Abstract
This review summarizes current data on influences of childhood obesity on the 12-lead electrocardiogram (ECG). Studies on obese adults showed a higher risk of cardiovascular complications and also, partly pathological, ECG alterations. Data on ECG alterations in obese children is rare. In current studies, no pathological findings were found. All alterations, which mimic the later pathological phenomena in obese adults, were within normal ranges. Studies reported significantly longer P-wave time and P-wave dispersion (Pd) in obese children [Üner A, Doğan M, Epcacan Z, Epçaçan S. The effect of childhood obesity on cardiac functions. J Pediatr Endocr Met 2014;27:261–71.], no correlation of heart rate, P-wave, or QT dispersions (QTd) [Akyüz A, Alpsoy S, Akkoyun DC, Nalbantoǧlu B, Tülübaș F, et al. Effect of overweight on P-wave and QT dispersions in childhood. Turk Kardiyol Dern Ars 2013;41:515–21.], significantly higher QTd in obese children [Yildirim S, Binnetoglu FK, Battal F, Aylanc H, Nazan Kaymaz N, et al. Relation between QT variables and left ventricular geometry in athletes and obese children. Acta Med Port 2016;29:95–100.], no significant association between obesity and QTc interval (QTc), but longer PR intervals, wider QRS duration and left axis shifting of frontal P-wave, QRS and T-wave axes [Sun G, Li Y, Zho X, Guuo X, Zhang X, et al. Association between obesity and ECG variables in children and adolescents: a cross-sectional study. Exp Ther Med 2013;6:1455–62.], significant prolongation of QTc, T peak-to-end, and QTd in the obese children [Paech C, Liebold A, Gebauer RA, Wagner F, Vogel M, et al. Relative QT interval prolongation and electrical inhomogeneity of cardiac repolarization in childhood obesity. Prog Pediatr Cardiol 2017;47:64–7.], slight shift to the left in the QRS axis (with no changes in the P axis), increased amplitudes of the left-sided leads in obese children, and no correlation of the heart rate with the weight [Paech C, Anhalt M, Gebauer RA, Wagner F, Vogel M, et al. New normal limits for pediatric ECG in childhood obesity? Influence of childhood obesity on the ECG. Prog Pediatr Cardiol 2018;48:119–23.]. Altogether, the study results are inconsistent. Clearly, pathological phenomena in the ECG of obese children were not reported: only preliminary stages like QTc prolongation within the norm were found. The pathological alterations seen in adult obese patients are not (yet) seen in childhood. The slight changes reported in childhood obesity are likely to manifest later and to develop into pathological phenomena in obese adults and, therefore, might increase the risk of cardiovascular events like arrhythmia and sudden cardiac death in adulthood.
Acknowledgments
We thank the “LIFE Child Study” team as well as all children and parents for their participation and assistance. The “LIFE Child Study’” is financed by means of the Free State of Saxony, Germany.
Author statements: The manuscript submitted is original, with no portion under simultaneous consideration for publication elsewhere or previously published. Only those who have made an important contribution to the study and are thoroughly familiar with the primary data are included as authors. All authors are responsible for the contents and have acknowledged the manuscript.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Reinehr T. Calculating cardiac risk in obese adolescents before and after onset of lifestyle intervention. Expert Rev Cardiovasc Ther 2013;11:297–306.10.1586/erc.13.6Search in Google Scholar
2. Giussani M, Antolini L, Brambilla P, Pagani M, Zuccotti G, et al. Cardiovascular risk assessment in children: role of physical activity, family history and parental smoking on BMI and blood pressure. J. Hypertens 2013;31:983–92.10.1097/HJH.0b013e32835f17c7Search in Google Scholar
3. Messerli FH, Nunez BD, Ventura HO, Snyder DW. Overweight and sudden death: Increased ventricular ectopy in cardiopathy of obesity. Arch Intern Med 1987;147:1725–8.10.1001/archinte.1987.00370100039008Search in Google Scholar
4. Drenick EJ, Fisler JS. Sudden cardiac arrest in morbidly obese surgical patients unexplained after autopsy. Am J Surg 1988;155:720–6.10.1016/S0002-9610(88)80029-1Search in Google Scholar
5. Flechtner-Mors M, Thamm M, Wiegand S, Reinehr T, Schwab KO, et al. Comorbidities related to BMI category in children and adolescents: German/Austrian/Swiss obesity register APV compared to the German KiGGS Study. Horm Res Paediatr 2012;77:19–26.10.1159/000334147Search in Google Scholar PubMed
6. Mangner N, Scheuermann K, Winzer E, Wagner I, Hoellriegel R, et al. Childhood obesity: impact on cardiac geometry and function. JACC Cardiovasc Imaging 2014;7:1198–205.10.1016/j.jcmg.2014.08.006Search in Google Scholar PubMed
7. Blüher S, Petroff D, Keller A, Wagner A, Classen J, et al. Effect of a 1-year obesity intervention (KLAKS Program) on preexisting autonomic nervous dysfunction in childhood obesity. J Child Neurol 2015;30:1174–81.10.1177/0883073814555190Search in Google Scholar PubMed
