173 ELECTROCARDIOGRAPHIC-ECHOCARDIOGRAPHIC CORRELATION OF ATRIAL ENLARGEMENT DURING CHILDHOOD

Abstract

Electrocardiographic(ECG) criteria for left atrial enlargement (LAE) are considered to accurately reflect left atrial dimensions. No data are available correlating left atrial size (LAS) and ECG criteria for LAE in children. ECG and echocardiograms (Echo) of ninety-five patients(pts) (age-1 day to 18y, median 7mos.)were studied to determine if LAE as manifested by four different ECG criteria accurately reflect LAE as determined by LAS and LA/AO ratio on echo, clinical and catheterization data. Four cardiac defects known to cause LAE were selected for study. There were 27 pts with ventricular septal defect(Group 1); 15 pts with mitral insufficiency(Group 2); 25 pts with patent ductus arteriosus(Group 3); and 28 pts with cardiomyopathy(Group 4). Our results show that 1)in pts with no ECG criteria for LAE 67% and 96% had increased LAS and LA/AO ratio on echo respectively. 2)in pts with LAE on ECG 67% and 73% had increased LAS and LA/AO ratio on echo. 3)66% and 57% of pts with increased LAS and LA/AO ratio by echo showed LAE by ECG. 4)with increasing magnitude of LAS by echo, LAE by ECG became more predictive. Overall sensitivity, and predictive value of LAE by ECG criteria were 66% and 67% and for the groups, Gr 1: 100%, 33%, Gr 2: 75%, 90%, Gr 3: 21%, 100%, Gr 4: 81%, and 81% respectively. We conclude that current ECG criteria for LAE in children are not as sensitive or predictive as previously suggested.

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