Key result
Composite ECG criteria detect ~89% of atrial septal defects with low false-positive rates.
Why the study?
Does a composite of specific ECG waveforms improve the detection of atrial septal defect in school-age children?
Case-Control (n=772)
Does a composite of specific ECG waveforms improve the detection of atrial septal defect in school-age children?
A composite ECG criteria including wide definition IRBBB, T wave abnormalities, and Crochetage pattern can effectively detect ASD in school-age children, though false positives remain a challenge.
Answers are grounded in this paper and cite their sources.
ECG patterns may aid school ASD screening; leaves open diagnostic criteria without prospective validation.
BACKGROUND: Data on atrial septal defect (ASD) diagnosis in school heart screenings in Japan are insufficient, and criteria for detecting abnormal waveforms in primary screening are unclear. METHODS: We analyzed 282 elementary school-age (5-10 years) and 90 middle/high school-age (11-18 years) ASD patients, along with 400 age-matched healthy controls. The prevalence of right bundle branch block (RBBB), right axis deviation (RAD), T wave abnormalities, and Crochetage (CR) patterns in inferior leads on electrocardiograms (ECG) was assessed. RBBB was classified as strict definition incomplete RBBB (IRBBB), wide definition IRBBB, or overall RBBB based on the ECG morphology. RESULTS: Strict definition IRBBB was observed in 38.3% and 24.4% of elementary and middle/high school-age ASD patients, respectively, but only in 2.0% of the healthy controls. Wide definition IRBBB was observed in 71.3% and 62.2% of elementary and middle/high school ASD patients, respectively, compared to 3.0% in controls. T wave abnormalities were present in 70.9%, 23.3%, and 0.8% of elementary, middle/high school ASD patients, and healthy controls, respectively. The CR pattern appeared in all inferior leads in 50.7% of elementary school ASD patients, 48.9% of middle/high school ASD patients, and 2.8% of healthy controls. Using a composite of wide definition IRBBB, T wave abnormalities, and CR pattern for screening would capture 89.3% of ASD cases, with a 6.0% false-positive rate in healthy children. CONCLUSION: Combining specific waveforms may improve the detection rate of ASD, though managing false-positives among healthy children remains a challenge.
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Nakano et al. (2025) conducted a case-control in Atrial septal defect (n=772). Composite ECG criteria (wide definition IRBBB, T wave abnormalities, and Crochetage pattern) vs. Healthy controls was evaluated on Detection of atrial septal defect (sensitivity) and false-positive rate. A composite ECG screening criteria of wide definition incomplete right bundle branch block, T wave abnormalities, and Crochetage pattern captured 89.3% of ASD cases with a 6.0% false-positive rate.
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