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1 = Abs t r ac t = E le ctroc ardiog raphic F indin g s of a Com m unity P e ople by Com puterize d D ev ic e for A n aly s is E s u n K o o, Jae - Y ou n g K im, H a e - Joon K im D epartm ent of Prev entiv e M edicine and In s titute for Env ironm ental He alth, Colleg e of Medicine, Korea U niv ersity In order t o determ ine the prev alence r at e an d fin d out th e sex ual difference of abnorm al electrocardiographic finding s m anifested by computerized EKG, w hich is equipped w ith auto- analy zin g function, a total of 2,083 electrocardiogram s that w ere taken from population ov er 20 y ear s - old from Octob er 1996 to F ebru ary 1997 w ere studied accordin g to th eir age, g ender and blood pres sure. 1. U sing th e electrocardiography w ith auto- an aly zing function, 33 kinds of abnorm al fin ding s w ere m anifested. T he prev alence rate of abnorm al findin g s w as 52.8% in male and 43.7% in fem ale. Am ong them, the m ost comm on fin din g w as sinu s brady cardia foun d in 17.6% of male an d 15.4% of fem ale. Left v entricular hypertrophy by v oltag e criteria, minim al v olt ag e of left v entricular hypertr ophy, left ax is deviation and atrial fibrillation w er e m or e common in m ale th an in fem ale statistically. Both of n ospecific T w av e an d ST segm ent abn orm ality w ere m ore comm on in fem ale than in male statistically. 2. T hirty - three kin ds of abn orm al findin g s w ere m anifested. T hey rev ealed one abnormal fin ding alone or combined w ith som e other on es m aking 128 kinds of abnormal findin g s. T he m ost comm on abn orm al finidin g th at m anifested alon e w as right ax is deviation (100% ), th en my ocardial isch emia (95.7% ) th e nex t. T h e m ost common abnormal fin ding that complex ed w ith other abn orm al finding s w er e left anterior fascicular block (per cent age of sin gle m anifestation ; 26.2% ) and non specific T w av e abnorm ality (percentage of single m anifestation ; 32.9% ). Also, combin ation of sinu s brady cardia an d minim al v oltage of left v entricular hypertr ophy, and com bination of sinu s brady cardia an d left v entricular hypertr ophy w er e included in 25th sequences of abnorm al findings. 3. T he prev alence rate of abnorm al electrocardiographic findin g s w ere high er in older group,

2 hyperten siv e group, and th e group of high er sy stolic or diastolic pressure in both sex es. 4. Abn orm al finding s that commonly m anifested w ith sinu s brady cardia w ere v oltage criteria or minim al v oltage of left v entricular hypertr ophy (38.6% ); sinu s arrhythm ia (10.5% ); n on specific T w av e or ST segm ent abn orm ality (18.4% ) and fir st degree AV block (7.2% ) in descendin g order. 5. T h e m ost comm on site w hich m anifested my ocardial ischemia w as posterior an d inferior w all w ith equal percentage of 23.4%. An d then anterior w all(19.1% ), an d antero- lateral w all an d septum w ith equ al percentag e of 10.6% w as noted in descendin g order. Key W ords : prev alen ce rate, abnorm al electrocardiographic fin din g, computerized device for an aly sis, electr ocardiography of com munity

3 I...,,,,,...,,.,.... II ,599 2,509 (21.6% ).,

4 3.,,,,,,,,,. 4.,,, 3. M arquette Electronic MA C (standard limb lead ) Lead I, II, III (au gm ented unipolar limb lead ) avr, avl, avf, (precordial lead) V 1, V 2, V3, V4, V5, V ,,,, 2 test, SA S v er sion III ,599 2, %, 425 2, %, 83.0% %, %. (T able 1).

