Diagnostic value of ECG patterns of right ventricular hypertrophy in children.
OBJECTIVE
To determine the diagnostic value of traditional criteria of right ventricular hypertrophy (RVH) in children.


METHODS
The electrocardiograms (ECGs) of 1000 consecutive pediatric patients were reviewed. Children under three months old were excluded as were patients with QRS prolongation.


RESULTS
Four hundred and thirty-four patients met all inclusion criteria. The medical records were then reviewed for diagnosis. Sixty-seven per cent had a diagnosis compatible with RVH. Of the ECG patterns evaluated, a precociously upright T wave in lead V1 was most predictive with 99% specificity. Presence of a QR complex in lead V1 had a 96% specificity but R:S ratio, voltage criteria and rSR' incomplete right bundle branch block pattern had intermediate specificities of 66%, 66% and 52%, respectively. Sensitivities of 12.6%, 13.2%, 34.0%, 63.3% and 74.2% were calculated for upright T, QR complex, R:S ratio, voltage criteria and rSR', respectively.


CONCLUSIONS
An upright T wave or qR pattern are highly specific but insensitive markers of RVH in children. In contrast, when an incomplete right bundle branch block exists, the rSR' pattern is a relatively sensitive but nonspecific predictor of RVH.
Fretz
E B
EB
Department of Paediatrics, Children's Hospital of Western Ontario, University of Western Ontario, London.
Rosenberg
H C
HC
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D006327:Heart Block / Q000150:complications*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D016017:Odds Ratio; D012189:Retrospective Studies; D012680:Sensitivity and Specificity