Holter Electrocardiographic Approach to Predicting Outcomes of Pediatric Patients With Long QT Syndrome

Background: This study was performed to clarify the clinical findings of pediatric patients diagnosed with long QT syndrome (LQTS) through electrocardiographic screening programs and to predict their outcome using Holter electrocardiographic approaches. Methods and Results: This retrospective study included pediatric patients with a Schwartz score of >= 3.5 who visited the National Hospital Organization Kagoshima Medical Center between April 2005 and March 2019. Resting 12 -lead and Holter electrocardiograms were recorded at every visit. The maximum resting QTc and maximum Holter QTc values among all recordings were used for statistical analyses. To test the prognostic value of QTc for the appearance of cardiac events after the first hospital visit, receiver operating characteristic curves were used to calculate the area under the curve (AUC). Among 207 patients, 181 (87%) were diagnosed through screening programs. The prevalence of cardiac events after the first hospital visit was 4% (8/207). Among QTc at diagnosis, maximum resting QTc, and maximum Holter QTc, only maximum Holter QTc value was a predictor (P=0.02) of cardiac events after the hospital visit in multivariate regression analysis. The AUC of the maximum Holter QTc was significantly superior to that of maximum resting QTc. Conclusions: The maximum Holter QTc value can be used to predict the appearance of symptoms in pediatric patients with LQTS.