Feasibility and benefits of extended 5-7 day holter monitoring in paediatric patients using the wireless one-patch holter monitoring devices (WOPH)

Background Holter ECG monitoring is essential for arrhythmia detection in children, yet conventional 24-48 h systems often cause discomfort, limit activity and reduce compliance. The wireless one-patch Holter monitoring devices (WOPH), enable continuous 5-7 day recording without cables, improving comfort and adherence. Extended monitoring is particularly relevant in paediatrics, where intermittent arrhythmias may be missed in shorter recordings. This study evaluated the feasibility, safety, and diagnostic performance of WOPH in routine clinical use, including during sports and daily activities. Methods We prospectively studied 150 paediatric patients (<18 years) requiring ambulatory ECG, as part of the PAC-SAMS program. Each child wore a WOPH continuously for 5-7 days, performing normal activities including school and sports. Only swimming and excessive sweating were restricted. Families reported device tolerance and any technical issues. ECG data were analysed through a secure online platform. Outcomes included compliance, technical success, and diagnostic yield. Results All 150 patients completed monitoring without major device-related events. Compliance and tolerability were excellent, with no early removals or significant skin irritation. The patch remained adherent throughout the wear time; minor loosening from sweating was easily corrected. Children freely engaged in daily and sports activities. Workflow integration was simple and well accepted by staff and families. Extended monitoring provided a high diagnostic yield, detecting clinically relevant arrhythmias missed by traditional Holter. A significant proportion of patients presented their first abnormal event after 24 h, including paroxysmal supraventricular tachycardia, atrial flutter, and intermittent AV block. Recordings during exercise revealed non-sustained ventricular tachycardia in some athletes, aiding diagnosis and treatment planning. Data quality remained high, and automated analysis allowed rapid interpretation. Conclusion Extended, patch-based Holter monitoring with the wireless one-patch Holter monitoring devices (WOPH), proved safe, well tolerated, and highly effective in children. The device’s comfort, water resistance, and simplicity enabled continuous rhythm surveillance during everyday life and sports. The longer, 5-7 day duration markedly enhanced diagnostic yield, capturing events beyond standard monitoring periods. With excellent compliance and minimal logistical burden, the WOPH is now part of our routine paediatric cardiology practice. This technology offers a practical and patient-friendly solution to improve arrhythmia detection and optimise cardiac care in young patients.