Understanding the Significance of Holter Monitoring in Children Presenting With Chest Pain and Palpitations, a Literature Review and Sharing Our Experience

Background: Holter monitoring has been established as one of the most effective non-invasive clinical tools in the diagnosis, assessment, and risk stratification of children presenting with palpitations, chest pain, or syncope . Studies in the paediatric age group are limited. The present work aims at determining the value of Holter monitoring in the diagnosis and management of children with a possible risk of developing cardiac arrhythmias. Methods: We conducted a review of the literature, and results from 15 different peer-reviewed studies were assessed and analysed for this study. We retrospectively analysed our Holter reports between February 2020 and Mar 2021 in our unit to understand the indications and results of the investigations. Results: The most common indications were palpitations, chest pain, and possible arrhythmia based on positive family history. We analysed 39 patients in our unit who had Holter studies and reviewed 15 studies with similar aims. Diagnostic yield was low in patients with palpitations and syncope. An abnormal ECG was significantly associated with a higher diagnostic yield. Children with chest pain rarely had abnormal Holter findings. Most common pathologies with abnormal Holters included Supraventricular tachycardias(SVTs), abnormal ECG at presentation to the emergency department, cardiomyopathies, post-cardiac surgeries, and familial cardiac syndromes. Conclusions: Holter monitoring has an extremely valuable role in the assessment of high-risk patients (strong family history, exertional dyspnoea, cardiomyopathies), postoperative, and with abnormal ECGs with tachy or bradyarrythmias. However, in children with palpitations, syncope, and chest pain, Holter monitoring has a low yield. Patients with abnormal ECGs are more likely to be associated with abnormal Holter recordings. Long-term follow-up and meticulous cardiovascular function assessments are very important for assessment of patients with continuing symptoms and deteriorating quality of life.