Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy

Mayme Marshall; Aneeq Malik; Maully Shah; Frank A Fish; Susan P Etheridge; Peter F Aziz; Mark W Russell; Svjetlana Tisma; Andreas Pflaumer; Narayanswami Sreeram; Peter Kubus; Ian H Law; Michal J Kantoch; Naomi J Kertesz; Margaret Strieper; Christopher C Erickson; Jeremy P Moore; Stephanie J Nakano; Harinder R Singh; Philip Chang; Mitchell Cohen; Anne Fournier; Maria V Ilina; Frank Zimmermann; Michaela Horndasch; Walter Li; Anjan S Batra; Leonardo Liberman; Robert Hamilton; Christopher M Janson; Shubhayan Sanatani; Ilana Zeltser; George McDaniel; Andrew D Blaufox; Jason M Garnreiter; Seshadri Balaji

doi:10.1007/s00246-023-03252-4

Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy

Pediatr Cardiol. 2024 Dec;45(8):1692-1701. doi: 10.1007/s00246-023-03252-4. Epub 2023 Sep 9.

Authors

Mayme Marshall¹, Aneeq Malik², Maully Shah³, Frank A Fish⁴, Susan P Etheridge⁵, Peter F Aziz¹, Mark W Russell⁶, Svjetlana Tisma⁷, Andreas Pflaumer⁸, Narayanswami Sreeram⁹, Peter Kubus¹⁰, Ian H Law¹¹, Michal J Kantoch¹², Naomi J Kertesz¹³, Margaret Strieper¹⁴, Christopher C Erickson¹⁵, Jeremy P Moore¹⁶, Stephanie J Nakano¹⁷, Harinder R Singh¹⁸, Philip Chang¹⁹, Mitchell Cohen²⁰, Anne Fournier²¹, Maria V Ilina²², Frank Zimmermann²³, Michaela Horndasch²⁴, Walter Li²⁵, Anjan S Batra²⁶, Leonardo Liberman²⁷, Robert Hamilton²⁸, Christopher M Janson³, Shubhayan Sanatani²⁹, Ilana Zeltser³⁰, George McDaniel³¹, Andrew D Blaufox³², Jason M Garnreiter³³, Seshadri Balaji³⁴

Affiliations

¹ Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
² University of Los Angeles Olive View, Los Angeles, CA, USA.
³ Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁴ Vanderbilt University, Nashville, TN, USA.
⁵ University of Utah, Salt Lake City, UT, USA.
⁶ C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
⁷ Nemours Children's Hospital, Wilmington, DE, USA.
⁸ Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia.
⁹ University of Cologne, Cologne, Germany.
¹⁰ Motol University, Prague, Czech Republic.
¹¹ University of Iowa, Iowa City, IA, USA.
¹² University of Alberta, Edmonton, AB, Canada.
¹³ Nationwide Children's Hospital, Columbus, OH, USA.
¹⁴ Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
¹⁵ Children's Specialty Physicians, University of Nebraska Medical Center, Omaha, NE, USA.
¹⁶ University of California, Los Angeles, CA, USA.
¹⁷ University of Colorado, Denver, CO, USA.
¹⁸ Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, USA.
¹⁹ Children's Mercy Hospital, Kansas City, MO, USA.
²⁰ Inova LJ Murphy Children's Hospital, Falls Church, VA, USA.
²¹ University of Montreal, Montreal, QC, Canada.
²² Royal Children's Hospital, Glasgow, Scotland, UK.
²³ Advocate Hospital, Chicago, IL, USA.
²⁴ German Heart Center, Munich, Germany.
²⁵ University of California, San Francisco, CA, USA.
²⁶ University of California, Irvine, CA, USA.
²⁷ Columbia University, New York, NY, USA.
²⁸ Hospital for Sick Kids, Toronto, ON, Canada.
²⁹ University of British Columbia, Vancouver, BC, Canada.
³⁰ University of Texas-Southwestern, Dallas, TX, USA.
³¹ University of Virginia, Charlottesville, VA, USA.
³² Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
³³ Saint Louis University, Saint Louis, MO, USA.
³⁴ Oregon Health and Science University, 707 SW Gaines Street, Portland, OR, 97239, USA. balajis@ohsu.edu.

PMID: 37684488
DOI: 10.1007/s00246-023-03252-4

Abstract

Hypertrophic cardiomyopathy (HCM), a common cardiomyopathy in children, is an important cause of morbidity and mortality. Early recognition and appropriate management are important. An electrocardiogram (ECG) is often used as a screening tool in children to detect heart disease. The ECG patterns in children with HCM are not well described.ECGs collected from an international cohort of children, and adolescents (≤ 21 years) with HCM were reviewed. 482 ECGs met inclusion criteria. Age ranged from 1 day to 21 years, median 13 years. Of the 482 ECGs, 57 (12%) were normal. The most common abnormalities noted were left ventricular hypertrophy (LVH) in 108/482 (22%) and biventricular hypertrophy (BVH) in 116/482 (24%) Of the patients with LVH/BVH (n = 224), 135 (60%) also had a strain pattern (LVH in 83, BVH in 52). Isolated strain pattern (in the absence of criteria for hypertrophy) was seen in 43/482 (9%). Isolated pathologic Q waves were seen in 71/482 (15%). Pediatric HCM, 88% have an abnormal ECG. The most common ECG abnormalities were LVH or BVH with or without strain. Strain pattern without hypertrophy and a pathologic Q wave were present in a significant proportion (24%) of patients. Thus, a significant number of children with HCM have ECG abnormalities that are not typical for "hypertrophy". The presence of the ECG abnormalities described above in a child should prompt further examination with an echocardiogram to rule out HCM.

Keywords: Electrocardiogram; Hypertrophic cardiomyopathy; Left ventricular hypertrophy; Pediatric; Strain; Sudden death.

MeSH terms

Adolescent
Cardiomyopathy, Hypertrophic* / complications
Cardiomyopathy, Hypertrophic* / diagnosis
Cardiomyopathy, Hypertrophic* / physiopathology
Child
Child, Preschool
Electrocardiography*
Female
Humans
Hypertrophy, Left Ventricular* / diagnosis
Hypertrophy, Left Ventricular* / physiopathology
Infant
Infant, Newborn
Male
Retrospective Studies
Young Adult

Grants and funding

Protocol #1651/Medtronic External Research Program