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Electrocardiographic P-wave amplitude as a discriminative marker for pediatric atrial septal defects
Takashi Kumamoto1, Masafumi Sanefuji1, Hiroto Doi1
1Department of Pediatrics, Faculty of Medicine, Saga University, Nabeshima, Saga 849-8501, Japan.
Insights
Accurate P-wave amplitude measurement on ECGs can help detect pediatric atrial septal defects (ASD). This method shows promise for identifying significant ASDs, outperforming traditional ECG markers.
Area of Science:
- Pediatric Cardiology
- Diagnostic Electrocardiography
- Congenital Heart Disease
Background:
- Atrial septal defects (ASD) are often asymptomatic in children, leading to delayed diagnosis.
- Electrocardiography (ECG) has limited sensitivity for ASD detection, primarily relying on QRS abnormalities.
- P-wave analysis is underutilized due to measurement challenges.
Purpose of the Study:
- To evaluate the diagnostic utility of baseline-corrected P-wave amplitude for identifying pediatric secundum ASD.
- To compare the performance of P-wave amplitude with conventional ECG findings in ASD detection.
Main Methods:
- Analysis of digital ECG data from 45 pediatric ASD patients and 94 controls.
- Utilized a semi-automated algorithm for precise, baseline-corrected P-wave amplitude measurement.
- Employed receiver operating characteristic (ROC) curve analysis to assess diagnostic performance.
Main Results:
- P-wave amplitude in lead V3 demonstrated high overall performance (AUROC 0.883).
- For defects ≥5 mm, V3 amplitude showed excellent performance (AUROC 0.954), with high sensitivity and specificity.
- P-wave amplitude correlated well with right atrial size, outperforming IRBBB detection.
Conclusions:
- Baseline-corrected P-wave amplitude shows significant potential for detecting hemodynamically significant pediatric ASD.
- Further research, including external validation and automated algorithms, is needed for clinical application.
Background:
Atrial septal defects (ASD) are often asymptomatic during childhood, resulting in a delayed diagnosis. Electrocardiography (ECG) screening is known to have a limited ability to detect ASD, relying mainly on QRS abnormalities, such as incomplete right bundle branch block (IRBBB). In contrast, P waves have been underused because they are small, often on a trended baseline, and thus difficult to quantify accurately. This observational study examined the utility of baseline-corrected P-wave amplitude in the identification of ASD.
Methods:
We analyzed digital ECG data from 45 secundum ASD patients 4-9 years old and 94 matched controls without structural heart defects. Using a semi-automated algorithm, we precisely measured the P-wave amplitude following rigorous baseline correction. We conducted a receiver operating characteristic (ROC) curve analysis to differentiate ASD patients from controls.
Results:
The overall performance of the P-wave amplitude in lead V3 was high, with an area under the ROC curve (AUROC) of 0.883. When the analysis was limited to patients with defect sizes of ≥5 mm, the V3 amplitude had an excellent AUROC (0.954) with 83.3% sensitivity and 95.7% specificity, outperforming conventional ECG findings, including IRBBB. This significance was supported by a good correlation between the V3 amplitude and the right atrial size quantified by echocardiography.
Conclusions:
The present study demonstrates the potential utility of accurately measured P-wave amplitude for the detection of hemodynamically significant pediatric ASD. Further investigations, including external validation in diverse clinical settings and the development of a fully automated analytic algorithm, are required before clinical implementation.
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