The yield of 24-hour ambulatory electrocardiography in the assessment of symptomatic school-age children


Khalil Ouaghlani
Meriem Drissa
Rihab Ben Othmen
Hela Msaad
Kaouther Hakim
Fatma Ouarda



Light-headedness, syncope, dyspnea, chest pain, palpitation, loss of consciousness (LOC) or malaise are frequent reasons for consultation in school-age children (SAC). The yield of holter monitoring (HM) in the investigation of these symptoms in SAC is still controversial given the scarce studies.

Aim: 1/To determine the prevalence of baseline ECG abnormalities and those detected in HM in SAC and 2/ to assess the predictive factors of abnormal HM test. 

Methods: We conducted a retrospective descriptive study in which we included SAC (6 to 12 years old) presenting with syncope or light-headedness or palpitation, dyspnea, or chest pain, malaise or LOC and referred to our department for HM

Results: We included 366 children. Mean age was 9.7±1.88 years. The major symptoms experienced by the patients were: palpitation (50.7%), chest pain (16.9%), light-headedness (11.9%), syncope (6.9%), LOC (5.3%), ECG was abnormal in 8.7%. The two most common baseline ECG abnormalities were premature ventricular contractions (PVCs) (1.8%) and right bundle branch block (1.6%). HM was abnormal in 101 (26.6%) patients. The most common abnormalities in HM were vagal hypertonia in 61 patients (16.1%), PVCs in 29 patients (7.7%), Malignant abnormalities were encountered in 16 patients (13.9%). In the multivariate analysis: Age≥10 years, mean heart rate <94 beats per minute, syncope, LOC, malaise and PVCs on baseline ECG were identified as independent risk factors of abnormal holter.

Conclusion: HM has an important diagnostic value in symptomatic SAC. It allows the identification of benign as well as malignant arrhythmias.


children, arrhythmia , holter monitoring



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