5 T able 1. Participation rate to E KG test am ong total population by sex and ag e A ge N o. of T arg et Population M ale No. of E KG Analy zed % No. of T arget Population F em ale N o. of EKG An aly zed , , , , , < = T otal 5, ,643 1, % 2. 10, (T able 2). T able 2. Sex subject s A g e Group an d age diatribution of EKG an aly zed M ale (n =721) F em ale (n =1,362) No. % No % < = p v alue ,. T able 3, 33. (left v entricular hypertrophy by v oltag e criteria ), 1, 1 1.,.

6 (sinu s brady cardia ) 17.6%, 15.4%. 2% 9,, v oltage criteria (12.2% ), (9.2% ), (4.4% ), 1 (2.9% ), (2.6% ), T (2.5% ), (2.4% ) (2.2% ). 2% 10,, (7.3% ), T (7.0% ), (5.7% ), ST (4.0% ), (3.3% ), 1 (3.2% ), (2.6% ), (2.3% ), (2.0% ).. 3 (7.0% ) T 7 (2.5% ), 5 (4.0% ) ST 11 (1.8% ). 12 (1.4% ) occasional premature v entricular complex 19 (0.7% ), 18 (0.7% ) 10 (1.9% ). 6, (p =0.001), (p =0.003), (p =0.014), (p =0.019), T (p =0.001) ST (p =0.008). (p =0.186).

7 T able 3. T he prev alence rate an d sequen ce of abn orm al findin g s accordin g to sex Abnorm al EKG Findin g s M ale (n =721) F em ale (n =1,362) p * No % Seq. * * No % Seq. * * Sinus Bradycardia st st LVH # by Voltage Crit eria n d nd Minim al Voltage of LVH # rd th Moderate Volt age of LVH # th th Fir st Degree AV Block th th Sinus Arrhythmia th th Nonspecific T W ave Abnormality th r d Right Bundle Branch Block th th Rightw ard Axis th th Left Axis Deviation th th Nonspecific ST Segment Abnormality th th Incomplet e RBBB th th Myocardial Ischemia th th Left Atrial Enlar gement th th Sinus T achycar dia th th Left Anterior Fascicular Block th th Atrial Fibrillation th th Occasional Premature Supraventricular Complex th th Occasional Premature Ventricular Complex th th Right Axis Deviation th th Occasional Premature Atrial Complex th Occasional Premature Ectopic Complex th Second Degree AV Block Frequent Pr emature Vent. Complex Left Bundle Branch Block Left Posterior Fascicular Block Ectopic Atrial Rhythm Wolff- Parkinson- White Syndrome Junctional ST Depression Right Ventricular Hypertrophy Left Atrial Rhythm Right Superior Axis Deviation Prolonged QT Int erval Bilateral Bundle Br anch Block * p v alue by 2 test ** Sequence # LVH : left ventricular hypertrophy

8 4.. (sinu s ),,, (ax is ),, 6 (T able 4). 21.9%, 18.6% (p =0.111) % 7.3% (p =0.492) % 4.4% (p =0.001) T able 4. T he prev alence rate of grouped abnormal fin ding s according to sex Group M ale (n =721) F em ale (n =1,362) p * N o % Rank No % Rank Sinu s Related Abn orm al F in ding s ( 1 ) st st Condu ction related Abn orm al F in ding s (2 ) nd rd Abnorm ality on Ax is (3 ) rd th Abnorm al W av es (4 ) th nd Atrium Related A bnormal Findin g s (5 ) th th Prem ature Complex es (6 ) th th * p value by 2 test (1) Sinus Bradycardia, Sinus Arrhythmia, Sinus T achycardia (2) 1st Degree AV Block, 2nd Degree AV Block, Left Bundle Branch Block, Right Bundle Branch Block, Bilateral Bundle Branch Block, Incomplete RBBB, Left Anterior F ascicular Block, Left Posterior F ascicular Block, W olff- Parkinson - White Syndrome (3) Left Axis Deviation, Rightw ard Axis, Right Axis Deviation, Right Superior Axis Deviation (4) Nonspecific T Wave Abnorm ality, Nonspecific ST Segment Abnorm ality, Junctional ST Depression, Prolonged QT Interval (5) Atrial Fibrillation, Left Atrial Rhythm, Left Atrial Enlargement, Ectopic Atrial Rhythm (6) Occasional Prem ature Vent. Complex, Occasional Premature Supraventriclar Complex, Occasional Prem ature Ectopic Complex, Occasional Premature Atrial Complex, Frequent Prem ature Vent. Complex T able , %.

