Pediatric ECG Interpretation

Introduction

Electrocardiography (ECG) is a crucial tool for evaluating the heart's electrical activity, particularly in pediatric patients. However, reading ECGs in children requires an understanding of normal age-related variations, as their cardiovascular physiology is different from that of adults.

Key Differences Between Pediatric and Adult ECGs

  1. Higher Heart Rates: Infants and young children naturally have faster heart rates, often exceeding 100 beats per minute.
  2. Right Ventricular Dominance: Due to intrauterine circulation, newborns show a rightward electrical axis and increased right ventricular forces, which gradually shift with age.
  3. Shorter PR and QT Intervals: Children have faster conduction times due to higher baseline heart rates.
  4. Variation in QRS Axis: The QRS axis in neonates is often rightward but normalizes as the child grows.
  5. T-wave Changes: Inversion of T-waves in anterior leads (V1-V3) is common in children until adolescence and should not be mistaken for pathology.

Common Pediatric ECG Abnormalities

  1. Congenital Long QT Syndrome: Prolonged QT interval can predispose to life-threatening arrhythmias.
  2. Wolff-Parkinson-White (WPW) Syndrome: Presence of delta waves suggests pre-excitation pathways.
  3. Hypertrophic Cardiomyopathy: Deep Q waves and repolarization abnormalities may suggest this condition.
  4. Congenital Heart Block: Often seen in neonates with maternal autoimmune disease.
  5. Arrhythmias: Supraventricular tachycardia (SVT) is the most common pediatric arrhythmia.

When to Refer to a Pediatric Cardiologist

  • Unexplained syncope or seizure-like episodes.
  • Family history of sudden cardiac death.
  • Persistent QT prolongation or features suggestive of WPW.
  • Symptoms such as chest pain, palpitations, or dizziness associated with ECG changes.

Conclusion

Pediatric ECG interpretation requires knowledge of age-specific normal values and recognition of common abnormalities. In case of doubt, referral to a pediatric cardiologist is advised.

Source recommendations

1. American Heart Association Guidelines on Pediatric ECG Interpretation

  1. https://www.ahajournals.org/doi/10.1161/circulationaha.108.191095
  2. https://elearning.heart.org/courses
  3. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
  4. https://www.ahajournals.org/doi/10.1161/CIRCEP.119.008253
  5. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf

2. European Society of Cardiology Guidelines on Pediatric Arrhythmias

  1. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  2. https://pubmed.ncbi.nlm.nih.gov/26320108/
  3. https://academic.oup.com/eurheartj/article/36/41/2793/2293363
  4. https://pubmed.ncbi.nlm.nih.gov/36017572/
  5. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Consensus-statement-on-paediatric-arrhythmias-released-by-ESC-and-AEPC

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