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

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Abstract

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.

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Authors and Affiliations

  1. Department of Cardiology, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China

    Lei Shen, Meng Xu & Jian-yi Wang

  2. Department of Emergency, Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China

    Jian Liu, Jin-kang Li, Lang Yuan, Guo-qin Zhang & Yu-juan Huang

Author notes

  1. Lei Shen and Jian Liu are co-first authors; Jian-yi Wang and Yu-juan Huang are co-last authors.

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    1. Lei Shen
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    2. Jian Liu
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    Correspondence to Yu-juan Huang.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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    Informed consent was obtained from all individual participants included in the study.

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    Shen, L., Liu, J., Li, Jk. et al. The Significance of Crochetage on the R wave of an Electrocardiogram for the Early Diagnosis of Pediatric Secundum Atrial Septal Defect. Pediatr Cardiol 39, 1031–1035 (2018). https://doi.org/10.1007/s00246-018-1857-0

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    • DOI: https://doi.org/10.1007/s00246-018-1857-0

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