Electrocardiographic Changes at Presentation and Over Time in Children with Anomalous Left Coronary Artery from the Pulmonary Artery: A Multicenter Analysis

Abstract

Multicenter studies describing electrocardiogram (ECG) patterns in children presenting with anomalous left coronary artery from the pulmonary artery (ALCAPA), to our knowledge, have not been published. This study aimed to describe the ECG findings at presentation and over time in a multicenter cohort of children with ALCAPA and assess their association with clinical outcomes. We performed a retrospective ECG analysis of 188 patients with ALCAPA who presented between 1/2009 and 3/2018 at 21 centers affiliated with Collaborative Research for the Pediatric Cardiac Intensive Care Society. ECGs were categorized apriori as Classic (pathologic Q waves in anterolateral leads), non-classic (abnormal but without pathologic Q waves), and normal. The primary outcome was major adverse cardiac events (MACE) following ALCAPA repair, defined as extracorporeal support, cardiopulmonary resuscitation, heart transplantation, or death. Classic, non-classic, and normal ECG findings were seen at presentation in 124 (66%), 49 (26%), and 15 (8%) patients, respectively. There was no association between ECG category and MACE. Patients with non-classic or normal ECG findings were significantly more likely to present with normal or mildly diminished left ventricular systolic function and had significantly shorter duration of ventilation and hospital stay. Among 70 patients with ECGs at ~ 3 years following surgery, classic, non-classic, and normal ECG patterns were seen in 6 (8%), 29 (41%), and 35 (50%) patients, respectively. In conclusion, one-third of patients with ALCAPA presented with non-Classic or normal ECG patterns, and these patients were more likely to have preserved cardiac function and recover more quickly following surgical repair.

Keywords: Anomalous left coronary artery; Child; Critical care; Electrocardiography; Pulmonary artery.