Comment on: Early Post-operative ECG Changes as a Predictor of Post-pericardiotomy Syndrome Following Atrial Septal Defect Repair

In response to the article “Early Postoperative ECG Changes as a Predictor of Post-Pericardiotomy Syndrome Following Atrial Septal Defect Repair” by Hyberg et al. I commend the authors for their valuable insights into early ECG changes predicting postoperative complications. However, I raise several concerns regarding their study’s methodology. Specifically, the use of European Society of Cardiology (ESC) criteria without incorporating pediatric-specific criteria, such as those proposed by Heching et al. potentially limits the study’s applicability to younger patients. Additionally, reliance solely on ST-segment elevation and PR segment depression for assessing pericardial inflammation overlooks the significance of Spodick’s sign. The lack of a standardized timing for postoperative ECGs and the omission of independent risk factors for Post-Pericardiotomy Syndrome (PPS), including history of pericarditis and pneumonia, further limit the study's comprehensiveness. I suggest that future research should address these aspects to refine diagnostic and monitoring strategies.