Correlation of electrocardiogram parameters and hemodynamic outcomes in patients with isolated secundum atrial septal defects

Abstract

Objective:The characteristic rSR’ pattern in lead V1 on electrocardiogram (ECG) has been described in association with atrial septal defect (ASD) and right ventricular dilation. We aimed to determine if temporal ECG changes can guide a more discriminate and cost-effective screening during follow-up of isolated secundum ASD.Methods:Our study population included all pediatric patients followed at the Stollery Children's Hospital with a secundum ASD, not associated with other significant heart disease, between 2004 and 2010. We collected clinical as well as serial echocardiographic and ECG data.Results:We identified 141 patients with ASD, 95% were asymptomatic and 88% referred for a murmur. Moderate-to-large (>5 mm) ASDs were present in 52%. The prevalence of an rSR’ pattern was 26% in the overall cohort and 54% in the large ASD group. During median follow-up of 28.7 months, 37 patients underwent surgical or transcatheter closure. Among patients with rSR’ on ECG, 78% had moderate-to-large ASD size. In that group, the presence versus the absence of rSR’ correlated with lower positive predictive value (PPV) for spontaneous closure (7% vs. 36%; P = 0.01) and higher PPV for device or surgical closure (71% vs. 38%; P = 0.02).Conclusion:We observed a lower prevalence of rSR’ pattern in patients with isolated ASD than previously reported. However, an rSR’ pattern had incremental value in predicting the need for surgical or device intervention for closure in moderate-large groups. This can be used to tailor patient echocardiographic screening and caregiver counseling.

School electrocardiography screening program prompts the detection of otherwise unrecognized atrial septal defect in children in Japan

“…Furthermore, these three parameters had hemodynamic relevance. The present study also showed that iRBBB (rsR') that has been regarded as reflecting right ventricular overload and invTV4 were associated with higher Qp/Qs, which is consistent with the previous studies ( 18 , 23 , 24 ). Patients with ST depression in aVF, an ECG index suggestive of right ventricular pressure load ( 25 ), was associated with the higher mPAP, not Qp/Qs.…”

“…In this study, the prevalence of a composite ECG parameter [the presence of iRBBB (rsR'), invTV4, or ST depression of aVF] was 63% in the non-screening group as well as 79% in the screening group, suggesting a reasonably high sensitivity of this parameter for detecting hemodynamically significant ASD. The sensitivity of rsR' QRS pattern in detecting hemodynamically significant ASD (55% in the non-screening group and 70% in the screening group) was consistent with previous reports (54%–79%) ( 2 , 15 , 18 , 22 ). Although the ECG finding invTV4 in ASD patients was reported previously ( 10 , 23 ), the sensitivity of invTV4 or ST depression in aVF in detecting ASD was unknown.…”

“…Based on the current study enrollment of 116 pediatric ASD patients over 11 years from 2009 to 2019, the estimated incidence of pediatric ASD patients was 28 per 100,000 live births. Previous reports on ASD diagnosis using echocardiography have reported the incidence ranging from 100 to 390 per 100,000 live births ( 2 , 17 , 18 ), with spontaneous closure rates of 62%–89% ( 17 , 19 ). Calculating patients with indications for closure from these reports yields 11–148 per 100,000 live births.…”