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"Abnormal ECG: Is that problem?!"

① Arrhythmia 

★ When the exam confirm you have an abnormal electrocardiogram and requires treatment.

An electrocardiogram of a medical examination may show abnormalities even if there are no subjective symptoms. If you find any abnormalities in the examine, do not leave it unattended and be sure to see a medical office.

Abnormal ECG-types of arrhythmia

There are various abnormalities in the electrocardiogram, but the ones with the highest frequency of arrhythmia are explained below.


Above is an anatomical chart of the heart. It is described as right and left atrium(heart atrium). It works to send blood to the ventricles. In addition, those with the description of right and left ventricle(ventricle). These are responsible for pumping blood to the lungs and the whole body.

Arrhythmias can occur from the atrium or ventricle, depending on where they occur.

■ Extra systole


Premature beats are most often pointed out in electrocardiography. Normally, the contraction of the heart occurs when electricity is generated from a "power plant" called the sinus node and the heart muscle reacts to the signal. However, extra systoles are electrical excitements that occur from sites other than the sinus node, causing the heart to contract earlier than normal pulses. When the electricity is generated from the atrium, it is called an "supraventricular" extrasystole . Also, when it originates from the ventricles, it is called a "ventricular" extrasystole .


<ECG findings>

Upper ventricular extra systole


The part surrounded by red is the extra systole. You can see that it appears earlier than the normal pulse. In the case of supraventricular extrasystoles, the ECG waveform is similar to the previous contraction waveform.

Ventricular extrasystole


The part surrounded by red is the extra systole. You can see that it appears earlier than the normal pulse. In the case of premature ventricular contractions, the electrocardiogram waveform is wider than the previous contraction waveform.

<Clinical significance of extra systoles>

Even if there is no special disease, premature beats may occur due to age, physique, physical condition, etc. Premature ventricular beats can be caused by myocardial infaction or other myocardial abnormalities, and in some cases can lead to dangerous arrhythmias that can lead to sudden death. Even supraventricular premature beats, if they occur in rapid succession, may turn to atrial fibrillation, which increases the risk of cerebral infarction.
The severity of extra systole is different each patient.


<Screening found the relationship between extra period contraction and prognosis>

Upper ventricular extrasystole 


Event avoidance rate (%)

Control group (non-frequent group)

Upper ventricular extrasystole frequent occurrence group

Observation period (day)

Binici Z et al. Circulation 2010; 121: 1904-1911.

This paper is a Holter test performed on 678 healthy people living in Copenhagen, Denmark. As a result, the group with frequent supra ventricular extrasystoles had a 60 risk of all-cause mortality and stroke during the 7-year observation period compared to the non-existent group. It was reported that the incidence of atrial fibrillation was 2.7 times higher in the same group.

From this result, it can be seen that even supraventricular extrasystoles require special attention when they occur frequently.

Ventricular extrasystoles , multisource premature ventricular contractions


Andreini D et al. J Am Coll Cardiol 2019; doi: 10.1016 / j.jcmg.2019.04.023.



The above is a study published at the University of Milan, Italy, published in 2019. The upper and lower left images (A and B) are echocardiographic images and are normal findings. However, in the contrast-enhanced cardiac MRI image (CF), the myocardium in the arrow part glows white, which is a finding of cardiomyopathy indicating fibrosis / disorder of the myocardium. In this way, cardiac MRI can evaluate even the internal state of the myocardium that cannot be detected by echocardiography .


This study retrospectively analyzed 946 patients with premature ventricular contractions who were thus normal on echocardiography (no complications of organic heart disease). As a result, 241 patients, or 25.5% of the total, were found to have complications of organic heart disease (cardiomyopathy, etc.). In addition to clinical findings such as age and gender, chest pain symptoms and persistent ventricular tachycardia were reported to be factors associated with the presence or absence of organic heart disease. In addition, the frequency of ventricular extrasystoles (10,000 times / day or more, 1000 times or more, 10,000 times or less / day) in the Holter test was not related to the presence or absence of organic heart disease. This study shows that it is important to evaluate the myocardium by cardiac MRI.

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