Adults with a Fontan procedure or total cavo-pulmonary connection (TCPC) have been shown to have abnormalities in their microcirculation (capillary rarefaction) and increased aortic stiffness. These are also a hallmark of essential hypertension. It remains unclear whether the blood pressure of Fontan patients differs from the general population. Therefore, we undertook a systematic review and meta-analysis in Fontan patients comparing blood pressure against healthy controls.

A systematic search of peer-reviewed publications for “Fontan adults” studies, including patients >=16 years of age, with a previous Fontan/TCPC and containing blood pressure data for both Fontan adults and controls, was included. The trial strategy was registered in PROSPERO (CRD42022355781). MEDLINE, Embase, and Cochrane (CENTRAL) database searches yielded 2168 records. Heterogeneity was assessed with Higgins I2 statistic with a value >50% indicative of high heterogeneity and P values based on Cochran’s Q test. A random-effects model was used to calculate the pooled effect size.

Eleven studies contained sufficient blood pressure data from 544 Fontan/TCPC adults. Their weighted mean systolic and diastolic blood pressure was 114 ± 14 mmHg and 69 ± 9 mmHg. Only four (130 patients) studies, were suitable for meta-analysis. Weighted mean difference in systolic BP was −1.36 mmHg (95% CI, −9 to 6.38) and in diastolic BP was +0.89 mmHg (95% CI, −2.92 to 4.70) between Fontan/TCPC patients and controls. A high level of heterogeneity in both SBP (P < 0.00001) and DBP (P < 0.003) was noted.

Neither systolic nor diastolic blood pressure in adults with a Fontan circulation differ from healthy controls. Overall weighted means of blood pressure were comparable for similar age groups. Arterial hypertension does not appear to explain the capillary rarefaction and aortic stiffness found in adults with a Fontan procedure or total cavo-pulmonary connection. Further studies are required to explore other causes of their vascular remodelling.

Children with cancer may develop cardiac dysfunction during sepsis or severe infection due to prior cardiotoxic therapy, fluid exposure, systemic inflammation, and critical illness. We aimed to map evidence on myocardial dysfunction and related cardiac involvement during sepsis or severe infection in this population.

We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library through June 2026. Eligible studies included pediatric patients with cancer or hematopoietic stem cell transplantation who developed sepsis, septic shock, febrile neutropenia, bacteremia, bloodstream infection, or invasive fungal infection and underwent cardiac or hemodynamic assessment.

Of 874 records identified, 749 remained after deduplication and 11 studies were included. Evidence consisted mainly of observational studies, case reports, case series, and conference abstracts. Cardiac findings included acute systolic dysfunction, myocarditis-like presentations, elevated B-type natriuretic peptide, transient bradycardia, abnormalities in echocardiographic assessment of fluid responsiveness, and endocarditis. Children with leukemia, particularly those exposed to anthracyclines, were most frequently represented. Cardiac recovery was reported in several cases, although mortality was high when sepsis and progressive cardiac dysfunction coexisted. No study directly compared incidence between children with and without cancer.

Cardiac involvement during sepsis in children with cancer is recognized but remains under-studied and inconsistently defined. Existing evidence does not establish a higher incidence than in children without cancer or an oncology-specific syndrome. Standardized definitions, baseline characterization, and prospective multicenter comparative studies are needed to clarify phenotype, recovery, and outcomes.

Artificial intelligence is increasingly applied in paediatric cardiology and cardiac intensive care, where CHD, postoperative physiologic instability, and continuous bedside monitoring generate complex datasets. This review summarises current applications of artificial intelligence in paediatric cardiology and the cardiac ICU, focusing on cardiac imaging, electrocardiography, predictive analytics, waveform intelligence, and postoperative outcome prediction.

A narrative review of PubMed, MEDLINE, and Scopus was performed for studies published from 2018 through 2026 evaluating artificial intelligence, machine learning, or deep learning in paediatric cardiology, CHD, congenital heart surgery, and cardiac critical care.

Studies addressing paediatric or CHD-focused applications in echocardiography, cardiac MRI, electrocardiography, cardiac ICU monitoring, waveform analytics, or postoperative complication prediction were included, together with relevant reviews.

Information was extracted on study population, artificial intelligence method, clinical task, model inputs, outcomes, validation strategy, and major limitations.

