Research Article
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Holter Records in Children with Palpitation, Chest Pain and Syncope: Single Center Experience

Year 2021, Volume: 15 Issue: 3, 192 - 197, 25.05.2021
https://doi.org/10.12956/tchd.688288

Abstract

Objective: Symptoms such as palpitations, chest pain and syncope, which are among the worrying complaints for
patients and their families can be the precursor of heart rhythm disorders. Electrocardiography (ECG) is sometimes
insufficient in the diagnosis of underlying serious rhythm disorders. The aim of our study was to present 24-hour Holter
monitoring examination results in pediatric patients presenting with palpitations, chest pain and syncope.


Material and Methods:
Anamnesis, physical examination findings, ECG, echocardiography (ECHO) and 24-hour Holter recordings of 450 children, who were admitted to our clinic between January 2016 and January 2018 with palpitations, chest pain
and syncope were evaluated retrospectively.

Results: Of 450 patients included in this study, 240 (53.3%) were female and 210 (46.6%) were male. The ages of the patients ranged
between 3-18 years (11.9±4.1). According to complaints of the patients, palpitation, chest pain and syncope were present in 220 (48.8%),
170 (37.7%) and 60 (13.1%) cases, respectively. When ECGs of the patients were evaluated, the frequency of arrhythmias was 6.6%
(30/450): 9 patients had supraventricular ectopic beats (SVE) and 21 patients had ventricular extrasystoles (VES). Congenital or acquired
heart diseases were detected with ECHO in 64 (14.9%) of the patients. Eighteen (28%) of 64 patients with pathological ECHO findings had
arrhythmias. In 24-hour Holter recordings, the frequency of total arrhythmias was found to be 34.6% (156/450); SVE, VES, SVT and VT
were seen in 65, 84, 3 and 4 patients, respectively. The incidence of arrhythmia was significantly higher in patients with syncope (51.6%)
than palpitations (31.3%) and chest pain (32.9%).

Conclusion: In children with palpitations, chest pain and syncope, sometimes the underlying cause can not be detected clearly with history
taking, physical examination and ECG. Therefore in this condition, we thought that it

References

  • 1. Patel S, Yazdi F, Perez M. Management of Pediatric Chest Pain, Palpitations, Syncope, and Murmur Presenting to the Emergency Department. Clinical Pediatric Emergency Medicine 2018;19:328-38.
  • 2. Premkumar S, Premkumar S, Sangaralingam T. Clinical Profile of Cardiac Arrhythmias in Children Attending the OutPatient Department of a Tertiary Paediatric Care Centre in Chennai.J Clin Diagn Res 2016;10: 06-08.
  • 3. Yiğit F. Ambulatuar Elektrokardiyografik Kayıt .TürkDisritmi, Pacemaker ve Elektrofizyoloji Dergisi 2007;5:109-23.
  • 4. Alexander ME, Berul CI. Ventricular arrhythmias: whentoworry. Pediatr Cardiol 2000;21:532-41.
  • 5. Niwa K, Warita N, Sunami Y, Shimura A , Tateno T, Sugita K.Prevalence of arrhythmias and conduction disturbances in large population-based samples of children. CardiolYoung 2004;14:68–74.
  • 6. Wren C, O’Sullivan JJ, Wright C. Sudden death in children and adolescents. Heart 2000; 83: 410-13.
  • 7. Sekar RP.Epidemiologyof Arrhythmias in Children. Indian Pacing Electrophysiol J 2008; 8:8-13.
  • 8. Kılıç Z, Karataş Z, Uçar B. Çocuklarda Retrospektif Üç Yıllık Holter Monitorizyonu Deneyimi. Yeni Tıp Dergisi 2012;29:95-99.
  • 9. Clausen H. Theophilus T, Jackno K, Babl FE. Paediatric arrhythmias in the emergency department. EmergMed J 2012; 29: 732-37.
  • 10. Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias*— Executive Summary A Report of the American College of Cardiology/American Heart AssociationTask Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation 2003;108:909-1871.
  • 11. BlackK.D, Seslar S.P, Woodward G.A.Cardiogenic Causes of Pediatric Syncope. Clinical Pediatric Emergency Medicine 2011;12:266-77.
  • 12. Hallıoğlu O, Giray D, Karpuz D, Özyurt A. Çarpıntı, göğüs ağrısı ve senkop yakınmalı çocuklarda holter monitorizasyon sonuçları: Sekiz yıllık deneyim. Mersin Univ Saglık Bilim Derg 2017;10:82-7.
  • 13. Levine MM. Neurally mediated syncope in children: Results of tilt testing, treatment and longterm follow-up. Pediatr Cardiol 1999;20: 331–35.
  • 14. Hegazy RA, Ltfy WN. The value of holtermonitoring in the assessment of pediatricpatients. Indian Pacing Electrophysiol J 2007;7:204-14.
  • 15. Karamanlı G, Kibar Gül A.E, Azak E, Gürsu H.A, Çetin İ.İ, Çocukluk Çağında Çarpıntı Yakınması ile Başvuran Hastalarda Ritim Holter Monitorizasyon Sonuçlarının Değerlendirilmesi; Türkiye Çocuk Hastalıkları Dergisi 2020:1-8(Basım aşamasında) DOI:10.12956/tchd.524017
  • 16. Kennedy H. Use of long-term (Holter) Electrocardiographic recordings. In: Zipes D, Jalife J, (eds). Cardiac Electrophysiology from cell tobedside. 3rd ed. WB. Saunders; 2000: 717–30.
  • 17. Ruby F. River R.F,Pau lChambers P, Ceresnak R. S. Evaluation of ChildrenWith Palpitations. Clinical Pediatric Emergency Medicine 2011;12:278-88.
  • 18. Drossner DM, Hirsh DA, Sturm JJ, Mahle WT, Goo DJ, Massey R, et al. Cardiacdisease in pediatric patients presenting to a pediatric ED with chestpain. Am J EmergMed 2011;29:632-48.
  • 19. Park MG. Child with chestpain. In: Park MK. (Ed). Pediatric Cardiology for Practitioners, 6th ed. Philadelphia : Elseviers Saunders, 2014: 505-15.
  • 20. Kervancıoğlu M, Devecioğlu C, Okur N. Çocuk Kardiyolojisi Polikliniğine Göğüs Ağrısı Yakınmasıyla Başvuran Hastaların Değerlendirilmesi. Dicle Med J 2005;32:196-200.
  • 21. Uysal F, Bostan ÖM, Çetinkaya F, Deniz T, Çil E. Çocuklarda Senkop: Ritim Holter Monitörizasyonu Gerekli mi? J Curr Pediatr 2016;14:124-28.

