods: The study included pediatric patients who presented to the pediatric cardiology clinic with palpitations between July 2013 and July 2024. Parameters such as age, gender, diagnosis, hemoglobin levels, thyroid function tests (TSH, T4, T3), CRP, types of arrhythmias, and comorbidities were assessed. The patients' clinic entries and files were reviewed retrospectively. Results: A total of 661 patients were included in the study, comprising 374 females and 287 males. The average age was found to be 12.74±4.12 years. The laboratory characteristics of the patients were evaluated, with an average hemoglobin (HGB) level of 13.06±1.41, CRP of 0.38±1.27, TSH of 2.46±1.96, T4 of 0.97±0.21, and T3 of 4.07±0.77. The most frequently observed rhythms were normal sinus rhythm (n=335, 53.1%), ventricular early beats (VEV) (n=99, 15.7%), and sinus tachycardia (n=76, 12.0%). Sinus rhythm was the most common finding in both groups under and over 13 years of age, followed by VEV and then sinus tachycardia. SVT (75.0%), nonsustained ventricular tachycardia (72.7%), atrial premature contractions (58.3%), sinus rhythm (56.1%), sinus tachycardia (53.9%), and VEV (53.5%) were more common in patients aged 13 and older, while WPW (44.4%) and long QT syndrome (33.3%) were more frequently observed in those under 13 years of age. Conclusion: Palpitations are a common complaint in childhood. Since patients typically present to the hospital when their symptoms have subsided, an electrocardiogram (ECG) taken at rest only captures a brief period of the heart's rhythm and may miss many arrhythmias. Therefore, we believe that 24-hour Holter ECG monitoring in patients presenting with palpitations allows for the accurate documentation of arrhythmias by capturing when and under what circumstances the symptoms occur.