The electrocardiogram and the secundum atrial septal defect: a reexamination in the era of echocardiography
Zufelt, K.; Rosenberg, H.C.; Li, M.D.; Joubert, G.I.
Canadian Journal of Cardiology 14(2): 227-232
1998
ISSN/ISBN: 0828-282X PMID: 9520859 Document Number: 490820
BACKGROUND: Ostium secundum atrial septal defects (ASDs) often present subtly and may be a diagnostic challenge to the community physician. Characteristic abnormalities of the electrocardiogram (ECG) have been described in adults. OBJECTIVE: To determine whether ECG abnormalities are consistently present in children with a hemodynamically significant ASD, and their potential for differentiating this group from patients with innocent murmurs. DESIGN: Retrospective evaluation of clinical characteristics, echocardiographic data, and ECGs was undertaken in 67 consecutive children with an ASD (mean age 2.9+-2.8 years, 63% female) and 77 patients with innocent murmur (mean age 3.2+-2.6 years, 61% mate). Predetermined ECG criteria were derived from adult studies (rsR'-V1 with evidence of right ventricular hypertrophy, isolated rsR'-V1, and unequivocal right ventricular hypertrophy without rsR'-V1). ECGs were interpreted blindly by two-observers. RESULTS: In the ASD group 58 (87%) patients had an ECG that met predetermined criteria compared with three (3.9%) controls (P<0.001). Completely normal ECGs were found in only four (6.0%) ASD patients compared with 66 (86%) controls (P<0.001). The ECG criteria had a sensitivity of 86% (95% CI 0.784 to 0.947) and a specificity of 96% (95% CI 0.918 to 1.000). When any ECG abnormality was considered the sensitivity increased to 94% (95% CI 0.884 to 0.997) with a decline in specificity to 86% (95% CI 0.779 to 0.935). CONCLUSIONS: The ECG is potentially a valuable adjunct to the physical examination in differentiating children with an ASD from those with an innocent murmur in the primary care setting.