Key result
24-hour Holter monitoring in children with syncope had a low overall diagnostic yield of 2.4%, but demonstrated higher utility in high-risk patients with a positive family history (16.6% yield).
Why the study?
Does 24-hour Holter monitoring improve diagnosis in pediatric patients with syncope?
Observational (n=323)
No
Does 24-hour Holter monitoring improve diagnosis in pediatric patients with syncope?
Holter monitoring has a low overall diagnostic yield in pediatric syncope but is valuable for detecting concealed long QT syndrome in high-risk patients with a family history of sudden death or exercise-induced syncope.
May support selective Holter use in high-risk pediatric syncope with family history; leaves open prospective validation of targeted strategies.
Introduction: Holter monitoring HM is usually used in patients with syncope when etiology cannot be explained with history, physical examination and electrocardiography ECG . In this study the objective was to evaluate the diagnostic value of HM in children with syncope.Materials and Methods: Databases were collected retrospectively by analyzing the HM results of 3.122 pediatric patients between 2010-2014. Gender, age at diagnosis, detailed clinical history, physical examination, 12-lead electrocardiographic and echocardiographic results were noted using standardized form.Results: The study included 323 patients with syncope with a mean age of 13.21±3.67. There were 199 female and 124 male patients in this study. Among all patients 284 87.9% had normal HM results, while 11 3.4% patients had abnormal Holter studies that consider to explain as syncope. Three of 11 patients with abnormal Holter results diagnosed through ECG before HM, hence, the diagnostic value of HM was calculated as 2.4%. In contrast, diagnostic value of HM in patients with positive family history was found to be 16.6%. In this study, 7 patients were considered to have long QT syndrome according to their HM findings. Conclusions: Detailed clinical history has a great value in children with syncope. As a result, HM has low diagnostic value if the patients are not in high risk group. However, HM was considered to be important because of concealed long QT syndrome especially if the patient had positive family history and exercise related syncope
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Uysal et al. (2016) conducted an observational in Syncope (n=323). 24-hour Holter monitoring was evaluated on Diagnostic yield of Holter monitoring (abnormal findings explaining syncope not previously diagnosed by ECG). 24-hour Holter monitoring in children with syncope had a low overall diagnostic yield of 2.4%, but demonstrated higher utility in high-risk patients with a positive family history (16.6% yield).
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