The body surface QRST isointegral maps in infants with right ventricular overload
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Published on: December 22, 2023
N Izumida1, K Kiyohara, Y Asano
1Department of Pediatrics, Faculty of Medicine, Tokyo Medical and Dental University, Japan.
Insights
The QRST isointegral map (QRST-Imap) effectively diagnoses right ventricular (RV) overload in infants. This body surface potential mapping method shows distinct patterns for conditions like atrial septal defect, pulmonary stenosis, and tetralogy of Fallot.
Area of Science:
- Cardiology
- Biomedical Engineering
- Pediatric Electrophysiology
Background:
- Standard electrocardiographic criteria for infant right ventricular (RV) hypertrophy have limited diagnostic accuracy.
- Accurate diagnosis of RV overload in infants is crucial for timely intervention.
Purpose of the Study:
- To evaluate the diagnostic utility of the QRST isointegral map (QRST-Imap) for detecting right ventricular (RV) overload in infants.
- To differentiate patterns of RV overload in specific congenital heart diseases.
Main Methods:
- Utilized QRST isointegral mapping of body surface potential distribution in infants.
- Compared QRST-Imaps of infants with RV overload (atrial septal defect, pulmonary stenosis, tetralogy of Fallot) to age-matched healthy infants.
- Analyzed spatial distribution and amplitude of QRST-Imap maxima.
Main Results:
- Healthy infants (NOR) exhibited a single dipole pattern with one maximum on the left anterior chest.
- Infants with RV overload showed abnormal QRST-Imaps with two maxima or a rightward shift of the maximum with increased amplitude.
- Specific patterns were observed for atrial septal defect (two maxima, decreased integral), pulmonary stenosis (two maxima, increased right integral correlating with pressure), and tetralogy of Fallot (single anterior median maximum, increased amplitude).
Conclusions:
- QRST-Imaps provide valuable insights into the presence and specific patterns of right ventricular overload in infants.
- This technique offers improved diagnostic accuracy compared to traditional electrocardiographic criteria for RV hypertrophy in this age group.
Abstract:
Electrocardiographic criteria for right ventricular (RV) hypertrophy in infants generally exhibit low sensitivity in terms of diagnostic accuracy. We studied the QRST isointegral map (QRST-Imap) of body surface potential distribution for the diagnosis of RV overload in patients less than 2 years old. Patients with atrial septal defect (ASD), pulmonary stenosis (PS) and tetralogy of Fallot (TOF) were examined (RV overload group) and the findings of their QRST-Imaps were compared to those of age-matched healthy infants (NOR). QRST-Imaps in RV overload showed abnormal findings, with two maxima or a rightward shift of the maximum with increased amplitude, in contrast to one maximum at the left anterior chest with a single dipole pattern in the NOR group. ASD patients had two maxima with a decreased integral value between them. In PS, two maxima were also observed, with increased integral values of the right maximum as the RV systolic pressure was elevated. TOF patients showed a single maximum shifted to the anterior median line with increased amplitude. These results indicate that the findings of QRST-Imaps are of value in detecting the presence and pattern of RV overload in infants.