9 (100.0% ), (95.7% ), (76.6% ), (75.7% ), occasion al prem ature v entricular complex (70.9% ), (70.8% ). (40.7% ), ST (32.9% ), left anterior fascicular block (26.1% ). 25 (26 ; 13 ), (22 ; 18 ) T able 5. T h e frequency of sin gle or combin ed m anifestation of comm on abnormal EKG finding s Sequ en ce Abn orm al Fin din g T otal Sin gle Comb - in ed Sin gle/ T otal (% ) 1st Sinu s Brady cardia nd V oltage Crit eria of Left Ventricular Hypertr ophy rd M inim al V oltag e of Left V entricular Hypertr ophy th Non specific T w ave abnorm ality th M oderate V oltage of Left V entricular Hypertr ophy th N on specific ST Segm ent Abn orm ality th F ir st Degree AV Block th Sinu s Arrhythm ia th My ocardial Ischemia th Right Bun dle Br an ch Block th Rightw ard Ax is Deviation th In complete Right Bundle Branch Block th Left A trial Enlar g em ent th Sinu s Brady cardia & Minimal Voltag e of LVH 26 (26) 15th Left A xis Deviation th Occasion al Prem ature V entricular Complex th Left A nt erior F ascicular Block th Sinu s T achy cardia th Sinu s Brady cardia & LVH 22 (22) 19th Occasion al Prem ature Suprav entricular Complex th Atrial F ibrillation th Non specific T W ave Abnorm ality & N on specific ST Segm ent Abn orm olity 14 (14) 22th Sinu s Brady cardia & Sinu s Arrhythmia 12 (12) 23th Sinu s Brady cardia & M oderate V oltag e LVH 11 (11) 24th Sinu s Brady cardia & Rightw ard Ax is 10 (10) 25th Right A xis Deviation

10 6.,, T able 6, 7, 8, 9,,. 50, , (T able 6). T able 6. T he prev alence rate abn orm al findin g s according to sex and ag e A g e Group M ale (n =721) F em ale (n =1,362) Abnorm al Norm al Abnorm al N orm al < = p v alue H g 90 H g, 140 H g 90 H g 95 H g 90 Hg 140 H g 160 H g, 160 H g 95 Hg (T able 7).,. 10.7%. 12.8% 10.7% 12.7% 17.0% (T able 7).

11 T able 7. T h e prev alence rate of abn orm al fin din g s according to sex and blood pres sure M ale F emale Group of (n =721) (n =1,362) Blood Pres sure Abnorm al N orm al Abn orm al Norm al N orm oten sion Borderlin e Hyperten sion Definite Hyperten sion p v alue H g, 180 Hg, 120 H g 180 H g 20 H g,. 120 H g 26.1%. 120 Hg (T able 8). T able 8. T h e prev alen ce rate of abn orm al finding s according to sex and sy stolic blood pressure Sy stolic Pres sure M ale (n =721) F em ale (n =1,362) ( H g ) Abn orm al N orm al Abnorm al Norm al < < = p v alue H g, 115 H g, 10 H g 5,. 115 Hg 15.0% (T able 9).

12 T able 9. T h e prev alence rate of abn orm al fin ding s according to sex and diastolic blood pressure Diastolic Pressure M ale (n =721) F em ale (n =1,362) ( H g ) Abnorm al N orm al Abn orm al N orm al < < = p v alue ,, , ,. 20.3%, 18.3%, 10.5%, 15 (T able 10).

