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Evaluating the diagnostic accuracy of reduced lead paediatric electrocardiograms

Published online by Cambridge University Press:  11 December 2024

Megan Carroll Damera Open the ORCID record for Megan Carroll Damera [Opens in a new window] ,
Ryan Centanni ,
Ashley Sherman ,
Jessica Kline ,
Christopher W. Follansbee ,
Philip M. Chang  and
Lindsey E. Malloy-Walton
Megan Carroll Damera*
Affiliation:
Children’s Mercy Hospital, Kansas City, MO, USA
Ryan Centanni
Affiliation:
Kansas City University of Medicine, Kansas City, MO, USA
Ashley Sherman
Affiliation:
Children’s Mercy Hospital, Kansas City, MO, USA
Jessica Kline
Affiliation:
Saint Luke’s Hospital, Kansas City, MO, USA
Christopher W. Follansbee
Affiliation:
University of Pittsburg Medical Center, Pittsburgh, PA, USA
Philip M. Chang
Affiliation:
Children’s Mercy Hospital, Kansas City, MO, USA
Lindsey E. Malloy-Walton
Affiliation:
Children’s Mercy Hospital, Kansas City, MO, USA
*
Corresponding author: Megan Carroll Damera; Email: megancarroll24@gmail.com
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Abstract

Introduction:

Alternate electrocardiogram acquisition with fewer leads lacks systematic evaluation in children. This study aims to determine if electrocardiograms with fewer leads maintain diagnostic accuracy in paediatrics.

Methods:

This is a single-centre review of 200 randomly selected standard 12-lead electrocardiograms from our hospital database (2017–2020) for patients aged 2 weeks to 21 years. An overlay technique generated 8-lead (limb + V1/V6) and 6-lead (limb only) variations of the 12-lead tracings, resulting in a total of 600 electrocardiograms, which were then interpreted by two independent paediatric electrophysiologists.

Results:

In total, 18% (35/200) of the baseline electrocardiograms were abnormal. Intervals were measured in lead II for all electrocardiograms. Comparing 12-lead to 6- and 8-lead electrocardiograms, there was almost perfect agreement for specific rhythm identification (97.5–100%, κ 0.85-1). The 8-lead showed substantial agreement with 12-lead electrocardiograms when identifying specific electrocardiogram patterns (97.5–100%, κ 0.66–1). A similar degree of agreement was not demonstrated with the 6-lead variant. Utilising the 12-lead electrocardiogram as the gold standard, sensitivity and specificity of the 8- and 6-lead electrocardiogram were > 89% for specific rhythm identification. Specificity for specific pattern recognition was > 99% while sensitivity was < 90% for certain variables for both 6- and 8-lead electrocardiogram, likely due to smaller sample size and fewer abnormal electrocardiograms. There was high percent reader agreement (92.5–100%).

Conclusions:

8-lead electrocardiograms provide comparable diagnostic accuracy to 12-lead electrocardiograms for children. This information holds potential for future technological advancements in electrocardiogram acquisition tailored specifically for paediatrics. Additional studies are required to further refine conventional electrocardiogram acquisition.

Keywords

Electrocardiogramreduced lead electrocardiogramelectrophysiologypaediatric cardiologytechnological advancements

Information

Type
Original Article
Information
Cardiology in the Young , Volume 35 , Issue 2 , February 2025 , pp. 283 - 288
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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