Sağlıklı çocukların normal elektrokardiyogram değerleri

Amaç: Elektrokardiyografi kardiyak hastalıkların değerlendirilmesinde önemli bir tanı aracıdır. Normal elektrokardiyogram yaşa bağımlıdır ve çeşitli etmenlerle değişmektedir. Çocukluk dönemi normal değerlerini belirlemek için bir çok çalışma yapılmıştır. Bu çalışmanın amacı Aydın ilinde sağlıklı Türk çocuklarında normal elektrokardiyogram değerlerini belirlemektir. Gereç ve Yöntemler: Çalışmada tüm çocukların fizik bakısı çocuk doktoru tarafından yapıldıktan sonra aynı kişi tarafından elektrokardiyogramları çekilerek değerlendirilmiştir. Uygun olmayan verilerin olması durumunda analiz tekrar edilmiştir. Fizik bakıda ya da elektrokardiyogramda şüphe olması durumunda hastaneye çağrılarak çocuk kardiyologu tarafından ayrıntılı inceleme yapılmıştır. Bulgular: Çalışmada 500 Hz örneklem hızıyla toplam 1 163 olgudan elektrokardiyogram örnekleri alınmıştır. Olguların 562’si kız (%47,4%) iken 601’i erkekti (%-52,6). Tüm çalışma popülasyonu toplam 10 yaş grubuna ayrıldı. Tüm gruplardan elde edilen normal değerlerde daha önce yayınlanmış normal değerlere göre anlamlı farklılıklar görüldü. Çıkarımlar: Elektrokardiyogram değişkenlerinde gözlenen farklılıklar biyolojik değişkenlik ve ırksal özelliklere ek olarak prekordiyal elektrot yerleştirme, kayıtların görsel kontrolü gibi bazı teknik detaylarla ilişkili olabilir.

Normal electrocardiogram values of healthy children

Aim: Electrocardiography is an important diagnostic tool in the evaluation of cardiac diseases. Normal electrocardiograms are age-dependent and may also vary due to several factors. Many studies have been performed to establish the normal values for the childhood period. The aim of this study was to determine the normal electrocardiograms values for healthy Turkish children in Aydın. Material and Methods: All children underwent physical examination by a pediatrician and the electrocardiograms were analyzed by the same pediatrician. In the event of improper or insufficient data, the analyses were repeated. Children with a suspicious electrocardiograms or physical examination were recalled and examined by same pediatric cardiologist in outpatient clinic. Results: In this study, electrocardiogram records were collected randomly from 1163 children with a sampling rate of 500 Hz. Of the children, 562 were female (47.4%) and 601 were male (52.6%). The total population was divided into ten age groups. Significant differences in normal limits were determined compared with previously published studies. Conclusion: The observed differences in various electrocardiograms parameters could be related to biologic variability and to some technical details such as precordial electrode placement and visual checking of the records in addition to race.

