6007 24 hoursECG in children referred for Holter tape, retrospective study and service evaluation project at princess Alexandra hospital, Harlow

Objectives To determine the diagnostic yield of 24-hours ECG in children, evaluate service provision and develop robust referral pathway. Methods 24 hours ECG of Childrens who presented to Paediatric Department between January 2022 to December 2022 were analyzed. Indications of doing Holter, its outcome, abnormalities, treatment and follow up were reviewed. Path web, PACS, Clinic letters,Dicom Encapsulated Report, Excel spreadsheet, data analysis software was used. Results From138 Holter, 29 excluded,109 were analyzed, in which 13% children were (0–5 years), 23% (6 -10 years), 45% (11–15 years),19% (16 years old). Indications observed were palpitations (41%), chest pain (15%), syncope (28%), arrythmia (15%). From 109 patients 100 Holter (92%) were normal 9 were abnormal (8%). From 9 abnormal Holter, 4 had palpitation (44.5%), 2 had syncope (22.2%), 2 had arrythmia (22.2%) and 1chest pain (11.1%). Amongst 9 abnormal Holter record 3 patient (32%) had Supraventricular Ectope, 2 patient (23%) had Ventricular Ectope, 2 patient (23%) had SVT, 1 patient (11%) had variable block, 1 patient (11%) had WPW. Out of 50 patients of palpitation 4 had abnormal Holter (8%) and 46 had normal (92%). Amongst 34 patients with syncope 2 had abnormal (6%), and 32 had normal Holter (94%). From 18 patients of chest pain1tape was abnormal (5%). Amongst 18 patients of arrythmia, 2 Holter (11%) were abnormal. 41% patients had Holter done within a month,35% within 2 months and 18% within 3 months. 3 patients having SVE had burden less than 1% discharged from follow-up. From 2 patient of Ventricular ectope1 patient having VE (MVP, MR, Bigeminy) was followed up at tertiary unit and 1 was reviewed locally.2 patient of SVT (Multiple SVT) were reviewed at tertiary unit.1patient having delta wave was reviewed locally,1 with 2:1 variable block was reviewed at tertiary unit. Conclusion 24 hours Holter monitoring has good diagnostic yield, however Extended period Holter and patient activated event recording could diagnose in majority of patients. 5- 12% Holter were abnormal across various condition, while 88–95% were normal. Therefor before requesting Holter good history, clinical examination, cardiologist screen, abnormal ECG are essential which can filter inappropriate referral and reduce waiting time. Robust referral criteria for 24 hours ECG needs to develop for which data entry in Dicom encapsulated sheet report needs to be complete. References Hegazy RA, Lotfy WIN. The value of Holter monitoring in the assessment of Pediatric patients. Indian Pacing Electrophysiology J. 2007 Oct22;7. Aman R, Qureshi AU, Sadiq M. Yield of 48-hour Holter monitoring in children with unexplained palpitations and significance of associated symptoms. J Pak Med Assoc. 2017 Jul. Practical management of common arrhythmias in children. Pfammatter JP. Der Umgang mit Herzrhythmusstörungen beim Kind Praxis (Bern 1994). 2005 Nov 9. Southhall DP, Jhonston F, Shinebourne EA,et al. 24-Hour electrocardiographic study of heart rate and rhythm patterns in population of healthy children. Br Heart J 1981.