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길광채,조정관,강정채 대한내과학회 1990 대한내과학회지 Vol.38 No.5
The clinical application and usefulness of various electrocardiographic findings have been verified, but the normal and abnormal configurations of the right chest leads electrocardiogram(ECG) is still to be determined. In order to present normal reference data of a right precordial ECG, 100 normal adults were examined by 12 conventional leads and additional right precordial leads(V3R, V4R, V5R and V6R) ECG. The QRS morphologies, amplitudes, r/s ratio and deviation of the ST segments from the baseline were analyzed. The most frequently recoreded QRS configurations were the rS or rSr' patterns with 98% in V3R and 92% in V4R. The qs configuration was rarely observed with 2% in V3R and 8% in V4R. But in the right lateral leads it was much more freguently observed, with 25% in V5R and 41% in V6R. In one case, the qs pattern was recorded in all the right precordial leads. The mean amplitudes of r waves were 2.2±1.2㎜ in V3R, 1.3±0.7㎜ in V4R, 1.0±0.5㎜ in V5R and 0.8±0.3㎜ in V6R. The mean amplitudes of the S waves were 6.2±2.4㎜ in V3R, 3.4±1.2㎜ in V4R, 2.9±1.1㎜ in V5R and 3.1±1.㎜ in V6R. The mean r/s ratio in the right precordial leads was less than 0.5, but in 4% of the cases the r was taller than s in V4R. The T waves were usually inverted or flat forms. There was no case showing ST segment deviations more than 1㎜ from the isoelectric line in V4R, V5R and V6R and only one case in V3R. The mean ST segment deviation was 0.3±0.3㎜ at 40 msec, 0.4±0.7㎜ at 80 msec after the end of QRS in V3R, and 0.1±0.2㎜ at 40 msec and 0.1±0.2㎜ at 80 m sec in V4R. The above results suggest that the normal right precordial QRS morphology is the rS or rSr' pattern, with an r/s ratio<1, that T waves are usually inverted or flat, and that the ST segment deviation of more than 1㎜ is not a normal finding.
방실결절 이중전도로의 빈도 및 방실결절 회귀성 빈맥의 유발 여부에 따른 전기생리학적 특성의 차이
길광채(Gwang Chae Gill),서정평(Jeong Pyeong Soe),박주형(Joo Hyung Park),정명호(Myung Ho Jeong),조정관(Jung Gwan Cho),박종춘(Jong Chun Park),강정채(Jung Chaee Kang) 대한내과학회 1997 대한내과학회지 Vol.52 No.4
N/A Objectives: Refractory period and conduction time of the slow and fast pathways in the atrioven-tricular node are known to be the most important determinant of the inducibility of atrioventricular nodal reentrant tachycardia (AUNRT) but their relationship has not been determined in Korean. Methods: Two hundred and ten patients under-gone electrophysioiogic study. One hundred twenty two patients with dual AV nodal pathways were divided into two groups (group I, 77 patients with no inducible AVNRT; group II, 45 patients with inducible AVNRT). Results: Antegrade dual AV nodal pathways were documented in 77 patients (47%) out of 165 patients on whom AVNRT was not induced, Antegrade ERP of slow pathway in paced rhythm (600 msec) was shorter in group II than in group I (331±14 msec vs 269±47 msec, p<0.05). Ventriculoatrial block cycle length (VABCL) and retrograde ERP of the AV conduction system were significantly shorter in group 2 than in group 1 (p<0.001). Maximum slow pathway conduction times in sinus rhythm and paced rhythm (600msec) in group 2 were significantly longer than in group 1 (sinus rhythm: 332±68msec vs. 379±88msec, p<0.005; paced rhythm: 332±69msec vs. 392±85msec, p<0.005). The ERP gaps of two AV nodal pathways of group 2 in sinus rhythm and in paced rhythm were also significantly longer than those of group 1 (sinus rhythm 41±3msec vs. 78±50msec, p<0.001; paced rhythm 36±32 msec vs. 72±19msec, p<0.005). The incidence of intact ventriculoatrial conduction was significantly higher in group 2 than in group 1 (p<0.05). Antegrade slow pathway conduction time (A2H2 interval) at the time of AVNRT induction with single atrial premature depolarization (APD) with a coupling interval over 10 msec less than that of an APD producing AH jump were not correlated with VABCL (r=0.193, p<0.05). Conclusion: Dual AV nodal pathways were observed in 47% of patients with no-inducible AVNRT group. The inducibility of AVNRT appears to be closely ralated to the some conduction characteristics of the dual pathways and the refractoriness, i.e. maximum slow pathway conduction time, the ERP gap of two pathways, retrograde fast pathway ERP, VABCL.