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Arch Dis Child. 2007 July; 92(7): 657.
PMCID: PMC2083761

How to read pediatric ECGs

Reviewed by A Graham Stuart

Edited by Myung K Park and Warren G Guntheroth. Published by Mosby Elsevier, 2006, £44.99 (paperback), pp 280. ISBN ‐10: 0‐3230‐3570‐1

How to read paediatric ECGs is an unusual book, which harks back to the past. In this era of information overload, the quick answer to most questions – medical or otherwise – can be obtained by “Googling” or similar shortcuts. This book takes a more traditional approach.

The first chapter deals with the lost art of vectorcardiography – the application of basic physics and mathematics to the interpretation of the ECG. Read this chapter carefully and the mysteries of QRS axis and even the EP Holy Grail – pathway spotting in Wolff‐Parkinson‐White syndrome – become less opaque. Chapter 2 is a bit more conventional and deals with the measurement of basic intervals (PR, QRS, etc) but also adds in exotica such as JT intervals. It deals with the calculation of axis for which three methods are detailed. In chapters 3 and 4, normal values are described with copious illustrations and tables covering the premature neonate upwards. Chapter 5 deals with the complexity of ECG evaluation of chamber hypertrophy. By this stage I started to twitch and reach for my imaginary echo probe. Clearly, in modern medical practice, echocardiography is simpler and more accurate in the assessment of chamber size and wall thickness. Nonetheless, a good understanding of the ECG may prove helpful in confusing cases. Chapter 6 deals in great detail with bundle branch block and includes an extensive treatise on partial right bundle branch block in children. Complex vector loops are drawn, prefaced with the warning that “this is for advanced readers only”! There then follow chapters on ST segment analysis (including the t wave), arrhythmias, AV block and chamber analysis. The book finishes with a description of a concise systematic approach which can be used to read the ECG and analyse arrhythmias and AV block.

How to read paediatric ECGs is clearly illustrated and each chapter is supplemented by excellent review questions that test knowledge of the preceding chapter. There are some very good reference tables of normal values. The book does, however, have some notable omissions. For example, the section on “reading the paced ECG” is extremely brief and omits to mention newer developments such as the biventricular pacemaker and implantable defibrillator. Similarly, the section on Wolff‐Parkinson‐White syndrome is short and could be improved by the inclusion of pathway localisation algorithms and a description of why the localisation of the pathway is useful in the ablation era.

Overall, this is an interesting and erudite book that will endow the reader with an improved understanding of the theoretical basis of the ECG. I am an enthusiast for endurance sports and, having recently completed the West Highland Way, I can testify to the purification of spirit that can be achieved by tramping through virgin snow across Rannoch Moor. The sense of achievement is immense and is supplemented by a deeper knowledge of oneself, one's Creator and fellow man. At the same time, there are blisters, sore muscles and relief that it is all over. This book is a bit like that. Try it!it!

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Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group