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The crochetage pattern in electrocardiograms of pediatric atrial septal defect patients
J S Cohen1, D J Patton, R M Giuffre
1Alberta Children's Hospital, Calgary, Canada.
Insights
The crochetage pattern on pediatric electrocardiograms shows 31.7% sensitivity for detecting secundum atrial septal defects but has high specificity, especially when present in all inferior limb leads.
Area of Science:
- Pediatric Cardiology
- Electrocardiography
- Congenital Heart Disease
Background:
- Secundum atrial septal defects (ASDs) are common congenital heart anomalies.
- Early detection of ASDs is crucial for timely intervention and management.
- Non-invasive diagnostic tools, including electrocardiography (ECG), are vital in pediatric cardiology.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the crochetage pattern in pediatric ECGs for identifying secundum ASDs.
- To determine the sensitivity and specificity of the crochetage pattern in detecting secundum ASDs.
Main Methods:
- Retrospective review of ECGs from 82 pediatric patients with confirmed secundum ASDs.
- Comparison with 244 control pediatric patients with various cardiac conditions or normal echocardiograms.
- Assessment for right ventricular hypertrophy and the crochetage pattern in inferior limb leads.
Main Results:
- The crochetage pattern was present in 31.7% of pediatric patients with secundum ASDs.
- High specificity (greater than 92%) was observed when the crochetage pattern appeared in all three inferior limb leads.
- No significant association was found between the crochetage pattern and incomplete right bundle branch block.
Conclusions:
- The crochetage pattern demonstrates a sensitivity of 31.7% and a specificity of 86.1% for secundum ASDs in pediatric patients.
- The crochetage pattern in inferior limb leads exhibits high specificity for diagnosing atrial septal defects in children.
- ECG crochetage pattern is a valuable, albeit not fully sensitive, indicator for pediatric ASD detection.
Objectives:
To test the sensitivity and specificity of the crochetage pattern (a notch near the apex of the R wave in electrocardiographic inferior limb leads) in the pediatric electrocardiogram for detecting patients with a secundum atrial septal defect.
Patients And Methods:
Electrocardiograms from 82 consecutive preoperative pediatric patients with a secundum atrial septal defect confirmed by two-dimensional echocardiography were reviewed for evidence of right ventricular hypertrophy and the crochetage pattern. These electrocardiograms were compared with 244 consecutive preoperative controls consisting of patients with echocardiographically proven patent foramen ovale, ventricular septal defect, pulmonary stenosis, tetralogy of Fallot and patients with normal echocardiogram studies.
Results:
The electrocardiographic crochetage pattern was observed in 31.7% of preoperative patients with a secundum atrial septal defect in at least one inferior limb lead. The specificity of the crochetage pattern for the detection of a secundum atrial septal defect was high when present in all three inferior limb leads (greater than 92%). The crochetage pattern in at least one lead in secundum atrial septal defects shows no association with incomplete right bundle branch block (c2(1)=0.80, not significant), and thus these two findings together do not improve the detection of an atrial septal defect.
Conclusions:
The sensitivity and specificity of the electrocardiographic crochetage patterns in at least one inferior limb lead in echocardiographically proven secundum atrial septal defects are 31.7% and 86.1%, respectively. The electrocardiographic crochetage or notching pattern in inferior limb leads has a high specificity for atrial septal defects in the pediatric population.