8. Elagizi A, Kachur S, Lavie CJ, Carbone S, Pandey A, et al. An overview and update on obesity and the obesity paradox in cardiovascular diseases. Prog Cardiovasc Dis 2018;61:142–50.10.1016/j.pcad.2018.07.003Search in Google Scholar PubMed
9. Van De Maele K, Devlieger R, Gies I. In utero programming and early detection of cardiovascular disease in the offspring of mothers with obesity. Atherosclerosis 2018;275:182–95.10.1016/j.atherosclerosis.2018.06.016Search in Google Scholar PubMed
10. Nishijima DK, Lin AL, Weiss RE, Yagapen AN, Malveau SE, et al. ECG predictors of cardiac arrhythmias in older adults with syncope. Ann Emerg Med 2018;71:452–61.e3. pii: S0196-0644:31902-9.10.1016/j.annemergmed.2017.11.014Search in Google Scholar PubMed PubMed Central
11. Shi S, Barajas-Martinez H, Liu T, Sun Y, Yang B, et al. Prevalence of spontaneous Brugada ECG pattern recorded at standard intercostal leads: a meta-analysis. Int J Cardiol 2017. pii: S0167-5273:36086-2.10.1016/j.ijcard.2017.11.113Search in Google Scholar
12. Leong KM, Ng FS, Roney C, Cantwell C, Shun-Shin MJ, et al. Repolarization abnormalities unmasked with exercise in sudden cardiac death survivors with structurally normal hearts. J Cardiovasc Electrophysiol 2018;29:115–26.10.1111/jce.13375Search in Google Scholar
13. Domienik-Karłowicz J, Rymarczyk Z, Lisik W, Kurnicka K, Ciurzyński M, et al. Questionable validity of left ventricular hypertrophy cutoff values in morbidly and super-morbidly obese patients. Ann Noninvasive Electrocardiol 2018;23:e12564.10.1111/anec.12564Search in Google Scholar
14. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, et al. Obesity and cardiovascular disease pathophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol 2006;26:968–76.10.1161/CIRCULATIONAHA.106.171016Search in Google Scholar
15. Alpert MA, Terry BE, Cohen MV, Fan TM, Painter JA, et al. The electrocardiogram in morbid obesity. Am J Cardiol 2000;85:908–10.10.1016/S0002-9149(99)00894-2Search in Google Scholar
16. Russo V, Ammendola E, De Crescenzo I, Ricciardi D, Capuano P, et al. Effect of weight loss following bariatric surgery on myocardial dispersion of repolarization in morbidly obese patients. Obes Surg 2007;17:857–65.10.1007/s11695-007-9160-9Search in Google Scholar
17. Eisenstein I, Edelstein J, Sarma R, Sanmarco M, Selvester RH. The electrocardiogram in obesity. J Electrocardiol 1982;15:115–18.10.1016/S0022-0736(82)80003-4Search in Google Scholar
18. Nault I, Nadreau E, Paquet C, Brassard P, Marceau P, et al. Impact of bariatric surgery-induced weight loss on heart rate variability. Metabolism 2007;56:1425–30.10.1016/j.metabol.2007.06.006Search in Google Scholar PubMed
19. Valencia-Flores M, Orea A, Herrera M, Santiago V, Rebollar V, et al. Effect of bariatric surgery on obstructive sleep apnea and hypopnea syndrome, electrocardiogram, and pulmonary arterial pressure. Obes Surg 2004;14:755–62.10.1381/0960892041590773Search in Google Scholar PubMed
20. Üner A, Doğan M, Epcacan Z, Epçaçan S. The effect of childhood obesity on cardiac functions. J Pediatr Endocr Met 2014;27:261–71.10.1515/jpem-2013-0157Search in Google Scholar PubMed
21. Akyüz A, Alpsoy S, Akkoyun DC, Nalbantoǧlu B, Tülübaș F, et al. Effect of overweight on P-wave and QT dispersions in childhood. Turk Kardiyol Dern Ars 2013;41:515–21.10.5543/tkda.2013.90688Search in Google Scholar PubMed
22. Yildirim S, Binnetoglu FK, Battal F, Aylanc H, Nazan Kaymaz N, et al. Relation between QT variables and left ventricular geometry in athletes and obese children. Acta Med Port 2016;29:95–100.10.20344/amp.6538Search in Google Scholar PubMed
23. Sun G, Li Y, Zho X, Guuo X, Zhang X, et al. Association between obesity and ECG variables in children and adolescents: a cross-sectional study. Exp Ther Med 2013;6:1455–62.10.3892/etm.2013.1337Search in Google Scholar PubMed PubMed Central
24. Paech C, Liebold A, Gebauer RA, Wagner F, Vogel M, et al. Relative QT interval prolongation and electrical inhomogeneity of cardiac repolarization in childhood obesity. Prog Pediatr Cardiol 2017;47:64–7.10.1016/j.ppedcard.2017.08.001Search in Google Scholar
25. Paech C, Anhalt M, Gebauer RA, Wagner F, Vogel M, et al. New normal limits for pediatric ECG in childhood obesity? Influence of childhood obesity on the ECG. Prog Pediatr Cardiol 2018;48:119–23.10.1016/j.ppedcard.2017.11.002Search in Google Scholar
26. Paech C, Moser J, Dähnert I, Wagner F, Gebauer RA, et al. Different habitus but similar electrocardiogram: cardiac repolarization parameters in children – comparison of elite athletes to obese children. Ann Pediatr Cardiol 2019;12:201–5.10.4103/apc.APC_90_18Search in Google Scholar PubMed PubMed Central
27. Poulain T, Baber R, Vogel M, Pietzner D, Kirsten T, et al. The LIFE child study: a population-based perinatal and pediatric cohort in Germany. Eur J Epidemiol 2017;32:145–58.10.1007/s10654-016-0216-9Search in Google Scholar PubMed
©2020 Walter de Gruyter GmbH, Berlin/Boston
