Diagnostic value of ECG patterns of right ventricular hypertrophy in children.

OBJECTIVE: To determine the diagnostic value of traditional criteria of right ventricular hypertrophy (RVH) in children. PATIENTS: The electrocardiograms (ECGs) of 1000 consecutive pediatric patients were reviewed. Children under three months old were excluded as were patients with QRS prolongation. RESULTS: Four hundred and thirty-four patients met all inclusion criteria. The medical records were then reviewed for diagnosis. Sixty-seven per cent had a diagnosis compatible with RVH. Of the ECG patterns evaluated, a precociously upright T wave in lead V1 was most predictive with 99% specificity. Presence of a QR complex in lead V1 had a 96% specificity but R:S ratio, voltage criteria and rSR' incomplete right bundle branch block pattern had intermediate specificities of 66%, 66% and 52%, respectively. Sensitivities of 12.6%, 13.2%, 34.0%, 63.3% and 74.2% were calculated for upright T, QR complex, R:S ratio, voltage criteria and rSR', respectively. CONCLUSIONS: An upright T wave or qR pattern are highly specific but insensitive markers of RVH in children. In contrast, when an incomplete right bundle branch block exists, the rSR' pattern is a relatively sensitive but nonspecific predictor of RVH.