ECG Interpretation Program: User'S Guide

USER’S GUIDE
ECG Interpretation
Program
ECAPS 12C
0614-903209A
Copyright Notice
The entire contents of this manual are copyrighted by Nihon Kohden. All rights are reserved. No part of this document
may be reproduced, stored, or transmitted in any form or by any means (electronic, mechanical, photocopied, recorded,
or otherwise) without the prior written permission of Nihon Kohden.
Contents 1
Section 1 Introduction 3
4
Section 2 Precautions 5
(Discrepancies between physician’s and ECAPS 12C’s
Findings) 6
6-1
Section 3 Outline of ECG Automatic Recording 6-2

Entering Patient Data........................................................................................................ 3.3
Recording ECG Data........................................................................................................ 3.4 6-3
Improving Waveform Quality............................................................................................. 3.4
Measuring ECG Waveform............................................................................................... 3.6 6-4
General Measurement Values to Be Printed.............................................. 3.10
Classification and Printing ECG Data............................................................................. 3.11 6-5
6-6
Section 4 Recorded Analysis Results
A-1
A-2
Section 5 How to Read Analysis Results
ECG Findings................................................................................................................... 5.3 A-3
Priority of ECG Findings................................................................................................... 5.3
Criteria.............................................................................................................................. 5.4 A-4
Overall Judgement............................................................................................................ 5.4
Analysis Result When ECG Cannot Be Analyzed............................................................ 5.5
Section 6 Criteria of Findings

Section 6-1 Arrhythmias.......................................................................................... 6.1.1
Rhythm analysis............................................................................................................. 6.1.2
1002 Marked rhythm irregularity, possible non-conducted PAC, SA block, AV
block, or sinus pause....................................................................................... 6.1.12
1100 Sinus rhythm...................................................................................................... 6.1.3
1102 Sinus arrhythmia.............................................................................................. 6.1.13
1108 Marked sinus arrhythmia................................................................................. 6.1.13
1120 Sinus tachycardia.............................................................................................. 6.1.3
1130 Sinus bradycardia.............................................................................................. 6.1.3
1200 Atrial rhythm...................................................................................................... 6.1.4
1210 Atrial fibrillation.................................................................................................. 6.1.7
12101 Atrial fibrillation with rapid ventricular response................................................ 6.1.7
12102 Atrial fibrillation with slow ventricular response................................................. 6.1.7
12103 Atrial fibrillation with aberrant conduction, or ventricular premature
complexes........................................................................................................ 6.1.18
User’s Guide ECAPS 12C C.

CONTENTS
12108 Atrial fibrillation with rapid ventricular response with aberrant conduction, or
ventricular premature complexes..................................................................... 6.1.18
12109 Atrial fibrillation with slow ventricular response with aberrant conduction, or
ventricular premature complexes..................................................................... 6.1.18
1220 Rapid atrial rhythm............................................................................................ 6.1.4
1250 Atrial flutter........................................................................................................ 6.1.8
12503 Atrial flutter with aberrant conduction, or ventricular premature complexes.... 6.1.19
12505 Cannot rule out atrial flutter............................................................................... 6.1.8
12506 Atrial fibrillation or flutter.................................................................................... 6.1.8
12507 Atrial fibrillation or flutter with aberrant conduction, or ventricular premature
complexes........................................................................................................ 6.1.19
1300 Junctional rhythm............................................................................................... 6.1.5
1320 Rapid junctional rhythm..................................................................................... 6.1.5
1400 Undetermined rhythm (Possible supraventricular rhythm)................................. 6.1.6
1420 Undetermined rhythm (Possible supraventricular tachycardia).......................... 6.1.6
1430 Undetermined rhythm (Possible supraventricular bradycardia)......................... 6.1.6
1470 with occasional supraventricular premature complexes.................................. 6.1.14
1474 with frequent supraventricular premature complexes...................................... 6.1.14
1475 with frequent supraventricular premature complexes in a pattern of
bigeminy.......................................................................................................... 6.1.14
1570 with occasional ventricular premature complexes........................................... 6.1.15
15708 with occasional ventricular premature complexes (Unreliable analysis due
to noise)........................................................................................................... 6.1.15
1574 with frequent ventricular premature complexes............................................... 6.1.15
15748 with frequent ventricular premature complexes (Unreliable analysis due to
noise)............................................................................................................... 6.1.15
1575 with frequent ventricular premature complexes in a pattern of bigeminy......... 6.1.15
15758 with frequent ventricular premature complexes in a pattern of bigeminy
(Unreliable analysis due to noise).................................................................. 6.1.15
1577 with couplet ventricular premature complexes................................................. 6.1.15
15778 with couplet ventricular premature complexes (Unreliable analysis due to
noise)............................................................................................................... 6.1.15
16006 Electronic atrial pacemaker............................................................................... 6.1.9
16007 Electronic ventricular pacemaker....................................................................... 6.1.9
16008 Electronic atrial pacemaker (Unreliable analysis due to noise)......................... 6.1.9
16009 Electronic ventricular pacemaker (Unreliable analysis due to noise)................ 6.1.9
1901 Undetermined regular rhythm.......................................................................... 6.1.10
1902 Undetermined rhythm...................................................................................... 6.1.10
1921 Undetermined regular rhythm (tachycardia).................................................... 6.1.10
1922 Undetermined rhythm (tachycardia)................................................................ 6.1.10
1931 Undetermined regular rhythm (bradycardia).................................................... 6.1.10
1932 Undetermined rhythm (bradycardia)................................................................ 6.1.10
1938 Extreme bradycardia....................................................................................... 6.1.11
1970 with occasional ectopic premature complexes................................................ 6.1.17
19708 with occasional ectopic premature complexes (Unreliable analysis due to
noise)............................................................................................................... 6.1.17
1974 with frequent ectopic premature complexes.................................................... 6.1.17
19748 with frequent ectopic premature complexes (Unreliable analysis due to
noise)............................................................................................................... 6.1.17
1975 with frequent ectopic premature complexes in a pattern of bigeminy.............. 6.1.17
C. User’s Guide ECAPS 12C

