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      Study of Cardiac Rate and Rhythm Patterns in Ambulatory and Hospitalized Children

      a , a , b

      Cardiology

      S. Karger AG

      Heart rate, Heart rhythm, Holter recording

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          Abstract

          Our aim was to underline possible differences in heart rate and rhythm patterns between ambulatory and hospitalized children. Holter monitoring was performed on 264 healthy ambulatory children and on 112 children who were hospitalized for noncardiotoxic conditions. Maximal, mean and minimal heart rates decreased with age. Maximal heart rate was significantly higher in ambulatory schoolchildren and adolescents than in hospitalized ones. Sinus arrhythmia was noted on every recording. Some children had episodes of first- or second-degree atrioventricular block while sleeping. Supraventricular and uniform ventricular extrasystoles were common. The incidence of all types of arrhythmia and conduction disturbances was similar in ambulatory and hospitalized children. These data can be taken as a basis for the analysis of 24-hour electrocardiogram monitoring in ambulatory but also in hospitalized children.

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          Most cited references 9

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          24-hour electrocardiographic study of heart rate and rhythm patterns in population of healthy children.

          Twenty-four hour electrocardiographic recordings were made on 104 randomly selected, healthy 7 to 11-year-old children. Ninety-two were technically adequate and suitable for analysis. The mean highest heart rate measured by direct electrocardiographic analysis over nine beats was 164 +/- 17. The mean lowest heart rates were 49 +/- 6 over three beats', and 56 +/- 6 over nine beats' duration. The maximum duration of heart rates less than 55/minute was 40 minutes. At their lowest heart rates 41 children (45 per cent) had junctional escape rhythms, the maximum duration of which was 25 minutes. Nine children showed PR intervals greater than or equal to 0.20 s and included three with Mobitz type I second degree atrioventricular block. Nineteen (21%) had isolated supraventricular or ventricular premature beats (less than 1/hour). Sixty subjects (65%) had sinus pauses that could not be distinguished on the surface electrocardiogram from those previously described as sinuatrial exit block or sinus arrest. The maximum duration of sinus pause measured over 24 hours on each child was 1.36 +/- 0.23 seconds. Thus apparently healthy children show variations in heart rate and rhythm over 24 hours hitherto considered to be abnormal.
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            Study of cardiac rhythm in healthy newborn infants.

            Twenty-four-hour electrocardiograms were recorded in the first 10 days of life on 134 healthy full-term infants with birthweights greater than 2.5 kg. The highest heart rate a minute, measured over nine beats, was 175 +/- 19 (SD). The lowest rates, measured over three, five, and nine beats were 82 +/- 12, 87 +/- 12, and 93 +/- 12, respectively. At their lowest rates 109 infants had sinus bradycardia and 25 had junctional escape rhythms. Thirty-three infants showed changes in P wave configuration with or without pronounced variation in PR interval. Atrial premature beats were present in 19 infants but only one had more than 12 per hour. In a randomly selected subgroup of 71 infants sinus pauses were found in 51 (72%). Five (7%) had electrocardiographic patterns and rhythm disturbances that could not be differentiated from those previously described as complete sinuatrial exit block or sinus arrest, eight (11%) had patterns indistinguishable from 2:1 sinuatrial block, and 23 (32%) had pattern indistinguishable from sinuatrial Wenckebach block. This study shows that normal infants have variations in heart rate and rhythm hitherto considered to be abnormal.
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              Results of 24 hour ambulatory monitoring of electrocardiogram in 131 healthy boys aged 10 to 13 years.

              Ambulatory monitoring of the electrocardiogram was performed in 131 healthy boys aged between 10 and 13 years for two consecutive periods of 24 hours. When awake the maximal heart rates ranged from 100 to 200 and the minimal from 45 to 80 beats per minute. During sleep maximal rates were 60 to 110 beats and minimal rates 30 to 70 beats per minute. Sinus arrhythmia was seen in every boy and in 36 (27.5%) no other changes were found. Sinuatrial block, Mobitz type I, was not seen. Sinuatrial block, Mobitz type II, occurred twice only. Complete sinuatrial block occurred in 8.4 per cent, never lasted more than one cycle, and was always followed by a junctional beat. First degree atrioventricular block occurred in 8.4 per cent and Mobitz type I atrioventricular block in 10.7 per cent. Premature beats were always single, atrial in 13 per cent, ventricular in 26 per cent, and except in two boys were never more than four in 24 hours. There were no episodes of ventricular or supraventricular tachycardia. Changes in P wave morphology were common and slow junctional rhythm occurred in 13 per cent during sleep.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2005
                June 2005
                10 June 2005
                : 103
                : 4
                : 174-179
                Affiliations
                aDivision of Pediatric Cardiology and bDepartment of Mathematics, University of Liège, Liège, Belgium
                Article
                84590 Cardiology 2005;103:174–179
                10.1159/000084590
                15785025
                © 2005 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 4, References: 10, Pages: 6
                Categories
                Pediatric Cardiology

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