ECG in the Child and Adolescent Normal Standards and Percentile Charts

105 Pages·2006·0.64 MB·English

by  Hung-Chi Lue

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ECG in the
Child and
Adolescent
NORMAL STANDARDS AND PERCENTILE CHARTS
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ECG in the
Child and
Adolescent
NORMAL STANDARDS AND
PERCENTILE CHARTS
Hung-Chi Lue,M.D., Ph.D., F.A.C.C., F.C.C.P.
AttendingPediatricCardiologistandPhysician-in-Chief,
Min-ShengGeneralHospital;andEmeritusProfessorofPediatrics,
CollegeofMedicine,NationalTaiwanUniversity
WITH THE COLLABORATION OF
Yung-Chang Lai,M.D.
Mei-Hwan Wu,M.D.,Ph.D.,F.A.C.C.
Jou-Kou Wang,M.D.,Ph.D.
Ming-Lon Young,M.D.,M.P.H.
Yung-Ching Chang,M.D.
Shu-Jen Yeh,M.D.
Jiuann-Huey Lin,M.D.
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C 2006byBlackwellPublishing
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Firstpublished2006
1 2006
ISBN-13:978-1-4051-5899-2
ISBN-10:1-4051-5899-9
LibraryofCongressCataloguing-in-PublicationData
Lue,Hung-Chi,1931–
ECGinthechildandadolescent:normalstandardsandpercentile
charts/Hung-ChiLue;withthecollaborationofYung-ChangLai...
[etal.].
p.;cm.
Includesbibliographicalreferences.
ISBN-13:978-1-4051-5899-2(hardcover:alk.paper)
ISBN-10:1-4051-5899-9(hardcover:alk.paper)
1.Pediatriccardiology—Standards—Tables. 2.Electrocardiography—
Interpretation—Tables. I.Lai,Yung-Chang. II.Title.
[DNLM: 1.Electrocardiography—standards—Tables. 2.Adolescent.
3.Child. 4.Infant.WS16L948e2007]
RJ423.5.E43L842007
618.92’12—dc22
2006014415
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Contents
Preface,ix
Foreword,xi
Introduction,xv
Howtousethisbook,xvii
References,xviii
Part1 Heartrate,P-QRS-Tintervalanddurationbyage
1.1 Heartratebyage,3
1.2 PRintervalbyage,4
1.3 PRintervalbyheartrate,5
1.4 QTintervalbyage,6
1.5 QTintervalbyheartrate,7
1.6 QTcintervalbyage,8
1.7 QTcintervalbyheartrate,9
1.8 QRSdurationbyage,10
1.9 RRintervalbyage,11
Part2 FrontalplaneP-QRS-Taxisbyage
2.1 FrontalplanePaxisbyage,15
2.2 FrontalplaneQRSaxisbyage,16
2.3 FrontalplaneTaxisbyage,17
Part3 P-QRS-Tamplitudebyage
3.1 PamplitudebyageinleadII,21
3.2 QamplitudebyageinleadI,22
3.3 QamplitudebyageinleadII,23
3.4 QamplitudebyageinleadIII,24
3.5 QamplitudebyageinleadaVR,25
3.6 QamplitudebyageinleadaVL,26
3.7 QamplitudebyageinleadaVF,27
3.8 QamplitudebyageinleadV4,28
3.9 QamplitudebyageinleadV5,29
3.10 QamplitudebyageinleadV6,30
3.11 RamplitudebyageinleadaVR,31
3.12 RamplitudebyageinleadV1,32
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3.13 RamplitudebyageinleadV2,33
3.14 RamplitudebyageinleadV4,34
3.15 RamplitudebyageinleadV5,35
3.16 RamplitudebyageinleadV6,36
3.17 SamplitudebyageinleadI,37
3.18 SamplitudebyageinleadII,38
3.19 SamplitudebyageinleadIII,39
3.20 SamplitudebyageinleadaVL,40
3.21 SamplitudebyageinleadaVF,41
3.22 SamplitudebyageinleadV1,42
3.23 SamplitudebyageinleadV2,43
3.24 SamplitudebyageinleadV4,44
3.25 SamplitudebyageinleadV5,45
3.26 SamplitudebyageinleadV6,46
3.27 TamplitudebyageinleadI,47
3.28 TamplitudebyageinleadII,48
3.29 TamplitudebyageinleadIII,49
3.30 TamplitudebyageinleadaVR,50
3.31 TamplitudebyageinleadaVL,51
3.32 TamplitudebyageinleadaVF,52
3.33 TamplitudebyageinleadV1,53
3.34 TamplitudebyageinleadV2,54
3.35 TamplitudebyageinleadV4,55
3.36 TamplitudebyageinleadV5,56
3.37 TamplitudebyageinleadV6,57
Part4 CalculatedvaluesonRSamplitudeand
ventricularactivationtimebyage
4.1 R/SamplituderatiobyageinleadI,61
4.2 R/SamplituderatiobyageinleadII,62
4.3 R/SamplituderatiobyageinleadIII,63
4.4 R/SamplituderatiobyageinleadaVR,64
