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Age-related criteria for signal-averaged electrocardiographic late potentials in children
Y Hayabuchi1, S Matsuoka, M Kubo
1Department of Pediatrics, University of Tokushima School of Medicine, Japan.
Insights
Signal-averaged electrocardiogram (SA-ECG) parameters show significant age-related differences in children, particularly in infants, impacting ventricular late potential criteria. Heart rate does not affect these SA-ECG findings.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Biomedical Engineering
Background:
- Signal-averaged electrocardiography (SA-ECG) is used to assess ventricular electrical activity.
- Establishing age-specific reference values for SA-ECG parameters is crucial for accurate interpretation in pediatric populations.
- Previous studies have not fully characterized the age-related normative data for SA-ECG in children.
Purpose of the Study:
- To determine age-related criteria for signal-averaged electrocardiographic (SA-ECG) parameters in healthy children.
- To establish normative values for SA-ECG parameters across different pediatric age groups.
- To investigate the influence of heart rate on SA-ECG parameters in children.
Main Methods:
- SA-ECGs were recorded from 82 healthy volunteers across six age groups (infancy to adulthood).
- Right atrial pacing was performed in 4 children with ventricular septal defect to assess heart rate effects.
- Statistical analysis was used to identify age-related trends and correlations between parameters.
Main Results:
- Root mean square voltage (RMS) was higher, while filtered QRS (f-QRS) duration and low amplitude signal (LAS) duration were lower in children compared to adults.
- Late duration (LD) showed no significant age-related differences.
- Age-specific criteria for ventricular late potentials were defined based on RMS, LAS, f-QRS, and LD values.
- RMS and LAS correlated significantly with f-QRS duration, suggesting association with ventricular muscle thickness and conduction time.
- Right atrial pacing did not alter measured SA-ECG parameters.
Conclusions:
- SA-ECG parameters exhibit significant age-related variations in children, necessitating age-specific criteria for interpreting ventricular late potentials.
- These differences are likely attributed to developmental changes in ventricular muscle thickness and conduction time, not heart rate.
- The established age-related criteria provide a valuable reference for pediatric SA-ECG analysis.
Abstract:
This study examined the age-related criteria of signal-averaged electrocardiographic (SA-ECG) parameters in children. SA-ECGs were obtained in 82 healthy volunteers in six groups depending on age (group 1: 1 day to < 1 month; group 2: 1 month to < 1 year; group 3: 1 to < 6 years; group 4: 6 to < 12 years; group 5: 12 to < 20 years; group 6: 20 to < 40 years). To examine the effect of heart rate on the parameters of SA-ECG, right atrial pacings were performed in 4 children with a ventricular septal defect aged 1-7 years. The root mean square voltage (RMS) was high; and the filtered QRS (f-QRS) duration and the duration of the low amplitude signal (LAS) were low during childhood, especially in infants (group 2), compared with those in adults. Late duration (LD) had no significant difference among age groups. The criteria for ventricular late potential were as follows: RMS < 25 microV, LAS > 35 ms, f-QRS duration > 110 ms, and LD > 35 ms for those age 1 day to < 1 month; RMS < 40 microV, LAS > 30 ms, f-QRS duration > 100 ms, and LD > 35 ms for those age 1 month to < 1 year; RMS < 20 microV, LAS > 40 ms, f-QRS duration > 130 ms, and LD > 35 ms for those age 1 to < 20 years; and RMS < 15 microV, LAS > 45 ms, f-QRS duration > 135 ms, and LD > 35 ms for those age 20 to < 40 years. RMS and LAS correlated with f-QRS duration (r = -0.78 and 0.76, respectively; p < 0.05), suggesting that these parameters are associated with the thickness of the ventricular muscle and the ventricular conduction time. Right atrial pacing had no effect on the measured SA-ECG parameters. The age-related differences in SA-ECG parameters might be due to age-related differences in the thickness of the ventricular muscle and the ventricular conduction time but are not due to differences in the heart rate. The age difference of each parameter on SA-ECG should be considered for ventricular late potentials.