Diagnostic Utility of Prominent Mid-Precordial Lead Voltage in a Pediatric Population

ECG criteria for diagnosing chamber enlargement has poor predictive value. Elevated voltages in mid-precordial leads may have clinical utility and we hypothesized that ECGs with a single mid-precordial voltage ≥ 60 mV correlate with congenital heart disease (CHD) in a pediatric cohort. This was a retrospective analysis of pediatric ECGs at the University of Minnesota from 2006 to 2021. Included patients had a single mid-precordial lead (V2-V5) QRS voltage ≥ 60 mV and an echocardiogram within 1 month. ECG parameters including rhythm, atrial enlargement, axis deviation, hypertrophy criteria and echocardiogram findings were evaluated. Of 122 patients (mean 1.6 ± 2.5 years, 62% male), seventeen (14%) (mean 2.5 ± 3.0 years) had normal anatomy and 105 (86%) (mean 1.5 ± 2.4 years) had CHD. Mean maximum QRS voltage was 75.9 ± 13.5 mV with a significantly higher mean maximum voltage in the CHD versus control group (77.0 ± 13.7 vs 69.2 ± 9.7 mV, p = 0.012). A receiver operating characteristic curve for maximum QRS voltage had an AUC of 0.691 (95% CI 0.546-0.835). 66.5 mV had the best sensitivity (76%) and specificity (59%) combination and a value of 92.5 mV had a specificity of 100% for CHD. A QRS voltage of 60 mV in mid-precordial leads was associated with CHD in a cohort of pediatric patients. Echocardiograms remain reasonable in these patients though larger cohort studies are needed to develop ideal cutoffs.