Artificial intelligence is most developed in imaging and electrocardiography, while paediatric and complex CHD evidence remains less mature. In cardiac ICU, models using electronic health record variables, high-frequency physiologic data, and risk indices have been evaluated for cardiac arrest, low cardiac output physiology, hyperlactatemia, extubation failure, and vasoactive de-escalation. External validation, prospective deployment, calibration, and workflow-safe implementation remain major gaps.

Artificial intelligence may improve diagnostic consistency, risk stratification, and early recognition of deterioration, but prospective validation and measurable clinical benefit are needed before autonomous use.

Cardiovascular diseases remain a major global health burden, and early diagnosis using cardiac magnetic resonance imaging (MRI) is essential. However, manual interpretation is subjective, while existing deep learning models often show inconsistent preprocessing, limited multi-scale feature learning, and poor interpretability.

CardioFusion-XAI, a hybrid explainable deep learning framework, was developed for four-class cardiac MRI classification. WaveCLAHE-Net integrates wavelet-based enhancement and contrast-limited adaptive histogram equalisation to improve image quality. CardioXtract Fusion Net combines ResNet-50, EfficientNet-B0, and a Vision Transformer to learn complementary local, multi-scale, and global features. An enhanced classification head performs prediction, while Grad-CAM and t-distributed stochastic neighbour embedding support model interpretability.

Using the Sunnybrook Cardiac Dataset, CardioFusion-XAI achieved 98.89% accuracy, 98.93% precision, a 98.90% F1-score, and an area under the curve of 0.9998.

CardioFusion-XAI provides accurate and interpretable cardiac MRI classification. Further multicentre validation is required before clinical implementation.

Children with CHD require long-term follow-up, but missed visits among patients are common. Missed appointments likely contribute to excess morbidity and mortality. Our study seeks to identify social factors that could predict patients at risk of missing cardiology visits and to determine if missed visits and these social factors contribute to increased emergency department utilisation.

We conducted a single-centre chart review of CHD patients seen from 2012–2024 and analysed trends in paediatric cardiology clinic attendance, particularly the number of missed appointments. We also looked at emergency department visits and subsequent admissions among these groups. The primary exposure was the area deprivation index, a composite measure of neighbourhood disadvantage based on income, education, employment, and housing quality. We also compared the number of acute visits between patients with more missed visits.

We included 1,060 patients with CHD, and 46% of our population had ≥2 missed clinic visits, 31% had ≥5 emergency department visits, and 32% had ≥2 admissions. The number of missed visits increased across area deprivation index quartiles, though the number of emergency department visits and admissions was not significantly affected by area deprivation index. Patients with more missed visits were more likely to have more emergency department visits and admissions.

Our data suggest a relationship between community deprivation and missed clinic visits, and missed clinic visits seem to confer a greater risk of emergency department visits and unplanned admissions. Area deprivation index is a parameter available in major electronic health records and could be used to identify patients at risk for missed visits.

Discrepancies between preoperative echocardiographic diagnosis and intraoperative surgical findings for incomplete atrioventricular septal defects are frequently encountered. We assess the frequency of diagnostic discordance and its impact, focusing on subtype-specific predictors of the postoperative course.

We reviewed 172 patients post repair of incomplete atrioventricular septal defects at a single institution between November 2000–February 2025, including transitional atrioventricular septal defects (n = 74), partial atrioventricular septal defects (n = 71), and primum atrial septal defect with isolated left atrioventricular valve cleft (n = 27). Preoperative echocardiographic diagnoses were compared with intraoperative surgical diagnoses to determine diagnostic discordance and assess impact.

Baseline characteristics were similar across subtypes. Transitional atrioventricular septal defects were associated with a higher prevalence of syndromic diagnoses (52.7% versus 33.8% versus 22.2%, p = 0.008) and greater preoperative ventricular dilation (LVIDd Z-score −0.88 versus −1.70 versus −1.70, p = 0.031). Diagnostic discordance occurred most frequently in partial atrioventricular septal defects (74.6%), followed by primum atrial septal defect with isolated left atrioventricular valve cleft (37.0%) and transitional atrioventricular septal defects (13.5%) (p < 0.001). Transitional atrioventricular septal defect repairs were associated with longer cardiopulmonary bypass and cross-clamp times, prolonged ventilation, and longer hospital stays (all p < 0.05). Residual shunt was more frequent in transitional atrioventricular septal defects early postoperatively and at the last follow-up (p < 0.001). One death was observed in the partial atrioventricular septal defects group, reintervention rates were similar across subtypes (p = 0.643), and follow-up duration differed modestly between groups (p = 0.047).

