Cardiac Early Repolarization Pattern Anomalies Among Children and Adolescents With and Without Attention-Deficit Hyperactivity Disorder: A Community Observational Study

Abstract

Our research had 2 aims, first, to determine if electrocardiographic early repolarization pattern anomalies (ERPAs) were more likely present among children and adolescents diagnosed with attention-deficit hyperactivity disorder (ADHD; n = 416) when compared with non-ADHD children (n = 187), and second, to asses if ADHD patients whose parents report severe ADHD psychometric scores were more likely to have ERPA in their surface ECG (electrocardiography) when compared with other ADHD patients with mild to moderate dysfunction or no dysfunction. In our unmatched case-control study, ERPA was recognized when there was an end QRS notch (J wave) or slur on the downslope of a prominent R wave with and without ST-segment elevation and the peak of the notch or J wave (Jp) ≥0.1 mV in ≥2 contiguous leads, excluding V1-V3 anterior lead, and QRS duration (measured in leads in which a notch or slur is absent) <120 ms or ST-segment elevation >0.1 mV in ≥2 contiguous leads, excluding V1-V3, and QRS duration <120 ms. The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria were used to diagnose ADHD. Our data analysis suggested a significant association between ERPA presence and ADHD (n = 603, P = .020). Our logistic regression model suggests that patients with ERPA (n = 167) were 2.778 times more likely to have a diagnosis of ADHD after controlling for age, gender, and ethnicity (95% confidence interval for odds ratio 1.087-7.100, P = .033). Multiple regression models suggested that age, P < .001; gender, P < .001; ERPA, P = .004; and ERPA leads number, P = .022, were significant predictors of global parental ADHD worry scale. Hispanic and black ethnicity were not significant predictors. Consequently, the presence of ERPA should be reported in all ECGs done in children and adolescents for prospective behavioral phenotype and/or arrhythmia risk stratification analysis.

Surface Electrocardiographic Parameters of Children and Adolescents Diagnosed with Attention-Deficit/Hyperactivity Disorder in an Ambulatory Community Pediatric Center: A Focus on Cardiac Repolarization Electrocardiogram Intervals

“…The IRB committee agreed with our request to waive the need for ethics approval and the need to obtain informed consent for the medical records review, data analysis, and publication of the retrospectively obtained and anonymized data for this noninterventional study. Our methodology had been previously published (Isart et al 2019 ). Our population research sample ( N = 2366) included two groups: Group 1 with children and adolescents (5–18 years of age) evaluated for ADHD at an urban community clinic (Kids ‘N Teen Clinics, PA, Houston, TX) who had an ECG done ( n = 418, 2008–2017); and Group 2 is the historical control group that included 1948 children and adolescents of 5–18 years of age from a large group of healthy children and adolescents who were subjects in pharmaceutical company-sponsored clinical trials with centralized management and interpretation of their ECGs by a core ECG laboratory (Covance, Reno, NV, 2003–2005, Table 1 ), reported by Mason et al ( 2007 ).…”

Early Repolarization Pattern and Suicidal Risks: A Single Center Case-Control Study

“…Power analysis, with β =0.20 and α =0.05, was conducted assuming a difference of 20% based on the previous studies [10,11]. We had a projected sample size of approximately 43 patients (total of 172 subjects).…”

“…Recently, there have been reports on psychiatric disorders and Early repolarization pattern (ERP). It has been reported associations between psychiatric disorders such as Attention-deficit hyperactivity disorder (ADHD) [10, 11], serious mental illness and ERP. [12] These reports suggest the associations between ERP and psychiatric disorders.…”

Early Repolarization Pattern is Associated with Schizophrenia: A Single Center Experience in Japan

“…The copyright holder for this preprint this version posted July 17, 2020. ; https://doi.org/10.1101/2020.07.16.20155838 doi: medRxiv preprint 5 sudden cardiac death [11,12]. Recently, it has been reported that there are associations between ERP and attention-deficit hyperactivity disorder [13,14],and the patients with suicidal risks [15].…”

“…ERP and J-point elevation pattern, which are not uncommon and often observed in younger and healthier people [10], are arrestive electrocardiographic patterns associated with sudden cardiac death [11,12]. Recently, it has been reported that there are associations between ERP and attention-deficit hyperactivity disorder [13,14],and the patients with suicidal risks [15]. Moreover, Fitzgerald et.al reported that Patients with serious mental illness, especially schizophrenia/schizoaffective disorder, exhibit a significantly high rate of abnormal late potentials on Signal-averaged electrocardiogram (SAECG) and ERP [16].…”