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Electrocardiograms in Healthy North American Children in the Digital Age
Elizabeth V Saarel1, Suzanne Granger2, Jonathan R Kaltman3
1Cleveland Clinic Children's, OH (E.V.S.) saarele@ccf.org.
Insights
Pediatric electrocardiogram (ECG) interpretation requires updated, diverse reference values. This study found significant sex and race variations in ECG measurements for children, impacting diagnosis and screening.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Clinical Diagnostics
Background:
- Pediatric electrocardiogram (ECG) interpretation is challenged by a lack of current, sex- and race-specific normal reference values.
- Modern technology is needed to obtain these reference values across all pediatric age groups.
Purpose of the Study:
- To establish contemporary digital ECG measurements in healthy North American children.
- To evaluate the influence of sex and race on these ECG parameters.
- To compare findings with existing pediatric ECG datasets.
Main Methods:
- Retrospective collection of 12-lead digital ECGs from 2400 children (≤18 years) with normal echocardiograms.
- Classification into 36 groups based on age, sex, and race (white, black, other/mixed).
- Measurement of standard ECG intervals and amplitudes, with analysis of mean±SD and 2nd/98th percentiles, and multivariable analysis.
Main Results:
- Significant variations in ECG intervals and amplitudes were observed across sex and race categories.
- Corrected QT interval in lead II was longer in girls (≥3 years) and in white children (≥12 years) compared to respective counterparts.
- R wave amplitude in V6 was greater in boys (≥12 years) and in black children (≥3 years) compared to respective counterparts.
Conclusions:
- Most pediatric ECG intervals and amplitudes demonstrate variability based on sex and race in a diverse cohort.
- These sex- and race-specific differences are crucial for accurate interpretation of pediatric ECGs in contemporary clinical practice.
- Findings have implications for diagnostic thresholds, including those for left ventricular hypertrophy.
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.
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