The high rate of diagnostic discordance reflects inherent challenges in preoperative classification and suggests that a simplified, clinically oriented nomenclature may improve communication, surgical planning, and outcome prediction.

Psychosocial challenges are well-described among adults with CHD. Limited literature explores the impact of adults with CHD interventions on patient-reported outcomes. We examined changes in patient-reported mental and physical health status 30 days after a diagnostic or interventional adult with CHD procedure.

A prospective registry captured patient-reported physical and mental health through the Patient Reported Outcomes Measurement and Information System Global Health Questionnaire before and 30 days after the procedure. Global mental and physical health scores were derived and standardised, with 50 points as the mean of the general U.S. population and a minimal important change of 3 points.

In our sample of 160 patients, patent foramen ovale closure and diagnostic catheterisation of complex CHDs were the most common procedures (44.4% and 35.6%, respectively). Palpitations were a commonly reported symptom before the procedure (21.8%), with increasing proportions at 30-days (34.0%, p = 0.003). At baseline, the median global mental health and global physical health scores were 48.3 [IQR = 43.5–53.3] and 47.7 [IQR = 39.8–54.1], respectively, within one standard deviation of the general U.S. population; there were no significant differences from baseline at 30 days. However, these differences were not uniform; approximately 53% and 72% of patients had a clinically meaningful improvement or decline in their global mental health or global physical health score (>minimal important change of 3).

In this novel investigation, patients experienced both improvement and decline in mental and physical self-reported health after adults with CHD interventions, indicating considerable variability in short-term outcomes. Future analyses should explore predictors of divergent changes in health scores after procedures, to promote patient-centred care.

Traditionally, pediatric cardiology has been fundamentally reactive: structural abnormalities were diagnosed, symptoms developed, complications occurred, and clinicians responded. Increasingly, however, the field is shifting upstream from reaction to anticipation.

To highlight the transition from reactive to predictive pediatric cardiology and discuss the implications of integrating molecular and computational approaches into the management of congenital heart disease (CHD).

Narrative review of emerging concepts in precision medicine, focusing on the integration of genomics, transcriptomics, proteomics, other multi-omics technologies, advanced cardiac imaging, and computational analysis.

Multi-omics approaches demonstrate that CHD is not solely an anatomical disorder but also a biological disease. Distinct molecular pathways may explain why patients with apparently identical cardiac anatomy experience markedly different clinical trajectories. The combination of molecular profiling, advanced imaging, and computational analysis enables more accurate risk stratification and earlier prediction of disease progression, paving the way for personalized management strategies.

The transition from reactive to predictive medicine represents more than a technological advance; it fundamentally redefines the role and responsibilities of pediatric cardiologists. As the ability to anticipate disease progression improves, clinical decisions must increasingly be made before overt manifestations appear, raising new opportunities and responsibilities regarding the timing and appropriateness of intervention.

Feeding neonates with CHD is clinically and emotionally challenging. Although human milk improves outcomes—including reduced necrotising enterocolitis, sepsis, and neurodevelopmental delays—its use remains suboptimal. Prior studies have focused on clinical endpoints, with limited attention to modifiable maternal or prenatal influences on feeding.

To evaluate how maternal expectations, prenatal counselling, and early lactation behaviours affect feeding outcomes in infants with prenatally diagnosed CHD.

We conducted a prospective cohort study of 49 mother–infant dyads with prenatally diagnosed CHD in a tertiary neonatal ICU and paediatric cardiac ICU. Mothers completed structured surveys during hospitalisation. Feeding outcomes were assessed through chart review over six months post-discharge. Primary outcomes included human milk volume at day of life 14, feeding type at discharge, and direct breastfeeding. Multivariable logistic regression and CHD risk stratification were used for analysis.

Direct breastfeeding during hospitalisation predicted oral feeding at discharge (77% vs. 28%, p = 0.0006) and ongoing human milk use. Early milk exposure (<72 hours) increased likelihood of human milk use at discharge (p = 0.0158). Strong maternal intent and prior breastfeeding experience were linked to sustained lactation. Prenatal counselling (reported by 68%) was not associated with outcomes. Higher Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery scores correlated with delayed achievement of 500 mL/day by day of life 14 (p = 0.0405).

