No CrossRef data available.
Article contents
Prevalence of electrocardiographic abnormalities among Iranian children and adolescents and associations with blood pressure and obesity: findings from the SHED LIGHT study
Published online by Cambridge University Press: 18 January 2024
Abstract
Background:
There are few studies for detecting rhythm abnormalities among healthy children and adolescents. The aim of the study was to investigate the prevalence of abnormal electrocardiographic findings in the young Iranian population and its association with blood pressure and obesity.
Methods:
A total of 15084 children and adolescents were examined in a randomly selected population of Tehran city, Iran, between October 2017 and December 2018. Anthropometric values and blood pressure measurements were also assessed. A standard 12-lead electrocardiogram was recorded by a unique recorder, and those were examined by electrophysiologists.
Results:
All students mean age was 12.3 ± 3.1 years (6–18 years), and 52% were boys. A total of 2900 students (192.2/1000 persons; 95% confidence interval 186–198.6) had electrocardiographic abnormalities. The rate of electrocardiographic abnormalities was higher in boys than girls (p < 0.001). Electrocardiographic abnormalities were significantly higher in thin than obese students (p < 0.001), and there was a trend towards hypertensive individuals to have more electrocardiographic abnormalities compared to normotensive individuals (p = 0.063). Based on the multivariable analysis, individuals with electrocardiographic abnormalities were less likely to be girls (odds ratio 0.745, 95% confidence interval 0.682–0.814) and had a lower body mass index (odds ratio 0.961, 95% confidence interval 0.944–0.979).
Conclusions:
In this large-scale study, there was a high prevalence of electrocardiographic abnormalities among young population. In addition, electrocardiographic findings were significantly influenced by increasing age, sex, obesity, and blood pressure levels. This community-based study revealed the implications of electrocardiographic screening to improve the care delivery by early detection.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2024. Published by Cambridge University Press
Footnotes
SHED LIGHT study (Structural HEart Disease in pupiLs by echocardIoGrapHic Test) is a population-based investigation to detect the burden of structural heart diseases among children in the urban areas of Tehran, Iran, by the implementation of echocardiographic examinations.
References
Maron, BJ, Friedman, RA, Kligfield, P, et al. Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American heart association and the American college of cardiology. Circulation 2014; 130: 1303–1334.CrossRefGoogle ScholarPubMed
Gonzalez Corcia, MC, Sieira, J, Pappaert, G, et al. Implantable cardioverter-defibrillators in children and adolescents with brugada syndrome. J Am Coll Cardiol 2018; 71: 148–157.Google ScholarPubMed
Rijnbeek, PR, Witsenburg, M, Schrama, E, Hess, J, Kors, JA. New normal limits for the paediatric electrocardiogram. Eur Heart J 2001; 22: 702–711.CrossRefGoogle ScholarPubMed
Davignon, A, Rautaharju, P, Boisselle, E, Soumis, F, Mégélas, M, Choquette, A. Normal ECG standards for infants and children. Pediatr Cardiol 1980; 1: 123–131.CrossRefGoogle Scholar
Semizel, E, Ozturk, B, Bostan, OM, Cil, E, Ediz, B. The effect of age and gender on the electrocardiogram in children. Cardiol Young 2008; 18: 26–40.CrossRefGoogle ScholarPubMed
Saarel, EV, Granger, S, Kaltman, JR, et al. Electrocardiograms in healthy North American children in the digital age. Circ Arrhythm Electrophysiol 2018; 11: e005808–e.CrossRefGoogle ScholarPubMed
Lue, HC, Wu, MH, Wang, JK, et al. Study on ECG in the adolescent. Pediatr Cardiol 2018; 39: 911–923.CrossRefGoogle Scholar
Basavarajaiah, S, Wilson, M, Whyte, G, Shah, A, Behr, E, Sharma, S. Prevalence and significance of an isolated long QT interval in elite athletes. Eur Heart J 2007; 28: 2944–2949.CrossRefGoogle ScholarPubMed
Liberthson, RR. Sudden death from cardiac causes in children and young adults. Eur Heart J 1996; 334: 1039–1044.Google ScholarPubMed
Pelliccia, A, Culasso, F, Di Paolo, FM, et al. Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening. Eur Heart J 2007; 28: 2006–2010.CrossRefGoogle Scholar
Baggish, AL, Hutter, AM Jr., Wang, F, et al. Cardiovascular screening in college athletes with and without electrocardiography: a cross-sectional study. Ann Intern Med 2010; 152: 269–275.CrossRefGoogle ScholarPubMed
Corrado, D, Basso, C, Schiavon, M, Thiene, G. Screening for hypertrophic cardiomyopathy in young athletes. J Am Coll Cardiol 1998; 339: 364–369.Google ScholarPubMed
Pelliccia, A, Di Paolo, FM, Quattrini, FM, et al. Outcomes in athletes with marked ECG repolarization Abnormalities. N Engl J Med 2008; 358: 152–161.CrossRefGoogle ScholarPubMed
