Left Axis Deviation in Children

¹ Assistant Professor, Department of Pediatrics, University of Minnesota
² Intern, Hennepin County General Hospital
³ Assistant Professor, Department of Medicine, University of Minnesota

The electrocardiograms of 3,000 patients have been reviewed for the presence of left axis deviation. This was defined as a QRS axis from 0° to -90° in the frontal plane. Variations in the diagnostic criteria were allowed if the electrocardiogram showed left axis deviation for age, according to Ziegler's criteria.

The only congenital defect that appeared to be significantly biased in favor of the first year of life was that of tricuspid atresia.

In the 129 pediatric patients with proved congenital cardiac anomalies, left axis deviation in the presence of left-to-right shunt was most frequently associated with isolated ventricular septal defect or atrioventricular canal. In the presence of cyanosis, or a right-to-left shunt, left axis deviation was most often associated with tricuspid atresia with or without transposition of the great vassels.

It is noted that left axis deviation may be associated with a variety of other noncardiac lesions. These include Henoch-Schoenlein's purpura, chronic lung disease, systemic diseases without known cardiac involvement, and apparently healthy children with functional murmurs who have normal findings at cardiac catheterization.