Çarpıntı, Göğüs Ağrısı ve Senkop Yakınması Olan Çocukların Holter Kayıtları: Tek Merkez Deneyimi

Year 2021, Volume: 15 Issue: 3, 192 - 197, 25.05.2021
https://doi.org/10.12956/tchd.688288

Abstract

Amaç: Hastalar ve aileleri için endişe verici yakınmalardan olan çarpıntı, göğüs ağrısı ve senkop gibi belirtiler kalp ritim
bozukluklarının habercisi olabilmektedir. Altta yatan ciddi ritim bozukluklarının tanısında elektrokardiyografi (EKG) bazen
yetersiz kalabilmektedir. Bu çalışmadaki amacımız çarpıntı, göğüs ağrısı ve senkop yakınması ile gelen çocuk hastalarda
24 saatlik ritim Holter inceleme sonuçlarının sunulmasıdır.

Gereç ve Yöntemler: Kliniğimize Ocak 2016 - Ocak 2018 tarihleri arasında çarpıntı, göğüs ağrısı ve senkop şikayeti ile
başvuran 450 çocuk hastanın anamnez, fizik muayene bulguları, EKG, ekokardiyografi (EKO) ve 24 saatlik ritim Holter
kayıtları geriye dönük olarak değerlendirildi.

Bulgular: Çalışmaya alınan hastaların 240’ı (%53.3) kız, 210’u (%46.6) erkekti. Hastaların yaşları 3-18 yaş arasında
(11.9±4.1) değişmekteydi. Şikayetlerine göre bakıldığında çarpıntı 220 (%48.8), göğüs ağrısı 170 (%37.7) ve senkop
60 (%13.1) hastada vardı. Elektrokardiyografide aritmi sıklığı %6.6 (30/450) saptanmakta iken bunlardan 9 hastada
supraventriküler ektopik atım (SVE) ve 21 hastada ventriküler ekstra atım (VES) olduğu görüldü. Yapılan EKO’ların
64’ünde (%14.9) konjenital veya edinsel kalp hastalığı olduğu tespit edildi. Patolojik EKO bulguları olan 64 hastanın
18’inin (%28) 24 saatlik ritim Holter kayıtlarında aritmi vardı. 24 saatlik ritim Holter kayıtlarında toplam aritmi sıklığı
%34.6 (156/450) saptandı; bunların 65’inde SVE, 84’ünde VES, üçünde supraventriküler taşikardi (SVT) ve dördünde
ventriküler taşikardi (VT) görüldü. Aritmi görülme sıklığı senkoplu (%51.6) hastalarda çarpıntısı (%31.3) ve göğüs ağrısı
(%32.9) olanlara göre anlamlı olarak daha fazla saptandı.

Sonuç: Çarpıntı, göğüs ağrısı ve senkop gibi yakınmalarla aritmi görülme sıklığı senkoplu hastalarda çarpıntısı ve göğüs
ağrısı olanlara göre anlamlı olarak daha fazla saptandı. 

