DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20192044

Experience with Holter monitoring for evaluation of infant arrhythmia

Anita Baghel, Manoj Kumar, J. P. Soni, Mudit Agarwal, Ravi Kumar

Abstract


Background: Arrhythmia is defined as abnormal heart rates. Sometimes they are intermittent and difficult to diagnose on routine ECG. Neonatologist and Pediatrician needs to rapidly establish accurate diagnosis and management for infants suspected to have arrhythmia. Hence Holter monitoring of the infants presenting with symptoms suggestive of arrhythmia is necessary as it provides a continuous record of heart’s electrical activity. The aim of this paper is to find out the role of continuous ambulatory electrocardiographic monitoring in daily clinical practice of Pediatrics.

Methods: All infants including neonates, either inborn or brought to the paediatric emergency with risk factors, between January 2016 to January 2018, were included in this prospectively study. Evaluation including chest X-ray, standard 12-lead electrocardiography, 24 hours continuous ECG monitoring using Mortara holter, echocardiography, biochemical and haematological analysis.

Results: A total of 73 babies were enrolled in present study. In this study arrhythmia was found in 29 (39.72%) new-borns. The most common arrhythmia observed was supraventricular tachycardia (SVT) (41.3%). Other arrhythmia observed were ventricular tachycardia (VT), AV block (34.4%), atria premature beats (3.4%) and ventricular premature beats (6.89%), tachy-bradyarrhythmia (3.4%) and junctional rhythm (3.4%). Of 29 arrhythmia patients four were diagnosed solely by Holter monitoring. None of the babies had long QT syndrome on Holter monitoring.

Conclusions: Cardiac arrhythmias are important causes of infant morbidity, and mortality if undiagnosed and untreated. It is important for the neonatologist and paediatrician to be aware of these of arrhythmias and the various diagnostic modalities available for them. A Holter electrocardiogram may be of value in identification of these transient arrhythmic events.


Keywords


Arrhythmia, Infant, Holter

Full Text:

PDF

References


Guadalupe Delgado-Onofre M. Rhythm disorders in neonates Luis Martín Garrido-García1.2014;35 (2):134.

Sharon Scott Morey. ACC/AHA guidelines for ambulatory ECG. Am Fam Physician. 2000 ;61 (3):884.

Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M,et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American college of cardiology/American heart association task force and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death). J Am Coll Cardiol. 2006;48(5):e247-346.

Binnetoğlu FK, Babaoğlu K, Altun G, Türker G. Diagnosis, treatment and follow up of neonatal arrhythmias. Cardiovasc J Africa. 2014;25(2):58.

Satar M, Narli N, Ozbarlas N, Yapicioglu-Yildizdas H, Kucukosmanoglu O, Ozlu F, et al. Evaluation of 21 infants with arrythmia in the neonatal period. J Cocuk Sagligi Dis. 2006;49(2):107.

Ko JK, Deal BJ, Strasburger JF, Benson Jr DW. Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardio. 1992;69(12):1028-32.

Lupoglazoff JM, Denjoy I. Attitude toward arrhythmia in the neonate and infant. Arch Pediatr. 2004;11:1268-73.

Gilljam T, Jaeggi E, Gow RM. Neonatal supraventricular tachycardia: outcomes over a 27-year period at a single institution. Acta Paediatr. 2008; 97:1035-9.

Kundak AA, Dilli D, Karagöl B, Karadağ N, Zenciroğlu A, Okumuş N, et al. Non benign neonatal arrhythmias observed in a tertiary neonatal intensive care unit. Indian J Pediatr. 2013;80(7):555-9.

Helton MR. Diagnosis and management of common types of supraventricular tachycardia. Am Fam Physic. 2015;92(9):793-800.

Poddar B, Basu S, Parmar VR. Neonatal arrhythmias. Indian J Pediatr. 2006; 73:131-4.

Southall D, Richards JE, Mitchell P, Brown DJ, Johnston PG, Shinebourne EA. Study of cardiac rhythm in healthy newborn infants. Heart. 1980;43(1):14-20.

Pinsky WW, Gillette PC, Garson A, McNamara DG. Diagnosis, management, and long-term results of patients with congenital complete atrioventricular block. Pediatr. 1982;69(6):728-33.

Badrawi N, Hegazy RA, Tokovic E, Lotfy W, Mahmoud F, Aly H. Arrhythmia in the neonatal intensive care unit. Pediatr Cardiol. 2009;30(3):325-30.