Normal electrocardiographic patterns in school-aged children: Data from a sports cardiology screening program

Assessing pediatric ECG variations to enhance screening accuracy, thus helps address challenges in distinguishing normal developmental changes from potential cardiac pathology. This study aims to establish age- and sex-specific ECG reference patterns in healthy young athletes to improve clinical interpretation during pre-participation screening, thereby reducing false positives and optimizing referral practices.

Of 320 patients evaluated at a cardio sports clinic, 243 healthy participants (114 aged 5-9 years; 129 aged 10-16 years) were included. No significant sex-based differences were found in age or weight within either age group. In the 10-16-year group, females had significantly higher heart rates (p = 0.020), while males had longer PR intervals (p = 0.011); no significant differences were observed in QTc or QRS durations. All participants demonstrated normal sinus rhythm and QRS axis. T-wave inversion patterns, commonly seen in leads V1-V3 among 5-9-year-olds and isolated to V1 in 10-16-year-olds. ECG abnormalities such as prolonged QTc or Wolff-Parkinson-White (WPW) pattern were infrequent, with only respiratory sinus arrhythmia being significantly more common in older females (p = 0.035).

The findings highlight the clinical implication of considering age and sex when interpreting pediatric ECGs, particularly in the context of sports screening. While most parameters showed no significant differences, the observed variations in heart rate and PR interval in older children suggest that sex-specific reference values may be beneficial in clinical practice.