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Defining the electrocardiogram in the neonate with hypoplastic left heart syndrome

Michael A Monaco1, Leonardo Liberman, Thomas J Starc

  • 1Division of Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, 3959 Broadway, CH-2 North, New York, NY, 10032-3784, USA.

Pediatric Cardiology
|January 22, 2015
PubMed

Insights

Hypoplastic left heart syndrome (HLHS) shows distinct ECG patterns, including longer PR intervals and wider QRS complexes. These findings help identify this severe congenital heart defect in neonates.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Electrocardiography

Background:

  • Hypoplastic left heart syndrome (HLHS) is a critical congenital heart defect.
  • A defined electrocardiogram (ECG) pattern for HLHS in a large population is lacking.

Purpose of the Study:

  • To identify a classic ECG pattern in neonates with HLHS.
  • To compare ECG findings in HLHS patients with a control group.

Main Methods:

  • Retrospective review of ECGs from 89 neonates with HLHS (2001-2011) before surgery.
  • Comparison of ECG parameters between HLHS patients and age-matched controls.

Main Results:

  • HLHS patients exhibited longer PR intervals, wider QRS complexes, and decreased left-sided forces (lower voltage S waves in V1, R waves in V6).
  • Absence of Q waves in lateral precordial and inferior leads, abnormal frontal plane QRS axis, and preexcited appearance were more common in HLHS.
  • 20% of HLHS patients presented with a normal ECG.

Conclusions:

  • Specific ECG findings are associated with HLHS, aiding in diagnosis.
  • ECG can reveal decreased left ventricular forces and conduction abnormalities in HLHS.
  • Despite characteristic findings, a normal ECG does not exclude HLHS.

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