The importance of electrocardiographic findings in the diagnosis of atrial septal defect

Bayar, Nermin; Arslan, Şakir; Köklü, Erkan; Çağırcı, Göksel; Çay, Serkan; Erkal, Zehra; Ayoglu, Raif Umut; Küçükseymen, Selçuk

doi:10.5603/kp.a2014.0240

Cited by 21 publications

(22 citation statements)

References 17 publications

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“…The ECG abnormality with the highest yield of abnormal TTE in our study was IRBBB. This finding on ECG suggests right‐sided volume overload, most commonly associated with the presence of an ASD . The odds of an abnormal TTE in an asymptomatic patient with IRBBB were approximately 10 times higher than in someone without IRBBB.…”

Section: Discussionmentioning

confidence: 96%

“…This finding on ECG suggests right-sided volume overload, most commonly associated with the presence of an ASD. 13 The odds of an abnormal TTE in an asymptomatic patient with IRBBB were approximately 10 times higher than in someone without IRBBB. It is important to note that interpretation of IRBBB has been suggested that LVH on ECG is more common in the African American population as compared to Caucasians.…”

Section: Re Sultsmentioning

confidence: 96%

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Application of pediatric Appropriate Use Criteria for initial outpatient evaluation of asymptomatic patients with abnormal electrocardiograms

Dasgupta

Anderson

Kelleman

et al. 2018

Congenital Heart Disease

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Introduction:In the pediatric Appropriate Use Criteria (AUC), abnormal electrocardiogram (ECG) in an asymptomatic patient has been rated as an "Appropriate" indication for transthoracic echocardiogram (TTE). We hypothesized that the yield of abnormal findings on TTE for this indication will be low.Methods: All asymptomatic patients (≤ 18 years) from January 1, 2015 to December 31, 2017 who underwent initial outpatient evaluation at our center and had a TTE ordered for an abnormal ECG, were included. Clinic records were reviewed to obtain ECG and TTE findings.Results: Of the 199 study patients, 13 (6.5%) had abnormal findings. Incomplete right bundle branch block (IRBBB) had the highest yield of abnormal TTE findings (7/28), with secundum atrial septal defect being the most common (5/7); (Odds ratio (OR) compared to other ECG findings 9.2, 95% CI (2.8-29.9), P < .001). OR further increased to 14.6, 95% CI (3.1-68.0), P < .001 when either IRBBB, right axis deviation, or right ventricular hypertrophy were present. Left ventricular hypertrophy on ECG had only one incidental abnormality on TTE, while ST segment changes, left axis deviation, right/left atrial enlargement, premature atrial/ventricular contractions, ectopic atrial rhythm, sinus bradycardia/pause, preexcitation, low-grade atrioventricular block, and junctional rhythm did not yield abnormal TTEs. Conclusions:The yield of abnormal findings on TTE when performed for the AUC indication for an abnormal ECG in asymptomatic pediatric patients is low except when performed for ECG abnormalities suggestive of right heart disease such as IRBBB, right axis deviation, or right ventricular hypertrophy. Future revisions of the AUC document could consider further stratification of this indication and corresponding appropriateness ratings based on ECG findings rather than combining into one broad category. K E Y W O R D Sappropriate, criteria, asymptomatic, electrocardiogram | 231 DASGUPTA et al.

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Section: Discussionmentioning

confidence: 96%

Section: Re Sultsmentioning

confidence: 96%

Application of pediatric Appropriate Use Criteria for initial outpatient evaluation of asymptomatic patients with abnormal electrocardiograms

Dasgupta

Anderson

Kelleman

et al. 2018

Congenital Heart Disease

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“…Clínicamente, estos defectos pueden ser sospechados en casos de moderada a severa repercusión, cuando los pacientes presentan cuadros respiratorios recurrentes, escasa ganancia ponderal o hallazgos en la auscultación cardíaca (segundo ruido desdoblado ( 3 ) o soplo sistólico pulmonar ) . Dentro de las herramientas paraclínicas, el electrocardiograma se considera como un elemento que puede llevar a la sospecha de un defecto del septo interatrial, cuando presenta signos de sobrecarga de cavidades derechas (4) o alteraciones en la morfología del QRS o la onda T .…”

Section: Introductionunclassified

Hallazgos clínicos y electrocardiográficos en pacientes pediátricos con comunicación interauricular

Suh

Greco

Romero

et al. 2019

Pediatr (Asunción).

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Introducción: La comunicación interauricular (CIA) es una cardiopatía congénita frecuente, cuyo diagnóstico es difícil en pacientes paucisintomáticos. Sin tratamiento, puede complicarse con insuficiencia cardiaca, arritmias e hipertensión pulmonar. El electrocardiograma puede proporcionar indicios de esta cardiopatía. Objetivo: Describir los hallazgos clínicos y electrocardiográficos de pacientes portadores de CIA. Materiales y Métodos: Trabajo retrospectivo, de pacientes menores de 18 años, evaluados cardiológicamente de enero 2008 a diciembre de 2013. Se describen las variables electrocardiográficas y semiológicas sugestivas de CIA. Resultados: Hubo 77 pacientes con CIA. Los motivos de consulta más frecuentes entre los pacientes con CIA fueron el soplo cardiaco, el síndrome de Down y la disnea. En el examen físico de los pacientes con CIA: soplo sistólico en 69% y R2 desdoblado en 56%. En el electrocardiograma, los pacientes tuvieron QRS de 79 ms, eje eléctrico desviado hacia la derecha, BIRD y notch. Los criterios de sobrecarga ventricular derecha (SVD) más frecuentes fueron la onda S profunda en V6 y la onda R alta en V1. La auscultación de un R2 desdoblado en el examen físico, así como la SVD y el patrón notch fueron los hallazgos más frecuentes en pacientes con CIA. Conclusión: el electrocardiograma constituye una herramienta válida en la evaluación de pacientes con sospecha de CIA pero precisa de la combinación de hallazgos clínicos para llegar al diagnóstico.

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“…[ 1 ] Incomplete RBBB is due to delayed depolarization of the thickened right ventricular outflow tract and possibly right ventricular volume overload. [ 2 ] RSR’ pattern in lead V1 carries the specificity of 80%, sensitivity of 36.1%, positive predictive value of 14.7%, and negative predictive value of 92.9% for the diagnosis of ASD. Hence, incomplete RBBB alone is inadequate to diagnose ASD.…”

mentioning

confidence: 99%

“…used the defective T-wave pattern which was defined as “inverted or horizontal displacement of the proximal T-wave limb in the right precordial leads.”[ 9 ] Incomplete RBBB along with the presence of defective T-wave had 100% specificity and 87.1% sensitivity for the diagnosis of ASD. [ 2 9 ] These ECG findings can potentially help clinicians diagnose ASD and assess the risk of transient ischemic attack even before confirming the diagnosis on echocardiography.…”

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confidence: 99%

Think beyond right bundle branch block in atrial septal defect

et al. 2017

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The importance of electrocardiographic findings in the diagnosis of atrial septal defect

Abstract: Detection of RBBB, DTW, and crochetage R wave in superficial ECG may contribute to early detection in patients with ASD.

Cited by 21 publications

References 17 publications

Application of pediatric Appropriate Use Criteria for initial outpatient evaluation of asymptomatic patients with abnormal electrocardiograms

Application of pediatric Appropriate Use Criteria for initial outpatient evaluation of asymptomatic patients with abnormal electrocardiograms

Hallazgos clínicos y electrocardiográficos en pacientes pediátricos con comunicación interauricular

Think beyond right bundle branch block in atrial septal defect

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