Direct breastfeeding, early milk exposure, and maternal intent are key modifiable drivers of feeding success in neonates with CHD. Standard prenatal counselling alone is insufficient. Targeted, risk-informed lactation support is needed to optimise outcomes.

To compare postoperative outcomes after tetralogy of Fallot repair in patients managed with unilateral versus bilateral pleural drains.

In this single-centre retrospective cohort study, patients undergoing complete tetralogy of Fallot repair between 2020 and 2025 were included. Patients with previous complete repair, extracorporeal membrane oxygenation, delayed sternal closure, or chylothorax were excluded. The primary outcome was undrained postoperative pleural effusion on routine chest radiographs. Secondary outcomes were postoperative pleural drain insertion, duration of invasive mechanical ventilation, diuretic score, ICU length of stay, and pleural drain-related complications. Multivariable regression adjusted for repair type, bypass duration, cross-clamp duration, and surgeon.

Of 180 patients, 122 (68%) underwent unilateral pleural drain placement and 58 (32%) bilateral placement. Complex repairs were more common in the bilateral group. Undrained pleural effusion was more frequent after unilateral than bilateral pleural drain placement (42.6% vs 5.2%; p < 0.001). Postoperative pleural drain insertion was required in 9 patients (7.4%) in the unilateral group and in none in the bilateral group (p = 0.06). Pleural drain-related complications were more frequent with bilateral pleural drains, with 4 pneumothoraces requiring intervention versus 1 self-resolving subcutaneous emphysema in the unilateral group (p = 0.01). In multivariable analysis, bilateral pleural drain placement remained independently associated with lower odds of undrained pleural effusion, but not with duration of mechanical ventilation, diuretic score, or ICU length of stay.

Bilateral pleural drains were associated with fewer radiographic pleural effusions but no measurable short-term clinical advantage. Placement should therefore be individualised according to intraoperative findings and local practice.

To describe the quality of life and moderate-to-vigorous physical activity level among children with CHD compared to children without CHD and to examine whether the association between these variables is modified by CHD or gender.

This cross-sectional analysis draws from a larger longitudinal study and included participants aged 5–10 years with or without any CHD and living in British Columbia, Canada. Parents/guardians completed the parent-proxy PedsQL 4.0 Generic Core Scales, providing a PedsQL Total Score out of 100. Children wore an Ametris GT3X accelerometer for 7 consecutive days to measure moderate-to-vigorous physical activity (min/day). Generalised linear regression models were used for group and gender comparisons. An adjusted linear regression model was used to examine the association between physical activity and quality of life.

166 children (41% girls; n = 78 CHD, n = 88 non-CHD) were included in the analysis. Children with CHD had poorer PedsQL Total Scores (p = 0.002) and accumulated less moderate-to-vigorous physical activity than the non-CHD group (p = 0.008). Among children with CHD, girls accumulated less moderate-to-vigorous physical activity than boys (p < 0.001) and had poorer PedsQL Total Scores than boys (p = 0.035). The association between moderate-to-vigorous physical activity (min/day) and PedsQL Total Score was significantly modified by CHD (p = 0.012), with a positive association found for children with CHD (β = 0.17 [95% confidence interval: 0.04, 0.29], p = 0.011), which was not modified by gender (p = 0.241).

These findings highlight the need to support the physical and psychosocial health of children with CHD, particularly girls with CHD.

Assessment of maximal heart rate is used in clinical practice to determine the degree of beta-blockade during exercise and periods of adrenergic stress. When direct measurement is not possible, indirect methods utilising heart rate prediction equations are commonly used, but their validity in children has been challenged.

Retrospective data on 109 healthy children (male 63, 58%; mean age 11.00 ± 3.09) undergoing routine exercise testing were analysed. Measured maximal heart rate was compared with estimates obtained from twenty-two prediction equations.

All prediction equations overestimated maximal heart rate in males. In females, two equations underpredicted (Fairbarn and Heinzmann-Filho et al.), whilst the remaining equations overpredicted. The equations that predicted most accurately differed between males (Fairbarn) and females (Whyte (males). The prediction equation used commonly in clinical practice, Fox (220-age), overestimated significantly in males and females (p = < 0.001). A moderate positive correlation with age and maximal heart rate was seen in males only (r = 0.3195, p = 0.0107).

