24-hour ambulatory ECGs in the detection and management of cardiac dysrhythmias in infants and children

Summary Sixty-four 24-hour ambulatory ECGs (cardioscans) were recorded in 47 patients, 5 days to 24 years of age, using a new commercially available miniature tape recorder and analysis system to evaluate known or suspected dysrhythmias. Only two of the 64 cardioscans were inadequate for interpretation, and the study was based on the 62 that could be interpreted. A dysrhythmia was found in 84% (52/62) and in 48% (30/62) a dysrhythmia was detected on the cardioscan, which had not been present on the previous standard 15-lead ECG.Of 25 cardioscans done to determine the cause of symptoms, symptoms coincided with dysrhythmia in only three; in 13 the symptoms did not occur during the cardioscan although dysrhythmia was recorded; in nine the symptoms did occur but no dysrhythmia was recorded, excluding dysrhythmia as their cause.Twenty-five of 44 cardioscans done to judge the adequacy of medical therapy for a dysrhythmia suggested that the therapy was suboptimal. Changes in therapy based on the cardioscan resulted in improvement in 21 patients and partial or no improvement in four patients.Useful information was detected in five of 13 postoperative cardioscans and in one of three cardioscans performed on children with artificial pacemakers.Of 25 cardioscans showing potentially life-threatening dysrhythmias, 12 showed an increase during sleep of frequency or duration of dysrhythmic episodes, five showed no change during sleep, and eight showed a decrease during sleep.The 24-hour cardioscan is a useful means of detecting and managing dysrhythmias in the pediatric age group.Supported in part by grant HL-07190 from the National Institutes of Health and by Public Health Service grant RR-00188 from the General Clinical Research Branch, National Institutes of Health. Dr. Gillette is recipient of a National Institutes of Health Research Career Development Award HL00571.Presented in part at the 26th Annual Scientific Session of the American College of Cardiology, Las Vegas, Nevada, March 1977