Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy

Area of Science:

• Pediatric Cardiology
• Cardiovascular Research
• Diagnostic Electrocardiography

Background:

• Hypertrophic cardiomyopathy (HCM) is a significant cause of pediatric morbidity and mortality.
• Early recognition and management of pediatric HCM are crucial.
• Electrocardiograms (ECGs) are vital screening tools for pediatric heart disease, but patterns in HCM are not well-defined.

Purpose of the Study:

• To describe the electrocardiogram (ECG) patterns in a large international cohort of children and adolescents with hypertrophic cardiomyopathy (HCM).
• To identify common and atypical ECG abnormalities in pediatric HCM.
• To assess the utility of ECG findings in prompting further diagnostic evaluation.

Main Methods:

• Retrospective review of 482 ECGs from an international cohort of pediatric and adolescent patients (≤21 years) diagnosed with HCM.
• Analysis of ECG findings including left ventricular hypertrophy (LVH), biventricular hypertrophy (BVH), strain patterns, and pathologic Q waves.
• Correlation of ECG abnormalities with HCM diagnosis.

Main Results:

• 88% of pediatric HCM patients exhibited abnormal ECGs.
• The most frequent abnormalities were left ventricular hypertrophy (LVH) or biventricular hypertrophy (BVH) (46%), often with a strain pattern (60% of LVH/BVH cases).
• A significant proportion of patients (9%) showed isolated strain patterns, and 15% had isolated pathologic Q waves, highlighting ECG findings beyond typical hypertrophy.

Conclusions:

• Pediatric hypertrophic cardiomyopathy frequently presents with diverse ECG abnormalities, including those not solely indicative of hypertrophy.
• The presence of LVH, BVH, strain patterns, or pathologic Q waves on ECG in children warrants further investigation.
• ECG findings in pediatric HCM are critical for early detection and should prompt echocardiographic assessment to rule out the condition.