This study shows that adult age regression equations do not accurately predict childhood maximal heart rate as determined by exercise testing. An inability to accurately predict maximal heart rate could have important implications for both childhood exercise prescription and the safe monitoring of pharmacological therapy that limits exertional heart rate response in children with inherited arrhythmic syndromes. In the absence of direct measurement of maximal heart rate, alternative paediatric-specific prediction methods should be developed to ensure appropriate estimation of childhood maximal heart rate.

Postoperative prophylactic peritoneal dialysis after paediatric cardiac surgery has been reported with mixed results. We aimed to describe a large cohort of patients who did and did not receive prophylactic peritoneal dialysis following cardiac surgery in our institution.

Single-centre, retrospective matched-cohort study of patients 0–30 days old who underwent cardiac surgery between 01/2015 and 05/2022. Patients who received prophylactic peritoneal dialysis were matched 1:1 with those who did not by age, sex, and surgical complexity. The objective of the study was to compare the prevalence of postoperative severe acute kidney injury by Kidney Disease Improving Global Outcomes criteria between patients who received prophylactic peritoneal dialysis and those that did not. The significance level was set at p = 0.05.

A total of 224 patients underwent prophylactic peritoneal dialysis, and 224 did not. Patients in the prophylactic postoperative peritoneal dialysis group had a lower incidence of severe acute kidney injury (13.4% versus 30.4%, p < 0.001). Fluid balance in the first 24 hours and 48 hours postoperatively was lower (p < 0.001), and time to negative fluid balance was shorter in the prophylactic postoperative peritoneal dialysis group (p < 0.001). Utilising adjusted multivariable logistic regression, we report no association between the use of prophylactic postoperative peritoneal dialysis and the development of severe acute kidney injury (p = 0.504).

In this large cohort of patients, we report that patients who underwent prophylactic postoperative peritoneal dialysis, although they had an improved fluid balance during the first 48 postoperative hours, had no association with the development of severe acute kidney injury.

Extrachromosomal circular DNAs are critical regulators of stress responses, immunity, and inflammation pathways. However, their role and underlying mechanisms in Kawasaki disease complicated by coronary artery aneurysm remain poorly understood.

Whole blood samples from six children with Kawasaki disease, including three with coronary artery aneurysm group and three without coronary artery aneurysm (control group), were subjected to extrachromosomal circular DNA sequencing. Putative extrachromosomal circular DNAs were identified using Circle-Map. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on genes associated with upregulated extrachromosomal circular DNAs, and an exploratory immune-signature profiling was performed using the single-sample gene set enrichment analysis algorithm.

We identified 4,790 differential extrachromosomal circular DNAs between the coronary artery aneurysm and control groups, of which 4,789 were upregulated in the CAA group. The extrachromosomal circular DNAs in the coronary artery aneurysm group were more concentrated and shorter in length than those in the control group. Upregulated extrachromosomal circular DNAs were mainly derived from autosomes, particularly chromosomes 3, 4, and 7. Functional enrichment analysis indicated that genes associated with upregulated extrachromosomal circular DNAs were mainly involved in response to stimulus-related terms and pathways, including chemokine signalling, cGMP-PKG signalling, and calcium signalling. Immune-signature analysis suggested that the coronary artery aneurysm group exhibited more specific immune responses, whereas the control group tended towards broader immune regulatory processes.

Coronary artery aneurysm and control groups exhibited distinct extrachromosomal circular DNA profiles. These findings suggest that extrachromosomal circular DNA alterations are associated with coronary artery aneurysm in Kawasaki disease and may provide new insights into the molecular features underlying this condition.

Neurodevelopment deficits are common among survivors of CHD and affect their future health and quality of life. Patients who have undergone cardiopulmonary bypass in infancy should have early, dedicated neurodevelopmental evaluation. There are many barriers to implementing this guidance. Our study examines the patterns of neurodevelopmental follow-up and outcomes in CHD patients in a rural, underserved, and resource-limited region.

We conducted a single-centre chart review of CHD patients seen from 2012 to 2024 and analysed trends in neurodevelopment follow-up, including the number of scheduled appointments, attended appointments, and missed appointments. We looked at whether area deprivation index was associated with differences in neurodevelopmental referral, attendance, and missed appointments. Area deprivation index is a composite measure of neighbourhood disadvantage based on income, education, employment, and housing quality.

