During the acute phase of acute rheumatic fever (ARF), cardiac arrhythmias and conduction disorders may occur. Standard electrocardiogram (ECG) may be insufficient in the cases of possible paroxysmal rhythm or conduction abnormalities. The aim of this study is to evaluate arrhythmias and conduction disorders and benefits of 24-hour Holter ECG on detecting these disorders in children with ARF. Two hundred and ten patients who were diagnosed with ARF during a four-year period, were retrospectively analyzed. Demographic characteristics, clinical, laboratory, and echocardiographic findings of the patients were evaluated. Standard ECG and 24-hour Holter analysis were examined. First (47.8%), second (6.9%) and third degree (4.3%) atrioventricular (AV) blocks, bundle branch blocks (9.8%), intermittent pre-excitation (1.1%), accelerated nodal rhythm (15.2%), supraventricular (10.9%) and ventricular premature contractions (8.7%), as well as supraventricular (3.3%) and ventricular tachycardia (1.1%) were detected with 24 -hour Holter ECG. Frequency of both rhythm and conduction abnormalities were detected higher with Holter ECG than 12-lead ECG, and this was statistically significant (p
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1. Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers 2016; 2: 15084.
2. Kula S, Olgunturk R, Ozdemir O. Two unusual presentations of acute rheumatic fever. Cardiol Young 2005; 15: 514-516.
3. Balli S, Oflaz MB, Kibar AE, Ece I. Rhythm and conduction analysis of patients with acute rheumatic fever. Pediatr Cardiol 2013; 34: 383- 389.
4. Karacan M, Isikay S, Olgun H, Ceviz N. Asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever: 24-hour electrocardiography study. Cardiol Young 2010; 20: 620-630.
5. Hubail Z, Ebrahim IM. Advanced heart block in acute rheumatic fever. J Saudi Heart Assoc 2016; 28: 113-115.
6. Ramoglu MG, Epcacan S, Yesilbas O. Acute rheumatic fever presenting with severe endocarditis involving four valves, and ventricular tachycardia. Cardiol Young 2019; 29: 78-81.
7. Argun M, Baykan A, Ozyurt A, Pamukcu O, Uzum K, Narin N. Syncope due to complete atrioventricular block and treatment with a transient pacemaker in acute rheumatic fever. Turk Pediatri Ars 2018; 53: 197-199.
8. Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation 2015; 131: 1806-1618.
9. Karthikeyan G, Guilherme L. Acute rheumatic fever. Lancet 2018; 392 : 161-174.
10. Narin N, Mutlu F, Argun M, et al. Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998-2011. Cardiol Young 2015; 25: 745-751.
11. Guilherme L, Kalil J. Rheumatic fever and rheumatic heart disease: cellular mechanisms leading autoimmune reactivity and disease. J Clin Immunol 2010; 30: 17-23.
12. Jaine R, Baker M, Venugopal K. Acute rheumatic fever associated with household crowding in a developed country. Pediatr Infect Dis J 2011; 30: 315-319.
13. Cann MP, Sive AA, Norton RE, McBride WJ, Ketheesan N. Clinical presentation of rheumatic fever in an endemic area. Arch Dis Child 2010; 95: 455-457.
14. Ceviz N, Celik V, Olgun H, Karacan M. Accelerated junctional rhythm in children with acute rheumatic fever: is it specific to the disease? Cardiol Young 2014; 24: 464-468.
15. Liberman L, Hordof AJ, Alfayyadh M, Salafia CM, Pass RH. Torsade de pointes in a child with acute rheumatic fever. J Pediatr 2001; 138: 280-282.
16. Carano N, Bo I, Tchana B, Vecchione E, Fantoni S, Agnetti A. Adams-Stokes attack as the first symptom of acute rheumatic fever: report of an adolescent case and review of the literature. Ital J Pediatr 2012; 38: 61.
17. Oba Y, Watanabe H, Nishimura Y, et al. A Case of Adult-Onset Acute Rheumatic Fever With Long-Lasting Atrioventricular Block Requiring Permanent Pacemaker Implantation. Int Heart J 2015; 56: 664-667.
18. Sokolow M. Significance of electrocardiographic changes in rheumatic fever. Am J Med 1948; 5: 365-378.
19. Zalzstein E, Maor R, Zucker N, Katz A. Advanced atrioventricular conduction block in acute rheumatic fever. Cardiol Young 2003; 13: 506-508.
20. Reddy DV, Chun LT, Yamamoto LG. Acute rheumatic fever with advanced degree AV block. Clin Pediatr 1989; 28: 326-328.
21. Yahalom M, Jerushalmi J, Roguin N. Adult acute rheumatic fever: a rare case presenting with left bundle branch block. Pacing Clin Electrophysiol 1990; 13: 123-127.
22. Olgun H, Ceviz N. Unusual rhythm problems in acute rheumatic fever: two patient reports. Clin Pediatr 2004; 43: 197-199.
23. Ergul Y MH, Nisli K, Aydogan U, Dindar A, Eker-Omeroglu R. A Rare Rhythm Abnormality in Acute Rheumatic Fever: Supraventricular Tachycardia. J Child 2011; 11: 36-38.
24. Kayali Ş DV, Keskin M, Yoldaş T, et al. Rhythm Disturbances in the Acute Stage of Acute Rheumatic Fever; Report of Four Cases. Ann Pediatr Child Health 2015; 3: aid1051.