Right ventricular apical activation time in children. Reference standards for clinical use

Area of Science:

• Pediatric Cardiology
• Cardiac Electrophysiology
• Congenital Heart Disease

Background:

• Differentiating proximal from peripheral right bundle-branch block is challenging in pediatric populations.
• Existing reference standards for right ventricular apical (RVA) activation time are lacking for infants and children.
• Accurate conduction time measurements are vital for diagnosing and managing cardiac conditions in pediatric patients.

Purpose of the Study:

• To establish reference standards for RVA activation time in a pediatric cohort.
• To provide normative data for assessing right bundle-branch conduction in children of varying ages.
• To aid in the differentiation of proximal versus peripheral right bundle-branch block in pediatric cardiology.

Main Methods:

• Intracardiac electrography was performed on 123 children undergoing surgery for congenital cardiac malformations.
• His bundle and RVA electrograms were recorded prior to surgical intervention.
• Surface ECGs were assessed to exclude pre-existing conduction defects.

Main Results:

• The average RVA activation time was 15 ± 7 msec (standard deviation).
• A linear increase in RVA activation time with age was observed, from infancy to adolescence.
• These findings provide a basis for age-specific reference values.

Conclusions:

• The established RVA activation times serve as valuable reference standards for pediatric populations.
• These data can assist clinicians in diagnosing conduction abnormalities in children.
• This study contributes essential electrophysiological data for pediatric cardiac care and research.