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1. Davignon A, Rautaharju P, Boiselle E, Souimis F, Megelas M, Choquette A. Normal ECG standards for infants and children. Pediatr Cardiol 1979: 80; 1: 123–31. [CrossRef]
2. Macfarlane PW, McLaughlin SC, Devine B, Yang TF. Effects of age, sex, and race on ECG interval measurements. J Electrocardiol 1994; 27 Suppl:1 4–9. [CrossRef]
3. Seham M. Electrocardiogram in normal children. Am J Dis Child 1921; 21: 247. [CrossRef]
4. Ziegler RF:Electrocardiographic Studies in Normal Infants and Children. Springfield, Illinois: Charles C Thomas Publisher; 1951.
5. Macfarlane PW, Coleman EN, Pomphrey EO, McLaughlin S, Houston A, Aitchison T. Normal limits of the high-fidelity pediatric ECG. Preliminary observations. J Electrocardiol 1989; 22 Suppl: 162–8. [CrossRef]
6. Semizel E, Oztürk B, Bostan OM, Cil E, Ediz B. The effect of age and gender on the electrocardiogram in children. Cardiol Young 2008; 18: 26–40. [CrossRef]
7. Olgun H, Karacan M, Ceviz N, Altay D, Ozturk CF, Karakelleoglu C. Electrocardiographic Reference Values in School-Aged Children Living in Moderate Altitude (185 m-Erzurum). Turkiye Klinikleri J Cardiovasc Sci 2010; 22: 324–32.
8. Rijnbeek PR, Witsenburg M, Schrama E, Hess J, Kors JA. New normal limits for the paediatric electrocardiogram. Eur Heart J 2001; 22: 702–11. [CrossRef]
9. Strong WB, Downs TD, Liebman J, Liebowitz R. The normal adolescent electrocardiogram. Am Heart J 1972; 83: 115–28. [CrossRef]
10. Garson A Jr. Clinically significant differences between the “old” analog and the “new” digital electrocardiograms. Am Heart J 1987; 114: 194–7. [CrossRef]
11. Bailey JJ, Berson AS, Garson A Jr, et al. Recommendations for standardization and specifications in automatedelectrocardiography: bandwidth and digital signal processing. A report for health professionals by an ad hoc writing group of the Committee on Electrocardiographyand Cardiac Electrophysiology of the Council on Clinical Cardiology, American Heart Association. Circulation 1990; 81: 730–9. [CrossRef]
12. Rajaganeshan R, Ludlam CL, Francis DP, Parasramka SV, Sutton R. Accuracy in ECG lead placement among technicians, nurses, general physicians and cardiologists. Int J Clin Pract 2008; 62: 65–70. [CrossRef]
13. McCann K, Holdgate A, Mahammad R, Waddington A. Accuracy of ECG electrode placement by emergency department clinicians. Emerg Med Australas 2007; 19: 442–8.
14. Coleman ME. What the Journal of Electrocardiology can do for electrocardiogram technologists: an electrocardiogram Technologist’s Perspective. J Electrocardiol 2006; 39: 3–6. [CrossRef]
15. Rautaharju PM, Park L, Rautaharju FS, Crow R. A standardized procedure for locating and documenting ECG chest electrode positions: consideration of the effect of breast tissue on ECG amplitudes in women. J Electrocardiol 1998; 31: 17–29. [CrossRef]
16. Olson WH, Schmincke DR, Henley BL. Time and frequency dependence of disposable ECG electrode-skin impedance. Med Instrum 1979; 13: 269–72.
17. Schwartz PJ, Garson A Jr, Paul T, Stramba-Badiale M, Vetter VL, Wren C. Guidelines for the interpretation of the neonatal electrocardiogram. A task force of the European Society of Cardiology. Eur Heart J 2002; 23: 1329–44.
18. Schwartz PJ, Stramba-Badiale M, Segantini A, Austoni P, Bosi G, Giorgetti R, et al. Prolongation of the QT interval and the sudden infant death syndrome. N Engl J Med 1998; 338: 1709–14. [CrossRef]
19. Bazett HC. Analysis of the time-relations of electrocardiograms. Heart 1918; 7: 353–70.
20. Ashman R. The normal duration of the QT interval. Am Heart J 1942; 23: 520–2. [CrossRef]
21. Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is “normal”. J Cardiovasc Electrophysiol 2006; 17: 333–6. [CrossRef]
22. Alimurung MM, Joseph LG, Craige E, Massell BF. The Q-T interval in normal infants and children. Circulation 1950; 1: 1329–37. [CrossRef]
23. Kolawole AJ, Omokhodion SI. Normal limits for pediatric electrocardiogram in Ilorin, Nigeria. Nig J Cardiol 2014; 11: 112–23. [CrossRef]
24. Sun K, Li F, Zhou Y, et al. Normal ECG Limits for Asian Infants and Children. Comput Cardiol 2005; 32: 455−8.
25. Yoshinaga M, Iwamoto M, Horigome H, et al. Standard Values and Characteristics of Electrocardiographic Findings in Children and Adolescents. Circ J 2018; 82: 831–9.
26. LaMonte CS, Freiman AH. The electrocardiogram after mastectomy. Circulation 1965; 32: 746–54. [CrossRef]
27. Kligfield P, Gettes LS, Bailey JJ, et al. Recommendations for the standardization and interpretation of the elec trocardiogram: part I: The electrocardiogram and its technology: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation 2007; 115: 1306–24. [CrossRef]
28. Lue HC, Wu MH, Wang JK, et al. Study on ECG in the Adolescent. Pediatr Cardiol 2018; 39: 911–23. [CrossRef]