Paeds Vivas · investigations-procedures-and-technology
Electrocardiogram acquisition and interpretation in children — branching viva
Branching viva on paediatric ECG acquisition and interpretation: the technical conventions and electrode placement, the age-specific normal ranges, the systematic seven-step read, the QTc and long QT syndrome, and the resuscitation of the paediatric tachyarrhythmia.
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RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A paediatric ward: a 14-year-old girl is referred after two syncopal episodes, the first during a swimming lesson and the second on hearing sudden bad news. The GP's 12-lead ECG shows a sinus rhythm at 75 beats per minute with a Bazett-corrected QT interval of 490 milliseconds. The examiner asks how you would acquire and systematically interpret a paediatric ECG, why the age-specific normal ranges matter, and what the QTc means — then branches to the technical conventions and electrode placement in a young child, to the false positives generated by reading a neonate's ECG against adult ranges, and finally to the resuscitation of a haemodynamically compromised infant with a narrow-complex tachycardia.
Opening question
This 14-year-old girl with two syncopal episodes has a Bazett-corrected QT interval of 490 milliseconds on her GP's ECG. Walk me through the systematic interpretation you would apply to her tracing, and tell me why the age-specific normal ranges matter at every step. [1] [2]
References5ShowHide
- [1]Miliaraki M, Germanakis I Pediatric Electrocardiogram in Preparticipation Screening: Narrative Review of Normal Values in Key Features Children (Basel), 2026.PMID 41749567
- [2]Sharieff GQ, Rao SO The pediatric ECG Emerg Med Clin North Am, 2006.PMID 16308120
- [3]Wathen JE, Rewers AB, Yetman AT, et al. Accuracy of ECG interpretation in the pediatric emergency department Ann Emerg Med, 2005.PMID 16308065
- [4]Schwartz PJ, Moss AJ, Vincent GM, Crampton RS Diagnostic criteria for the long QT syndrome. An update Circulation, 1993.PMID 8339437
- [5]Gotta V, Donner B QT interval prolongation: clinical assessment, risk factors and quantitative pharmacological considerations J Pharmacokinet Pharmacodyn, 2025.PMID 41204044