Right Atrial Enlargement on Electrocardiogram in Previously Healthy Young Patients

Area of Science:

• Pediatric Cardiology
• Diagnostic Imaging
• Clinical Electrophysiology

Background:

• Right atrial enlargement (RAE) is a potential indicator of cardiac conditions in pediatric patients.
• Electrocardiogram (ECG) is a common initial diagnostic tool, but its accuracy for specific findings like RAE requires validation.
• Echocardiography serves as a gold standard for assessing cardiac chamber dimensions and morphology.

Purpose of the Study:

• To evaluate the correlation between RAE identified on ECG and confirmed RAE via echocardiogram in previously healthy young individuals.
• To identify specific ECG criteria that may increase the likelihood of true RAE on echocardiogram, guiding further diagnostic workup.

Main Methods:

• Retrospective analysis of 162 previously healthy young patients with ECGs interpreted as RAE by a pediatric cardiologist.
• Echocardiograms were obtained within 90 days of ECGs, with RAE defined as an RA z score >2.
• ECG criteria for RAE and right ventricular hypertrophy were reviewed.

Main Results:

• The overall positive predictive value (PPV) of ECG-diagnosed RAE for true RAE on echocardiogram was low at 14%.
• In patients younger than 1 year, the PPV for RAE was significantly higher (35%) compared to older children (7%).
• True RAE on echocardiogram was associated with RAE criteria in anterior precordial leads (V1-V3) and right ventricular hypertrophy on ECG.

Conclusions:

• ECG findings suggestive of RAE have limited accuracy in confirming true RAE on echocardiogram in the general pediatric population.
• Younger infants (<1 year), presence of RAE in anterior leads (V1-V3), and signs of right ventricular hypertrophy on ECG are indicators that warrant closer echocardiographic evaluation for RAE.