High prevalence of widened P waves among pediatric patients in 2 separate hospitals

IntroductionIn adults, P waves of 110 milliseconds or longer are often associated with significant disease. In the pediatric population, however, cutoffs for P-wave durations are naturally lower but could vary physiologically with age because of increasing heart mass. We appraised if age-proportionate increase in P-wave duration does indeed occur in both hospitalized infants and children and also investigated the prevalence of widened P-wave durations using currently accepted “normal” cutoffs (≤70 milliseconds for infants and ≤90 milliseconds for children).MethodsWe consecutively obtained 12-lead electrocardiograms of infants and children aged up to 16 years (range, 0.1-16 years; mean ± SD, 10.1 ± 5.2 years; male, 46.9%) who presented through the emergency department for nonacute, noncardiac conditions at the Nassau University Medical Center (NUMC), East Meadow, NY, and Saint Vincent Hospital (SVH), Worcester, MA, from January to May 2006. Electrocardiograms were then evaluated for the greatest P-wave duration in every lead to the nearest 10 milliseconds using a calibrated magnifying graticule on a blinded, single read.ResultsThe study sample consisted of 96 nonacute pediatric patients: infants and children from NUMC (age, 0.1-16 years; mean ± SD, 9.1 ± 5.4 years; male, 46.6%) and children from SVH (age, 6-16 years; mean ± SD, 13.1 ± 2.5 years; male, 47.8%). Prolonged P waves longer than 70 milliseconds were present in 3 (23%) of the 13 NUMC infants, whereas prolonged P waves longer than 90 milliseconds were observed in 16 (27%) of the 60 NUMC children and 7 (30%) of the 23 SVH children. Linear regression analysis revealed that age was the sole predictor of increasing P-wave durations on any lead [age = −15.33 + 0.30 (P-wave duration [milliseconds]); r2 = 0.44]. Moreover, there was a significant increase in P-wave duration for patients aged 10 years or older, where a notable step-up in such measurements was observed.ConclusionP-wave duration is significantly associated with age among hospitalized children as well as infants, where particular increase occurs at 10 years of age or older. General pediatricians and, more importantly, pediatric cardiologists, need to be more vigilant in using appropriate age-based P-wave cutoffs when assessing interatrial conduction in this population.