The electrocardiogram in patients with scoliosis

Electrocardiograms of 802 patients with isolated scoliosis followed and/or operated at Columbia Presbyterian Medical Center were reviewed. There were 586 patients younger than 18 years and 216 patients older than 18 years of age. There were 86 males and 716 females. Eleven patients had associated congenital heart disease. Effects of age, site of scoliosis, side of convexity and severity of curvature on multiple electrocardiographic variables were analysed. Electrocardiographic variables such as heart rate, Q-Tc, P wave amplitude, P-R interval, amplitude of R and S waves in V1 and V6 were similar to data reported in the normal population without scoliosis. The effect of age on these electrocardiographic variables was similar to changes reported in the normal population and were not affected by site of scoliosis or side of curvature. The frontal QRS axis was within normal limits of 94% in patients under 18 years of age with right-sided thoracic scoliosis and in 87% of patients over 18 years. Evidence of right axis deviation (5%) and right ventricular hypertrophy (2%) were present equally in patients younger and older than 18 years of age and 8% of patients over 18 years old. Since in our patient population the degree of scoliosis severity increased with age it is likely that the increasing incidence of left axis deviation found in patients over 18 years of age with scoliosis is related to scoliosis severity and the altered intrathoracic cardiac orientation. Because right axis deviation and right ventricular hypertrophy are noted occasionally in patients with scoliosis and because congenital heart disease and pulmonary disease are more prevalent in this patient population, it is recommended that the presence of right axis deviation and right ventricular hypertrophy on the ECG should lead to a complete cardiopulmonary evaluation and exclusion of possible additional cardiac or pulmonary anomalies.