4.5 R/SamplituderatiobyageinleadaVL,65
4.6 R/SamplituderatiobyageinleadaVF,66
4.7 R/SamplituderatiobyageinleadV1,67
4.8 R/SamplituderatiobyageinleadV2,68
4.9 R/SamplituderatiobyageinleadV3,69
4.10 R/SamplituderatiobyageinleadV4,70
4.11 R/SamplituderatiobyageinleadV5,71
4.12 R/SamplituderatiobyageinleadV6,72
4.13 RamplitudeinleadV3+SamplitudeinleadV3byage,73
4.14 RamplitudeinleadV6+SamplitudeinleadV1byage,74
4.15 RamplitudeinleadV6+SamplitudeinleadV2byage,75
4.16 VentricularactivationtimebyageinleadI,76
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4.17 VentricularactivationtimebyageinleadII,77
4.18 VentricularactivationtimebyageinleadIII,78
4.19 VentricularactivationtimebyageinleadaVR,79
4.20 VentricularactivationtimebyageinleadaVL,80
4.21 VentricularactivationtimebyageinleadaVF,81
4.22 VentricularactivationtimebyageinleadV1,82
4.23 VentricularactivationtimebyageinleadV2,83
4.24 VentricularactivationtimebyageinleadV4,84
4.25 VentricularactivationtimebyageinleadV5,85
4.26 VentricularactivationtimebyageinleadV6,86
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Preface
Electrocardiograms(ECGs)arethegraphicrepresentationofbodysurfacepo-
tentialdifferencesgeneratedbytheelectricalactivityoftheheart.Bipolarlimb
leads,augmentedunipolarlimbleadsandprecordialleadshavebeenusedrou-
tinely for recording the ECG, which remains an essential part of the cardiac
examination,evenaftertheadventofcardiaccatheterization,angiocardiogra-
phy,echocardiographyandmanyothersophisticateddiagnosticmodalities.
Fundamentalchangesincirculationoccurimmediatelyafterbirth,followed
by typical and characteristic changes in physiology, position and size of the
cardiacchambersrelativetothebody,throughoutinfancy,childhoodandado-
lescence.Normaladultvaluesareabnormalinchildren.Likewise,manyofthe
normalpediatricvaluesareabnormalintheadult.Studiesonthedeveloping
ECGs reflecting these changes in the healthy pediatric population are of ut-
mostimportance,butarestillfewandlimited.Reliablenormalstandardsfor
P-QRS-T wave intervals and amplitudes are needed as the reference for the
diagnosisandevaluationofchildrenwithheartdisease.Traditionally,normal
ECG values in the pediatric population were derived from those published
byZieglerRF(1951)andDavignonetal.(1979).Wefoundthattheavailable
interpretationpackageswereinadequate,andnoteasytouse.
Normal ECG standards for infants, children and adolescents provide not
only the reference for physicians in their daily practice of ECG reading, but
alsoprovidethedatabaseforthestudyofgrowinganddevelopingheartand
forthecomputer-assistedelectrocardiographyanalysis.Toestablishsuchaset
ofnormalECGstandardsandpercentilechartsintheyoungin1995,westarted
tocollectandanalysetheelectrocardiographicdatafromhealthynewborns,
infants,childrenandadolescents.
Thanks must go to Drs. Y. C. Lai, M. H. Wu, J. K. Wang, M. L. Young,
Y. C. Chang, S. J. Yeh, J. H. Lin, and Ms. S. C. Lin together with her team
oftechnicians,whocollaboratedinthisstudy.Withouttheireffortscollection
oftheECGsforanalysisofnormalstandardsandpercentilechartswouldnot
havebeenpossible.TheauthorisgratefultoDr.W.Y.Shauforhisadvicein
thestatisticalanalysisofthenormativedata,andalsotoMs.ReneeShenfor
hersecretarialwork.
TheauthorisgratefultotheFukudaDenshiforprovidingustheFCP-4301
Electrocardiographwitha500Hzacquisitionprogram,asrecommendedby
the American Heart Association. Last but not least, the author is grateful to
BlackwellPublishingfortheireffortsineditingandprinting.
Hung-ChiLue
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