THE ELECTROCARDIOGRAM IN NORMAL CHILDREN AND IN CHILDREN WITH RIGHT VENTRICULAR HYPERTROPHY

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Abstract
Standard and unipolar lead ecg''s from normal children from 1-15 yrs. of age were compared with records from 36 children of similar age with right ventricular hypertrophy. In the normal subjects V1 showed an rS pattern with an R/S ratio less than 1. In 15%, this ratio was greater than 1. Ventricular excitation never exceeded 0.03 sec. except in 1 case showing an RSR'' complex. In lead aVR the positive deflection was never greater than the negative and the activation time did not exceed 0.06 sec. In right ventricular hypertrophy the following patterns were seen in V1: qR with Q/R ratio less than 1; Rs with R/S greater than 1 (both with excitation times exceeding 0.03 sec); and RS or rS with R/S ratio equal to 1 or less than 1, and activation times of 0.03 sec. or less. In lead aVR the positive deflection was greater than the negative in 83% of cases including 5 with rS and 2 with RS patterns in V1. An excitation time of more than 0.06 sec. in aVR did not occur in any normal subject but was seen in cases of right ventricular hypertrophy in which the QR ratio in this lead exceeded 1. The mechanism suggested was extreme clockwise rotation, causing the left ventricle to face V1 and aVR.