13 T able 10. T he frequen cy of combin ed abnorm al finding s w ith sinu s brady cardia Sequen ce Combined Abn orm al F in ding w ith Sinu s Brady cardia N o % 1st Left Ventricular Hypertr ophy by V oltage Crit eria nd M inim al V oltage of Left V entricular Hypertr ophy rd Sinu s Arrhythmia th Non specific T W ave Abnorm ality th N on specific ST Segm ent Abnorm ality th F ir st Degree AV Block th M oderate V oltage of Left V entricular Hypertrophy th Rightw ard Ax is Div iation th Right Bun dle Br an ch Block th Left Axis Dev iation th Left Ant erior F ascicular Block th Occasion al Premature Suprav entricular Complex th In complete Bundle Branch Block th Left Atrial Enlargem ent th Occasion al Premature Atrial Complex T otal T able 11. (posterior ) (inferior ) 11 (23.4% ), (anterior ) 9 (19.1% ), (antero- lateral) (septal) 5 (10.6% ). T able 11. T he frequen cy of my ocardial ischemia by site Sequ en ce Site No % 1st Posterior st Inferior rd Anterior th Antero- lateral th Septal th Lateral th My ocardial Infarction th A cute My ocardial Infarction T otal

14 IV.,, 18%,.. T able %, 21.1%, 15.4%, 11.7%. Kim (1981) 14.0%, 9.8% NHA NESII( ) %, 18.0%.,., %, 45.4%.,,. (1984) (1996) %, 43.7%. (1984) 49%, 47%.. (1996) 6.5%, 5.7%,, (w ithin norm al limit ).,, 21.9%, 18.6%. 60,, (Hu ston, 1985; Ordw ay, 1982). 17.6%, 15.4%. Hiss (1962) 122, %, (1984) 3.0% 1.4% (1971) 2.4%, 1.4%.. 50% (Coh en, 1980; Gan se, 1970),,, (, 1991;, 1992a ;, 1992b ) 25.0% 45.5% 33.0% 60,0% %, 0.9%. Hiss (1961) 0.31% ( ) (1984)

15 7.1%, 7.9%. (1984) %, 2.3% (1984) % 38.5%.. 7,104 (1971) 10.9%, 13.6%,. (1971). 2.6%, 2.3%. His s (1962) 2.3% ( ), (1984) 2.5%, 2.0%. (1971) 8.1%, 7.6%.. (, 1991). 3, left v entricular hypertrophy by v oltag e criteria, m oderate v oltag e of LVH, minimal v oltag e of LVH.,,. 12.2%, 7.3%. Hiss (1962) 3.9% ( ) (1984) 4.8%, 2.5%. (1971) 18.9%, 10.3%.,. Cohen (1980) Smith (1964) 14-85% (1992b ) 33.3%, 58.3%. (1983) %. Hiss (1962) (1983), 60. T 2.5%, 7.0%. Hiss (1962) 1.15%, 5.4%, 8.0% (1984). (1971) 17.1% 19.9%. Ostran der (1965). ST 1.8%, 4.0%. (1984) 2.0%, 2.2%. 30 ST (, 1984). (1971) ST 22.1%, 20.9% ST

16 2.9%, 0.5%. Ostrander (1965). 8.2%, 7.3%. (1996), 2.8%, 1.6%. 1, 2,,, %, 3.2%. Hiss (1962) 0.65% (1984) 1.6%, 0.9%. (1984), %, 1.9%. (1984) %, 30.5% 69.5% (T abel 2).. M eytes (1975), Smith (1964), North cote (1989) 10-33%,. 2.4%, 2.0%. Hiss (1962) 0.18% ( ) (1984) 1.4%, 0.9%, (1971) 1.6%., 50 (1984). (1984). 1.8%, 1.5%. (1971) 0.9%, (1984) 4.3%, 1.8%. (1984) , 0.0%, 0.3%. (1971) 0.2% (1984) 0.2%, 0.2%. Hiss (1961) 0.013% ( ). 1.2%. (1971) 4.7% (1968) 3.48% %. (1971) 1.1%, 1.2%. W olff- P arkin son - W hite %. (1971) 0.14%, (1967) 0.21%. 4.7%, 2.6%. 1.2% 0.5%. 1.9%, 0.7%. Hiss (1962) 1.02% ( ). (1984) 1.4%, 0.7%

