Electrocardiographic criteria for detecting atrial septal defect during school heart screening.

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.