References

  • 1. Patel S, Yazdi F, Perez M. Management of Pediatric Chest Pain, Palpitations, Syncope, and Murmur Presenting to the Emergency Department. Clinical Pediatric Emergency Medicine 2018;19:328-38.
  • 2. Premkumar S, Premkumar S, Sangaralingam T. Clinical Profile of Cardiac Arrhythmias in Children Attending the OutPatient Department of a Tertiary Paediatric Care Centre in Chennai.J Clin Diagn Res 2016;10: 06-08.
  • 3. Yiğit F. Ambulatuar Elektrokardiyografik Kayıt .TürkDisritmi, Pacemaker ve Elektrofizyoloji Dergisi 2007;5:109-23.
  • 4. Alexander ME, Berul CI. Ventricular arrhythmias: whentoworry. Pediatr Cardiol 2000;21:532-41.
  • 5. Niwa K, Warita N, Sunami Y, Shimura A , Tateno T, Sugita K.Prevalence of arrhythmias and conduction disturbances in large population-based samples of children. CardiolYoung 2004;14:68–74.
  • 6. Wren C, O’Sullivan JJ, Wright C. Sudden death in children and adolescents. Heart 2000; 83: 410-13.
  • 7. Sekar RP.Epidemiologyof Arrhythmias in Children. Indian Pacing Electrophysiol J 2008; 8:8-13.
  • 8. Kılıç Z, Karataş Z, Uçar B. Çocuklarda Retrospektif Üç Yıllık Holter Monitorizyonu Deneyimi. Yeni Tıp Dergisi 2012;29:95-99.
  • 9. Clausen H. Theophilus T, Jackno K, Babl FE. Paediatric arrhythmias in the emergency department. EmergMed J 2012; 29: 732-37.
  • 10. Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias*— Executive Summary A Report of the American College of Cardiology/American Heart AssociationTask Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation 2003;108:909-1871.
  • 11. BlackK.D, Seslar S.P, Woodward G.A.Cardiogenic Causes of Pediatric Syncope. Clinical Pediatric Emergency Medicine 2011;12:266-77.
  • 12. Hallıoğlu O, Giray D, Karpuz D, Özyurt A. Çarpıntı, göğüs ağrısı ve senkop yakınmalı çocuklarda holter monitorizasyon sonuçları: Sekiz yıllık deneyim. Mersin Univ Saglık Bilim Derg 2017;10:82-7.
  • 13. Levine MM. Neurally mediated syncope in children: Results of tilt testing, treatment and longterm follow-up. Pediatr Cardiol 1999;20: 331–35.
  • 14. Hegazy RA, Ltfy WN. The value of holtermonitoring in the assessment of pediatricpatients. Indian Pacing Electrophysiol J 2007;7:204-14.
  • 15. Karamanlı G, Kibar Gül A.E, Azak E, Gürsu H.A, Çetin İ.İ, Çocukluk Çağında Çarpıntı Yakınması ile Başvuran Hastalarda Ritim Holter Monitorizasyon Sonuçlarının Değerlendirilmesi; Türkiye Çocuk Hastalıkları Dergisi 2020:1-8(Basım aşamasında) DOI:10.12956/tchd.524017
  • 16. Kennedy H. Use of long-term (Holter) Electrocardiographic recordings. In: Zipes D, Jalife J, (eds). Cardiac Electrophysiology from cell tobedside. 3rd ed. WB. Saunders; 2000: 717–30.
  • 17. Ruby F. River R.F,Pau lChambers P, Ceresnak R. S. Evaluation of ChildrenWith Palpitations. Clinical Pediatric Emergency Medicine 2011;12:278-88.
  • 18. Drossner DM, Hirsh DA, Sturm JJ, Mahle WT, Goo DJ, Massey R, et al. Cardiacdisease in pediatric patients presenting to a pediatric ED with chestpain. Am J EmergMed 2011;29:632-48.
  • 19. Park MG. Child with chestpain. In: Park MK. (Ed). Pediatric Cardiology for Practitioners, 6th ed. Philadelphia : Elseviers Saunders, 2014: 505-15.
  • 20. Kervancıoğlu M, Devecioğlu C, Okur N. Çocuk Kardiyolojisi Polikliniğine Göğüs Ağrısı Yakınmasıyla Başvuran Hastaların Değerlendirilmesi. Dicle Med J 2005;32:196-200.
  • 21. Uysal F, Bostan ÖM, Çetinkaya F, Deniz T, Çil E. Çocuklarda Senkop: Ritim Holter Monitörizasyonu Gerekli mi? J Curr Pediatr 2016;14:124-28.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Hüseyin Yılmaz 0000-0002-9971-9669

Fatih Şap 0000-0001-7870-9704

Muhammed Güneş This is me 0000-0002-8739-4553

Emin Ünal This is me 0000-0002-7297-0319

Mehmet Burhan Oflaz 0000-0003-1515-4654

Tamer Baysal This is me 0000-0001-6145-1831

Publication Date May 25, 2021
Submission Date February 17, 2020
Published in Issue Year 2021 Volume: 15 Issue: 3

Cite

Vancouver Yılmaz H, Şap F, Güneş M, Ünal E, Oflaz MB, Baysal T. Çarpıntı, Göğüs Ağrısı ve Senkop Yakınması Olan Çocukların Holter Kayıtları: Tek Merkez Deneyimi. Türkiye Çocuk Hast Derg. 2021;15(3):192-7.


The publication language of Turkish Journal of Pediatric Disease is English.


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