12-Kanal-Elektrokardiogramm bei Kindern und Jugendlichen

The surface electrocardiogram (ECG) is an important diagnostic tool in general medicine, for children, adolescents and adults. Although technical aspects of ECG recordings are similar in young and old patients, there are some age-specific differences between children and adults. The QRS axis shifts from right to left at several stages during childhood. The heart rate decreases from 140/min (newborns) to 130/min (young children) to 75/min (adolescents). First and second degree atrioventricular (AV) blocks (I and II type Wenckebach) are frequent in children. Duration of the QRS is age-dependent as is the R peak amplitude. The ST-segment elevation is relatively frequent in children and is normal up to 0.1 mV. Negative T waves diminish with age and QTc times are also age-dependent. Supraventricular tachycardia (SVT) is characterized by small QRS complexes (QRS width <?0.12 s) during tachycardia. It is important to analyze the relationship between the p wave and QRS complex and to look for electrical alternans as a leading finding for an accessory pathway. Wide QRS complex tachycardia (QRS width ≥?0.12 s) occurs in SVT with aberrant conduction, SVT with bundle branch block or ventricular tachycardia (VT). In broad complex tachycardia, AV dissociation, negative or positive concordant pattern in V₁–V₆, a notch in V₁ and qR complexes in V₆ in tachycardia with left bundle branch block morphologies are findings indicating VT. In addition, an R/S relationship in V₆ favors VT when right bundle branch block tachycardia morphologies are present. By analyzing the surface ECG in the correct way with a systematic approach, a specificity and sensitivity of correctly identifying SVT or VT of over 95?% can be achieved.