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Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy

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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.

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Abbreviations

HCM:

Hypertrophic cardiomyopathy

ECG:

Electrocardiogram

PACES:

Pediatric and Congenital Electrophysiology Society (PACES)

LVH:

Left ventricular hypertrophy

RVH:

Right ventricular hypertrophy

BVH:

Biventricular hypertrophy

ICD:

Implantable cardioverter device

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Acknowledgements

Many thanks to the PACES (The Pediatric and Congenital Electrophysiology Society), and, in particular, to the PACES-HCM study group for their contributions to this project.

Funding

This study was supported by Medtronic External Research Protocol Number CR-1651.

Author information

Authors and Affiliations

  1. Cleveland Clinic Children’s Hospital, Cleveland, OH, USA

    Mayme Marshall & Peter F. Aziz

  2. University of Los Angeles Olive View, Los Angeles, CA, USA

    Aneeq Malik

  3. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Maully Shah & Christopher M. Janson

  4. Vanderbilt University, Nashville, TN, USA

    Frank A. Fish

  5. University of Utah, Salt Lake City, UT, USA

    Susan P. Etheridge

  6. C.S. Mott Children’s Hospital, Ann Arbor, MI, USA

    Mark W. Russell

  7. Nemours Children’s Hospital, Wilmington, DE, USA

    Svjetlana Tisma

  8. Royal Children’s Hospital, University of Melbourne, Parkville, VIC, Australia

    Andreas Pflaumer

  9. University of Cologne, Cologne, Germany

    Narayanswami Sreeram

  10. Motol University, Prague, Czech Republic

    Peter Kubus

  11. University of Iowa, Iowa City, IA, USA

    Ian H. Law

  12. University of Alberta, Edmonton, AB, Canada

    Michal J. Kantoch

  13. Nationwide Children’s Hospital, Columbus, OH, USA

    Naomi J. Kertesz

  14. Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, USA

    Margaret Strieper

  15. Children’s Specialty Physicians, University of Nebraska Medical Center, Omaha, NE, USA

    Christopher C. Erickson

  16. University of California, Los Angeles, CA, USA

    Jeremy P. Moore

  17. University of Colorado, Denver, CO, USA

    Stephanie J. Nakano

  18. Children’s Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, USA

    Harinder R. Singh

  19. Children’s Mercy Hospital, Kansas City, MO, USA

    Philip Chang

  20. Inova LJ Murphy Children’s Hospital, Falls Church, VA, USA

    Mitchell Cohen

  21. University of Montreal, Montreal, QC, Canada

    Anne Fournier

  22. Royal Children’s Hospital, Glasgow, Scotland, UK

    Maria V. Ilina

  23. Advocate Hospital, Chicago, IL, USA

    Frank Zimmermann

  24. German Heart Center, Munich, Germany

    Michaela Horndasch

  25. University of California, San Francisco, CA, USA

    Walter Li

  26. University of California, Irvine, CA, USA

    Anjan S. Batra

  27. Columbia University, New York, NY, USA

    Leonardo Liberman

  28. Hospital for Sick Kids, Toronto, ON, Canada

    Robert Hamilton

  29. University of British Columbia, Vancouver, BC, Canada

    Shubhayan Sanatani

  30. University of Texas-Southwestern, Dallas, TX, USA

    Ilana Zeltser

  31. University of Virginia, Charlottesville, VA, USA

    George McDaniel

  32. Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Andrew D. Blaufox

  33. Saint Louis University, Saint Louis, MO, USA

    Jason M. Garnreiter

  34. Oregon Health and Science University, 707 SW Gaines Street, Portland, OR, 97239, USA

    Seshadri Balaji

Authors
  1. Mayme Marshall
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  2. Aneeq Malik
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  3. Maully Shah
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  4. Frank A. Fish
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  32. Ilana Zeltser
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  33. George McDaniel
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  35. Jason M. Garnreiter
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  36. Seshadri Balaji
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Contributions

MM, SB, and AM wrote the main manuscript text. MM and SB prepared all the figures. All authors reviewed the manuscript.

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Correspondence to Seshadri Balaji.

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Dr Balaji is a consultant to Milestone Pharmaceuticals and Janssen Pharmaceuticals.

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Marshall, M., Malik, A., Shah, M. et al. Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03252-4

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