• The results of transtelephonic electrocardiography for transient symptomatic event recording in 61 consecutive pediatric patients (aged 4 months to 21 years) were reviewed. In 13 (21%) of 61 patients, previous arrhythmia diagnoses had been made by electrophysiologic study; monitoring was utilized to evaluate symptoms before or after pharmacological/surgical therapy. Transtelephonic electrocardiography was used to study undocumented symptomatic events consistent with an arrhythmia in the remaining 48 (79%) of 61 patients. Adequate transmissions during symptoms were obtained in 36 (59%) of 61 patients. Goals of monitoring were achieved in all 13 patients with previous diagnoses. Of the 25 of 48 patients without prior diagnoses who provided transmissions during symptoms, 15 had sinus rhythm, while 10 manifested an arrhythmia. Abnormal transmissions were most common in patients with palpitations and never evident in patients with symptoms of chest pain.