The Significance of Crochetage on the R wave of an Electrocardiogram for the Early Diagnosis of Pediatric Secundum Atrial Septal Defect

• Published in: Pediatric cardiology Vol. 39; no. 5; pp. 1031 - 1035
• Main Authors: Shen, Lei, Liu, Jian, Li, Jin-kang, Xu, Meng, Yuan, Lang, Zhang, Guo-qin, Wang, Jian-yi, Huang, Yu-juan
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2018; Springer
• Subjects: Cardiac Surgery; Cardiology; Electrocardiogram; Electrocardiography; Heart diseases; Medicine; Medicine & Public Health; Original Article; Pediatric cardiology; Vascular Surgery; Crochetage on R wave; Secundum atrial septal defect; Inferior leads; Pediatric
• ISSN: 0172-0643; 1432-1971; 1432-1971
• DOI: 10.1007/s00246-018-1857-0

The purpose of this study was to test the hypothesis that the incidence of crochetage on the R wave in inferior limb leads can be used for the diagnosis of pediatric secundum atrial septal defect (ASD). Two hundred fifty-six children with secundum ASD (case cohort) and 256 age- and gender-matched children without heart disease (control cohort) were included in the study. Statistical analyses were performed to test the relationship between the ASD and the crochetage on the R wave with a single lead and three leads, respectively. The impact of incomplete right bundle branch block (IRBBB) and ASD diameter (≥ 5 and < 5 mm) on ASD diagnosis were also explored. Crochetage on the R wave was observed in all three inferior limb leads on 28.13% (72/256, 28 with IRBBB) of subjects with secundum ASD, while it was seen in only 2.73% (7/256, one with IRBBB) of control subjects ( P  < 0.001). Subgroup analysis showed that the incidence of R wave crochetage correlated with ASD size in both the single inferior limb lead (26.14%, 23/88 on ASD ≥ 5 mm vs. 10.71%, 18/168 on ASD < 5 mm; P  = 0.001) and all three inferior limb leads (44.32%, 39/88 on ASD ≥ 5 mm vs. 19.64%, 33/168 on ASD < 5 mm; P  < 0.001). Our findings suggest that crochetage on the R wave in inferior limb leads can serve as an independent marker for ASD diagnosis.