17 . (1971) 4.7%, 2.4%.. 0.6%, 0.4%. His s (1962) 0.11%. (1984) 0.3%, 0.4%. (1984) 30. (1971) 0.7%, 0.6%. 50.,, 3.2%, 1.7%. 1.4%, 0.4%. Hiss (1962) 0.004%. (1984) 1.8%, 1.2%. (1984). (1984) 30. (1971) 3.4%, 3.5%.,,,,,.. ( ). V. 20,. 20 2,083 ( ;721, ;1,362 ) , %, 43.7%. 17.6%, 15.4%.,,,, T ST , 128. (100.0% ) (95.7% ). left anterior fascicular block ( ; 73.9% ) T ( ; 67.1% ). 25 ( ; 14 ), ( ; 19 ). 3.,,

18 %, (15.5% ), T ST (18.4% ), 1 (7.2% ) %, 19.1%, 10.6%.,, 1968; 1(10):11-14.,,,,., 1983;13 (1): ,,,.,,. 1996;29 (4): ,,,,,. W olff- Parkin son - W hite. 1967, 2;95,,. 18,000, 1984;14(1): Minn esota 14; Code, 1971,,,,,,,,, a, 22;2: ,,,,,,,,, b, 22;6: ,,,,,. 10, , 11;765..,, 1996.,,,,,, , 21;2: Beckner GL, W in sor T. Cardiov ascular adaptation to prolon ged phy sical effort. Circulation 1954;9: Coh en JL, Gupta PK, Lich stein E, Ch adda KD. T he heart of a dancer. Noninv asiv e cardiac ev aluation of professional ballet dan cer s. A m J cardiology 1980;45:

19 Gan se W V. V er see L. Eylenbosh W. Vuylsteek K. T he electrocardiogram of athletes. Com parison w ith untr ain ed subject. Br Heart 1970;32: His s RG, Lam b IE. Electr ocar diogr aphic findin g s in 122,043 individuals. Circulation 1962;25: Hu ston T M, Puffer JC, Rodney W M. T he athletic heart sy sdrom e. N En gl J M ed 1985;313: Kim IS, Lee YH, Suh I. Korean nation w ide blood pressure study. Departm ent of Prev entiv e M edicine an d Public H ealth. Yon sei Univ er sity College of M edicin e M eytes I, Kaplin sky E, Yahini J, H anna - Paparo N, Neufeld H. W en ckeb ach A - V block : A fr equ ent follow in g heavy phy sical tr aining. Am Heart J 1975;90:426. North cote RJ, Cannin g GP, Ballantyne D. Electrocardiographic fin ding s in m ale v eteran endurance athletes. Br H eart J 1989;61: Ordw ay GA, Charles JB, Ran dall DC, Billman GE, W ek stein DR, Heart rate adaptation to ex ercise training in cardiac- denerv ated dog s. J Appl Phy siol 1982;52: Ostran der LD, Bran dt RL, Kjellsferg M O, Ep stein FH. Electrocardiographic fin din g s am ong th e adult population of a t otal natural comm unity. Cir culation 1965, 31;888. Smith W G, Cullen KJ, T h orburn IO. Electrocardiogram s of m arathon runn er s in 1962 comm on - w ealth gam es. Br Heart J 1964;26:

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<B0E6C8F1B4EBB3BBB0FA20C0D3BBF3B0ADC1C E687770> 심전도연수강좌 : 처음시작하는사람들을위한심전도 연세대학교원주의과대학순환기내과학교실 안민수 Cardiac Electrophysiology I : Automaticity : 60-100 회 /min, His bundle : 40-60 회 /min Bundle branch : 20-40 회 /min Purkinje fiber : 20 회 /min Cardiac Electrophysiology