Out of 1,060 patients in total, neurodevelopment appointments were scheduled for 270 (25%) of patients. The incidence of neurodevelopment diagnoses was similar across area deprivation index quartiles. Patients across area deprivation index quartiles had similar rates of attending at least one appointment, but children in the third and fourth quartiles had more than twofold higher odds of missing visits compared with those in the least deprived quartile. There was no significant difference in the age at which children received a neurodevelopment diagnosis.

CHD patients from more socially disadvantaged neighbourhoods were more likely to miss neurodevelopmental appointments. Area deprivation index, which is routinely available in major health record systems, may help identify patients at higher risk of poor follow-up.

CHD is the most common congenital anomaly worldwide. Advances in paediatric cardiology and cardiac surgery have transformed survival, shifting attention towards long-term psychosocial adaptation, neurodevelopment, quality of life, and relational well-being for children and their families.

This narrative review examines the psychosocial, developmental, familial, and relational dimensions of childhood CHD. Literature was identified through PubMed, Scopus, and Google Scholar, with thematic synthesis of evidence relating to psychosocial adaptation, parental mental health, neurodevelopment, resilience, belonging, peer relationships, and models of family- and relationship-centred care.

Childhood CHD is associated with repeated hospitalisation, developmental disruption, emotional distress, and lifelong uncertainty, with psychosocial effects extending beyond the child to parents, siblings, grandparents, peers, schools, and healthcare professionals. Families frequently experience anxiety, depression, chronic vigilance, and posttraumatic stress symptoms, while children and adolescents face challenges related to identity, belonging, and social participation. Supportive relationships, multidisciplinary psychosocial care, educational integration, peer support, and developmentally informed interventions may strengthen resilience and improve long-term adaptation. Patients with advanced heart failure requiring ventricular assist devices or heart transplantation, and their families experience additional uncertainty and psychological burden that warrant dedicated psychosocial support.

Psychosocial outcomes in CHD are shaped not only by medical care but also by the quality of the relationships surrounding the child. Relationship-centred care builds upon established family-centred care by recognising the broader relational ecosystem that influences development, resilience, participation, and quality of life. Future paediatric cardiology care should integrate longitudinal psychosocial, developmental, educational, and relational support alongside advances in medical treatment.

Childhood obesity is associated with adverse cardiovascular outcomes, including increased risk of arrhythmias and subclinical myocardial dysfunction. However, its impact on cardiac electrophysiological balance remains underexplored. The index of cardiac electrophysiological balance, calculated as QT/QRS ratio and corrected form of index of cardiac electrophysiological balance, emerged as novel electrocardiographic markers of ventricular arrhythmia risk. Although these parameters have been investigated in adult populations, data in obese children are lacking. This study aimed to evaluate the effects of obesity on index of cardiac electrophysiological balance and corrected form of index of cardiac electrophysiological balance in children and explore their associations with metabolic and anthropometric measures.

This retrospective cross-sectional study included 50 obese, 23 healthy children aged 10–18 years. Demographic, metabolic, electrocardiographic, and echocardiographic data were retrieved from hospital records. Index of cardiac electrophysiological balance, corrected form of index of cardiac electrophysiological balance, and repolarisation indices (QTc dispersion, Tp-e dispersion, and P-wave dispersion) were manually measured from 12-lead electrocardiograms. Associations with metabolic and anthropometric parameters were analysed using linear regression.

Index of cardiac electrophysiological balance and corrected form of index of cardiac electrophysiological balance values were significantly lower in obese children than in controls (p < 0.001). QTc, Tp-e, and P-wave dispersions were also increased, indicating greater electrical heterogeneity. Index of cardiac electrophysiological balance showed negative correlations with LDL and total cholesterol levels. Tp-e duration and Tp-e/QTc ratio were inversely associated with hip circumference z-scores, possibly reflecting protective effects of gluteofemoral fat distribution.

Childhood obesity may disrupt cardiac electrophysiological balance and repolarisation, even in the absence of overt cardiovascular disease. Index of cardiac electrophysiological balance and corrected form of index of cardiac electrophysiological balance could serve as early markers of arrhythmia risk. Prospective studies are needed to validate their prognostic significance.