High prevalence of widened P waves among pediatric patients in 2 separate hospitals
Ray M Loo1, Vignendra Ariyarajah, Debra O'Brien
1Department of Pediatrics, Nassau University Medical Center, East Meadow, New York, USA.
Insights
Pediatric P-wave duration increases with age, particularly after age 10. Clinicians should use age-appropriate P-wave cutoffs for accurate assessment of interatrial conduction in infants and children.
Area of Science:
- Pediatric Cardiology
- Electrocardiography
- Cardiac Electrophysiology
Background:
- P-wave duration in adults is linked to disease, but pediatric cutoffs are lower and may vary with age.
- Physiological increases in heart mass with age may affect P-wave duration in children.
- Current P-wave duration cutoffs for pediatric populations are not age-proportionate.
Purpose of the Study:
- To determine if P-wave duration increases proportionally with age in hospitalized infants and children.
- To investigate the prevalence of widened P-wave durations using established normal cutoffs.
- To establish age-based P-wave duration norms for pediatric patients.
Main Methods:
- 12-lead electrocardiograms were obtained from 96 non-acute pediatric patients (0.1-16 years).
- P-wave durations were measured to the nearest 10 milliseconds by blinded readers.
- Linear regression analysis was used to assess the relationship between age and P-wave duration.
Main Results:
- P-wave duration significantly increased with age (r(2) = 0.44).
- Age was the sole predictor of increasing P-wave durations.
- A notable increase in P-wave duration was observed in patients aged 10 years and older.
Conclusions:
- P-wave duration is significantly associated with age in infants and children.
- A substantial increase in P-wave duration occurs at age 10 and older.
- Pediatricians and cardiologists must use age-appropriate P-wave cutoffs for accurate interatrial conduction assessment.
Introduction:
In adults, P waves of 110 milliseconds or longer are often associated with significant disease. In the pediatric population, however, cutoffs for P-wave durations are naturally lower but could vary physiologically with age because of increasing heart mass. We appraised if age-proportionate increase in P-wave duration does indeed occur in both hospitalized infants and children and also investigated the prevalence of widened P-wave durations using currently accepted "normal" cutoffs (
Methods:
We consecutively obtained 12-lead electrocardiograms of infants and children aged up to 16 years (range, 0.1-16 years; mean +/- SD, 10.1 +/- 5.2 years; male, 46.9%) who presented through the emergency department for nonacute, noncardiac conditions at the Nassau University Medical Center (NUMC), East Meadow, NY, and Saint Vincent Hospital (SVH), Worcester, MA, from January to May 2006. Electrocardiograms were then evaluated for the greatest P-wave duration in every lead to the nearest 10 milliseconds using a calibrated magnifying graticule on a blinded, single read.
Results:
The study sample consisted of 96 nonacute pediatric patients: infants and children from NUMC (age, 0.1-16 years; mean +/- SD, 9.1 +/- 5.4 years; male, 46.6%) and children from SVH (age, 6-16 years; mean +/- SD, 13.1 +/- 2.5 years; male, 47.8%). Prolonged P waves longer than 70 milliseconds were present in 3 (23%) of the 13 NUMC infants, whereas prolonged P waves longer than 90 milliseconds were observed in 16 (27%) of the 60 NUMC children and 7 (30%) of the 23 SVH children. Linear regression analysis revealed that age was the sole predictor of increasing P-wave durations on any lead [age = -15.33 + 0.30 (P-wave duration [milliseconds]); r(2) = 0.44]. Moreover, there was a significant increase in P-wave duration for patients aged 10 years or older, where a notable step-up in such measurements was observed.
Conclusion:
P-wave duration is significantly associated with age among hospitalized children as well as infants, where particular increase occurs at 10 years of age or older. General pediatricians and, more importantly, pediatric cardiologists, need to be more vigilant in using appropriate age-based P-wave cutoffs when assessing interatrial conduction in this population.
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