Extent of T-wave inversions in ECG of children with ASD
Research type
Research Study
Full title
Observational study on the extent of T-wave inversion in praecordial leads of electrocardiogram in children with isolated atrial septal defect
IRAS ID
126805
Contact name
James Gnanapragasam
Contact email
Sponsor organisation
University Hospital Southampton NHS Foundation Trust
Research summary
Atrial septal defect (ASD) is a common congenital abnormality of the heart, accounting for approximately 10% of all congenital heard disease (CHD). Infants and children with ASDs are often asymptomatic, and ASDs are commonly diagnosed through coincidental finding of a heart murmur or with electrocardiogram (ECG) changes typical of ASDs. Undiagnosed ASDs will potentially result in irreversible long-term comorbidities and it is important that children with undiagnosed ASDs are picked up before they develop symptoms later in life.
Existing literature describe a number of ECGs changes commonly seen in adults with symptomatic ASDs. However, these changes are neither sensitive nor specific enough to diagnose or exclude asymptomatic ASDs in children. With limited availability of alternative, more definitive diagnostic tools, an interest remains in enhancing the diagnostic value of ECG in children with asymptomatic ASDs.
T-waves in ECG represent ventricular repolarisation, and inverted T-waves are considered abnormal in the left-sided praecordial leads. While an extension of T-wave inversion from the right praecordial leads towards the left has been described in otherwise healthy children, T-wave inversion in the V4 lead is rarely seen and its presence increases suspicion of an underlying pathology. However, its potential association with ASD has not been described in the literature.
The investigators hypothesise that, with the effect of volume overload and ventricular strain, ASDs may be associated with an extension of T-wave inversion towards the left praecordial leads in ECG. More specifically, the investigators hypothesise that extension of T-wave inversion to V4 is more commonly observed in children with ASDs than in otherwise healthy children, and its finding will add significantly to the existing diagnostic criteria of ASDs in children. An improved diagnostic power of ECG is likely to lead to earlier diagnosis and intervention, and prevention of devastating long-term complications of undiagnosed ASDs.
REC name
North West - Preston Research Ethics Committee
REC reference
13/NW/0445
Date of REC Opinion
23 May 2013
REC opinion
Favourable Opinion