ECG Criteria and Diagnostic Score for Right Atrial Disease in Children: The CHILDHEART Study

To develop a novel diagnostic electrocardiogram (ECG) score to improve the early detection of right atrial disease (RAD) in pediatric patients with congenital heart disease (CHD). We conducted a retrospective case-control study involving 219 pediatric patients aged 0 to 14 years with confirmed CHD and 1,418 controls without congenital disease. The ECG data were analyzed to identify specific criteria predictive of RAD. Receiver operating characteristic (ROC) curves and multivariate analyses were used to refine and develop a diagnostic score. Key variables assessed included right bundle branch block (RBBB), a pure R wave in V1, an initial q wave in V1, an S wave greater than the R wave in V6, and RV1 + SV6 ≥ 18 mm. The diagnostic score demonstrated robust performance. In children under 3 years, the score achieved an area under the curve (AUC) of 0.826 (95% CI: 0.779-0.879). A score of ≥ 2 had a sensitivity of 63.2% and specificity of 89.7%. For children aged 3 years and older, the score had an AUC of 0.817 (95% CI: 0.764-0.871), with a sensitivity of 48.67% and specificity of 98.1%. The CHILDHEART diagnostic score provides a practical and reliable tool for identifying RAD in pediatric patients using a standard 12-lead ECG. This score offers significant potential for early diagnosis and improved management of RAD in children, especially in clinical settings where advanced imaging modalities may not be readily available.