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Owsianka, N; Schober, L; Sallmon, H; Scherr, D; Köstenberger, N; Manninger, M; Öffl, N; Kurath-Koller, S.
Electrocardiographic markers of hypertrophy in children: revisiting R/S overlap and the Katz-Wachtel phenomenon.
Front Pediatr. 2025; 13:1713053 Doi: 10.3389/fped.2025.1713053 [OPEN ACCESS]
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Leading authors Med Uni Graz
Manninger-Wünscher Martin
Owsianka Nikola
Co-authors Med Uni Graz
Kurath-Koller Stefan
Öffl Nathalie Maria
Sallmon Hannes
Scherr Daniel
Schober Lukas
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Abstract:
BACKGROUND: Many children show R/S overlap in ECG chest leads. The Katz-Wachtel phenomenon, described in the 1960s, characterizes high R and S waves ≥50 mm as an ECG feature of biventricular cardiac hypertrophy. This study investigates the KWP and the association between an R/S overlap and cardiac hypertrophy. METHODS: Retrospective study including 800 pediatric patients, treated at the Division of Pediatric Cardiology, University Hospital Graz, between 2016 and 2022. ECG measurements with regard to R/S overlap and voltage in chest leads and review of echocardiography findings of cardiac hypertrophy. ECG measurements were manually obtained and reviewed by two blinded pediatric cardiologists. RESULTS: Of the 500 patients with an R/S overlap, 4% had confirmed cardiac hypertrophy compared to 1% of children without confirmed R/S overlap. Sensitivity was highest in leads V3/4 (69%), while specificity was highest in leads V1/V2 (93%) and V5/V6 (96%), respectively. A statistically significant correlation between R/S overlap and hypertrophy was found. CONCLUSION: R/S overlap correlates with myocardial hypertrophy in children. While it demonstrates high sensitivity, its limited specificity prevents its use as a standalone diagnostic parameter. It may contribute to early identification when combined with other ECG features and echocardiographic evaluation.

Find related publications in this database (Keywords)
ECG
children
ventricular hypertrophy
chest leads
Katz-Wachtel-Phenomenon
biventricular hypertrophy
electrocardiography
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