The Poor Performance of RSR′ Pattern on Electrocardiogram Lead V1 for Detection of Secundum Atrial Septal Defects in Children

Objective To assess the accuracy of RSR′ patterns in lead V1 (RSR′-V1) in diagnosing atrial septal defects (ASDs) in children. Study design Children who underwent an electrocardiogram (ECG) during 2010 were divided into 2 ECG groups: RSR′-V1 and normal (no RSR′-V1). Children who underwent an echocardiogram during 2010 were also divided into an ASD group and a normal echocardiogram group. The 4 groups were matched in a 2 × 2 table format where the RSR′-V1 was the "test" and ASD was the "disease." Sensitivity, specificity, positive/negative predictive values, and pre/post-test probabilities were calculated. Results There were 4658 ECG studies included in the analysis: 836 had RSR′-V1 and 3822 were normal without RSR′-V1. Of 4935 echocardiographic studies analyzed, 329 had an ASD and 4606 were normal; 1363 patients had both studies done during the study period. The ECG sensitivity for diagnosing an ASD was 36.1%, specificity was 80%, positive predictive value was 14.7%, and negative predictive value was 92.9% with an overall accuracy of 76.2%. Patients with ASD and RSR′-V1 were significantly older than patients with ASD and no RSR′-V1 pattern. Conclusion RSR′-V1 is a poor screening test for the detection of ASD. It should not change the clinical suspicion or the decision to obtain an echocardiogram. Older children without RSR′-V1 on ECG are unlikely to have an ASD.