Faculty Collaboration Database

Electrocardiograms in Healthy North American Children in the Digital Age. Circ Arrhythm Electrophysiol 2018 Jul;11(7):e005808

Date

06/23/2018

Pubmed ID

29930156

Pubmed Central ID

PMC6034977

DOI

10.1161/CIRCEP.117.005808

Scopus ID

2-s2.0-85055073305 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

BACKGROUND: Interpretation of pediatric ECGs is limited by lack of accurate sex- and race-specific normal reference values obtained with modern technology for all ages. We sought to obtain contemporary digital ECG measurements in healthy children from North America, to evaluate the effects of sex and race, and to compare our results to commonly used published datasets.

METHODS: Digital ECGs (12-lead) were retrospectively collected for children ≤18 years old with normal echocardiograms at 19 centers in the Pediatric Heart Network. Patients were classified into 36 groups: 6 age, 2 sex, and 3 race (white, black, and other/mixed) categories. Standard intervals and amplitudes were measured; mean±SD and 2nd/98th percentiles were determined by age group, sex, and race. For each parameter, multivariable analysis, stratified by age, was conducted using sex and race as predictors. Parameters were compared with 2 large pediatric ECG data sets.

RESULTS: Among ECGs from 2400 children, significant differences were found by sex and race categories. The corrected QT interval in lead II was greater for girls compared with boys for age groups ≥3 years (P≤0.03) and for whites compared with blacks for age groups ≥12 years (P<0.05). The R wave amplitude in V6 was greater for boys compared with girls for age groups ≥12 years (P<0.001), for blacks compared with white or other race categories for age groups ≥3 years (P≤0.006), and greater compared with a commonly used public data set for age groups ≥12 years (P<0.0001).

CONCLUSIONS: In this large, diverse cohort of healthy children, most ECG intervals and amplitudes varied by sex and race. These differences have important implications for interpreting pediatric ECGs in the modern era when used for diagnosis or screening, including thresholds for left ventricular hypertrophy.

Author List

Saarel EV, Granger S, Kaltman JR, Minich LL, Tristani-Firouzi M, Kim JJ, Ash K, Tsao SS, Berul CI, Stephenson EA, Gamboa DG, Trachtenberg F, Fischbach P, Vetter VL, Czosek RJ, Johnson TR, Salerno JC, Cain NB, Pass RH, Zeltser I, Silver ES, Kovach JR, Alexander ME, Pediatric Heart Network Investigators*

Author

Joshua Kovach MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Age Factors
Child
Child, Preschool
Electrocardiography
Female
Health Status Disparities
Healthy Volunteers
Heart Rate
Humans
Infant
Infant, Newborn
Male
North America
Observer Variation
Predictive Value of Tests
Reference Values
Reproducibility of Results
Retrospective Studies
Sex Factors
Signal Processing, Computer-Assisted