Palhares, DMF, Marcolino, MS, Santos, TMM, et al. Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients. BMC Cardiovasc Disor 2017; 17: 152.Google ScholarPubMed
Pelliccia, A, Di Paolo, FM, Corrado, D, et al. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J 2006; 27: 2196–2200.CrossRefGoogle ScholarPubMed
Santini, M, Di Fusco, SA, Colivicchi, F, Gargaro, A. Electrocardiographic characteristics, anthropometric features, and cardiovascular risk factors in a large cohort of adolescents. Europace 2018; 20: 1833–1840.Google Scholar
Schwartz, PJ, Stramba-Badiale, M, Crotti, L, et al. Prevalence of the congenital long-QT syndrome. Circulation 2009; 120: 1761–1767.Google ScholarPubMed
Hosseini, S, Samiei, N, Tabib, A, et al. Prevalence of structural heart diseases detected by handheld echocardiographic device in school-age children in Iran: the SHED LIGHT study. Glob Heart 2022; 17: 17.CrossRefGoogle ScholarPubMed
Flynn, JT, Kaelber, DC, Baker-Smith, CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017; 140: 140.CrossRefGoogle ScholarPubMed
Whelton, PK Carey, RM Aronow, WC, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. Hypertension 2018; Tex: 1979–1324.Google Scholar
Kuczmarski, RJ, Ogden, CL, Grummer-Strawn, LM, et al. CDC growth charts: United States. Advance data 2000; (314): 1–27.Google ScholarPubMed
Li, C, Ford, ES, Mokdad, AH, Cook, S. Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics 2006; 118: e1390–e1398.CrossRefGoogle ScholarPubMed
Maron, BJ, Friedman, RA, Kligfield, P, et al. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American heart association and the American college of cardiology. J Am Coll Cardiol 2014; 64: 1479–1514.CrossRefGoogle ScholarPubMed
Hancock, EW, Deal, BJ, Mirvis, DM, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American heart association electrocardiography and arrhythmias committee, council on clinical cardiology; the American college of cardiology foundation; and the heart rhythm society: endorsed by the international society for computerized electrocardiology. Circulation 2009; 119: e251–e261.Google Scholar
Rautaharju, PM, Surawicz, B, Gettes, LS, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart association electrocardiography and arrhythmias committee, council on clinical cardiology; the American college of cardiology foundation; and the heart rhythm society: endorsed by the international society for computerized electrocardiology. Circulation 2009; 119: e241–50.CrossRefGoogle Scholar
Kligfield, P, Gettes, LS, Bailey, JJ, et al. Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology a scientific statement from the American heart association electrocardiography and arrhythmias committee, council on clinical cardiology; the American college of cardiology foundation; and the heart rhythm society endorsed by the international society for computerized electrocardiology. J Am Coll Cardiol 2007; 49: 1109–1127.CrossRefGoogle Scholar
Ackerman, MJ, Priori, SG, Willems, S, et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the heart rhythm society (HRS) and the European heart rhythm association (EHRA). Heart rhythm 2011; 8: 1308–1339.CrossRefGoogle ScholarPubMed
Sharma, S, Drezner, JA, Baggish, A, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol 2017; 69: 1057–1075.CrossRefGoogle ScholarPubMed
Bazett, HC. An analysis of the time relations of electrocardiograms. Heart 1920; 7: 353–370.Google Scholar
Haïssaguerre, M, Derval, N, Sacher, F, et al. Sudden cardiac arrest associated with early repolarization. Bmc Cardiovasc Disor 2008; 358: 2016–2023.Google ScholarPubMed
Brugada, J, Blom, N, Sarquella-Brugada, G, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-arrhythmia working group joint consensus statement. Europace 2013; 15: 1337–1382.CrossRefGoogle Scholar
de Alencar Neto, JNunes, Baranchuk, A, Bayés-Genís, A, de Luna, AB. Arrhythmogenic right ventricular dysplasia/cardiomyopathy:an electrocardiogram-based review. Europace 2018; 20: f3–f12.CrossRefGoogle Scholar
Marek, J, Bufalino, V, Davis, J, et al. Feasibility and findings of large-scale electrocardiographic screening in young adults: data from 32,561 subjects. Heart rhythm 2011; 8: 1555–1559.CrossRefGoogle Scholar
Harmon, KG, Zigman, M, Drezner, JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol 2015; 48: 329–338.CrossRefGoogle ScholarPubMed
Kofler, T, Thériault, S, Bossard, M, et al. Relationships of measured and genetically determined height with the cardiac conduction system in healthy adults. Circ Arrhythm Electrophysiol 2017; 10: e004735.CrossRefGoogle ScholarPubMed
Haneda, N, Mori, C, Nishio, T, et al. Heart diseases discovered by mass screening in the schools of Shimane Prefecture over a period of 5 years. Jpn Circulation J 1986; 50: 1325–1329.Google Scholar
Vink, AS, Neumann, B, Lieve, KVV, et al. Determination and interpretation of the QT interval. Circulation 2018; 138: 2345–2358.CrossRefGoogle ScholarPubMed
Khorgami et al. supplementary material
File
15.1 KB