Demystifying the Pediatric Electrocardiogram: Tools for the Practicing Pediatrician

• Based on research evidence and consensus, the pediatric electrocardiogram (ECG) is an important tool for the screening and diagnosis of congenital heart disease, cardiomyopathies, arrhythmias, and arrhythmia syndromes. (31)(47)(48)(49)(50)(51) • Based on research evidence and consensus, ECG interpretation changes with patient age; awareness of these changes is key to identification of abnormalities. (4)(5)(6)(7)(8) • Based on some research evidence, the QRS axis is most important in infancy as a screening tool in the setting of suspected congenital heart disease. (52)(53)(54) • Based on some research evidence, T-wave inversion in the inferior and/or lateral leads may warrant evaluation for cardiomyopathy. (25)(46) • Based on research evidence and consensus, if bradycardia is present, AV block or blocked atrial ectopy should be considered. Sinus bradycardia is typically benign. (10) • Based on research evidence and consensus, if narrow QRS complex tachycardia is present and no preceding P waves are seen, supraventricular tachycardia must be ruled out. (55) • Based on research evidence and consensus, wide QRS complex tachycardia should be considered ventricular tachycardia until proved otherwise. (42) • Based on research evidence and consensus, in a young patient with syncope or palpitations, arrhythmia syndromes that may be seen on resting ECG should be considered. Common examples include Wolff-Parkinson-White syndrome, long QT syndrome, and Brugada syndrome. (31)(45).