Pediatric Electrocardiogram in Preparticipation Screening: Narrative Review of Normal Values in Key Features

Area of Science:

• Pediatric Cardiology
• Sports Medicine
• Diagnostic Electrocardiography

Background:

• Electrocardiography (ECG) is a critical noninvasive tool for preparticipation screening of competitive athletes to detect heart disease.
• Interpreting pediatric ECGs is complex due to significant variations in age-specific reference values across studies.
• Variability in normal pediatric ECG values for left ventricular hypertrophy (LVH), QTc prolongation, and pre-excitation impacts screening efficacy.

Purpose of the Study:

• To compare current pediatric ECG reference ranges for key features relevant to LVH, QTc, PR, and QRS duration.
• To identify physiological and methodological factors contributing to the observed variability in pediatric ECG reference values.

Main Methods:

• A comprehensive literature review of biomedical databases was conducted.
• Studies reporting quantitative ECG reference values in healthy children (infancy through adolescence) for selected key features were included.
• Reported values were descriptively summarized, focusing on developmental trends and methodological influences.

Main Results:

• ECG parameters showed consistent age-dependent patterns across 16 pediatric studies, despite variations in absolute values.
• PR intervals and QRS duration increased with age; QTc values remained stable with minimal sex differences.
• Variability was greater for amplitude-based parameters (e.g., R-wave, S-wave) than for duration parameters, influenced by population, acquisition, and measurement methods.

Conclusions:

• This review consolidates contemporary pediatric ECG reference data essential for detecting LVH, pre-excitation, and QT prolongation in young athletes.
• Understanding variability sources is crucial for refining ECG screening protocols in pediatric populations.