Hypertrophic cardiomyopathy (HCM), a common cardiomyopathy in children, is an important cause of morbidity and mortality. Early recognition and appropriate management are important. An electrocardiogram (ECG) is often used as a screening tool in children to detect heart disease. The ECG patterns in children with HCM are not well described.ECGs collected from an international cohort of children, and adolescents (≤ 21 years) with HCM were reviewed. 482 ECGs met inclusion criteria. Age ranged from 1 day to 21 years, median 13 years. Of the 482 ECGs, 57 (12%) were normal. The most common abnormalities noted were left ventricular hypertrophy (LVH) in 108/482 (22%) and biventricular hypertrophy (BVH) in 116/482 (24%) Of the patients with LVH/BVH (n = 224), 135 (60%) also had a strain pattern (LVH in 83, BVH in 52). Isolated strain pattern (in the absence of criteria for hypertrophy) was seen in 43/482 (9%). Isolated pathologic Q waves were seen in 71/482 (15%). Pediatric HCM, 88% have an abnormal ECG. The most common ECG abnormalities were LVH or BVH with or without strain. Strain pattern without hypertrophy and a pathologic Q wave were present in a significant proportion (24%) of patients. Thus, a significant number of children with HCM have ECG abnormalities that are not typical for "hypertrophy". The presence of the ECG abnormalities described above in a child should prompt further examination with an echocardiogram to rule out HCM.

Advocate Hospital Chicago IL USA

C S Mott Children's Hospital Ann Arbor MI USA

Children's Healthcare of Atlanta Emory University Atlanta GA USA

Children's Hospital of Philadelphia Philadelphia PA USA

Children's Hospital of San Antonio Baylor College of Medicine San Antonio TX USA

Children's Mercy Hospital Kansas City MO USA

Children's Specialty Physicians University of Nebraska Medical Center Omaha NE USA

Cleveland Clinic Children's Hospital Cleveland OH USA

Columbia University New York NY USA

German Heart Center Munich Germany

Hospital for Sick Kids Toronto ON Canada

Inova LJ Murphy Children's Hospital Falls Church VA USA

Motol University Prague Czech Republic

Nationwide Children's Hospital Columbus OH USA

Nemours Children's Hospital Wilmington DE USA

Oregon Health and Science University 707 SW Gaines Street Portland OR 97239 USA

Royal Children's Hospital Glasgow Scotland UK

Royal Children's Hospital University of Melbourne Parkville VIC Australia

Saint Louis University Saint Louis MO USA

University of Alberta Edmonton AB Canada

University of British Columbia Vancouver BC Canada

University of California Irvine CA USA

University of California Los Angeles CA USA

University of California San Francisco CA USA

University of Cologne Cologne Germany

University of Colorado Denver CO USA

University of Iowa Iowa City IA USA

University of Los Angeles Olive View Los Angeles CA USA

University of Montreal Montreal QC Canada

University of Texas Southwestern Dallas TX USA

University of Utah Salt Lake City UT USA

University of Virginia Charlottesville VA USA

Vanderbilt University Nashville TN USA

Zucker School of Medicine at Hofstra Northwell Hempstead NY USA

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