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Holter recording is the most efficacious cardiac examination during routine daily activities and in the nighttime to detect different cardiac abnormalities such as arrhythmias, ischemia, disturbance of the cardiac autonomic nerve activities, and to evaluate the symptoms such as palpitation, atypical angina, or syncope. To improve the electrical signal quality, the adequate attachment of the electrodes to the cleaned skin is required. When the cardiac events occur rarely, cardiac event recorders are indicated. Two types of event recorders are available: Loop recorders which can save the electrical abnormalities for 30 sec to 60 sec prior to pressing the recording button (presymptom recording). The other is an event monitor without loop memory. When symptoms occur, the patient presses a button to start the recording (patient activation). Now, many Holter ECG softwares are available such as Lorenz plot, Winkle plot, 3D expression of ST-segments displacement, heart rate variability, heart rate turbulence, QT interval, microvolt T-wave alternans and SAECG late potentials. However, standard data about HRV, HRT, QT dynamics, and TWA in infants and children are not established.

Holter ECG in Pediatric Patients, How to Record and Analyze