CONTENTS
Section 6-2 Conductive Defect............................................................................... 6.2.1 1

2210 Short PR interval............................................................................................... 6.2.2
2216 Type-A Wolff-Parkinson-White syndrome.......................................................... 6.2.3 2
2217 Type-B Wolff-Parkinson-White syndrome.......................................................... 6.2.3
2218 Atypical Wolff-Parkinson-White syndrome........................................................ 6.2.3 3
2219 Intermittent Wolff-Parkinson-White syndrome................................................... 6.2.3
2231 First degree AV block........................................................................................ 6.2.5 4
2232 2nd degree AV block, Mobitz type I................................................................... 6.2.5
2233 2nd degree AV block, Mobitz type II.................................................................. 6.2.5
5
2234 Possible 3rd degree AV block............................................................................ 6.2.5
6
2320 Nonspecific intraventricular conduction delay................................................. 6.2.10
2330 Nonspecific intraventricular conduction block................................................. 6.2.10 6-1
2420 RSR (QR) in lead V1/V2, consistent with right ventricular conduction delay.... 6.2.6
6-2
2440 Incomplete right bundle branch block............................................................... 6.2.6
2450 Right bundle branch block................................................................................. 6.2.6 6-3
24501 Right bundle branch block, plus possible RVH.................................................. 6.2.6
2540 Incomplete left bundle branch block.................................................................. 6.2.8 6-4
2550 Left bundle branch block................................................................................... 6.2.8
2630 Left anterior fascicular block............................................................................. 6.2.9 6-5
2730 Left posterior fascicular block............................................................................ 6.2.9
6-6
Section 6-3 Myocardial Infarction........................................................................... 6.3.1
A-1
Analysis Criteria................................................................................................... 6.3.2
Anterior Myocardial Infarction.............................................................................. 6.3.5
A-2
Septal Myocardial Infarction................................................................................ 6.3.8
Lateral Myocardial Infarction.............................................................................. 6.3.10
A-3
Inferior Myocardial Infarction............................................................................. 6.3.12
Children............................................................................................................. 6.3.14 A-4
Inferior Q Wave.................................................................................................. 6.3.15
Poor R Wave Progression.................................................................................. 6.3.16
Section 6-4 ST-T Abnormality................................................................................. 6.4.1

ST Depression..................................................................................................... 6.4.2
Injury.................................................................................................................... 6.4.4
Subendocardial Ischemia.................................................................................... 6.4.8
Early Repolarization.......................................................................................... 6.4.11
Pericarditis......................................................................................................... 6.4.12
T Wave Abnormality........................................................................................... 6.4.13
Nonspecific ST Elevation................................................................................... 6.4.15
Right Precordial ST-Segment Elevation............................................................. 6.4.16
ST Elevation, Cannot Rule Out Inferior Injury.................................................... 6.4.17
Section 6-5 Ventricular Hypertrophy...................................................................... 6.5.1

Point Score System....................................................................................................... 6.5.2
Analysis Criteria for RVH............................................................................................... 6.5.2
5120 Possible right ventricular hypertrophy........................................................ 6.5.4
5130 Right ventricular hypertrophy..................................................................... 6.5.4
5134 Right ventricular hypertrophy, probably repolarization abnormality .......... 6.5.5

CONTENTS
Analysis Criteria for LVH................................................................................................ 6.5.6

5211 Minimal voltage criteria for LVH, may be normal variant........................... 6.5.7
5220 Possible left ventricular hypertrophy.......................................................... 6.5.7
5222 Moderate voltage criteria for LVH, may be normal variant......................... 6.5.7
5233 Voltage criteria for LVH.............................................................................. 6.5.7
5234 Left ventricular hypertrophy with repolarization abnormality..................... 6.5.7
Section 6-6 Atrial Enlargement, Abnormal Axis Deviation and Others.............. 6.6.1
6120 Possible right atrial enlargement....................................................................... 6.6.2
6130 Right atrial enlargement.................................................................................... 6.6.2
6220 Possible left atrial enlargement.......................................................................... 6.6.3
6230 Left atrial enlargement....................................................................................... 6.6.3
7100 Abnormal right axis deviation............................................................................ 6.6.4

7102 Moderate right axis deviation............................................................................. 6.6.4
7200 Abnormal left axis deviation............................................................................... 6.6.4
7202 Moderate left axis deviation............................................................................... 6.6.4
7300 Indeterminate axis............................................................................................. 6.6.4
7400 S1-S2-S3 pattern, consistent with pulmonary disease, RVH, or normal
variant................................................................................................................ 6.6.6
7500 Abnormal QRS-T angle..................................................................................... 6.6.7
8003 Consistent with pulmonary disease................................................................... 6.6.8

8100 Low QRS voltage............................................................................................... 6.6.9
8101 Low QRS voltage in limb leads.......................................................................... 6.6.9
8102 Low QRS voltage in chest leads........................................................................ 6.6.9
8200 Dextrocardia.................................................................................................... 6.6.10
8304 Long QTc interval............................................................................................ 6.6.11
8305 Short QTc interval........................................................................................... 6.6.11
0101 Possible arm leads reversed, check lead requested....................................... 6.6.12

0102 ARTIFACT PRESENT...................................................................................... 6.6.13
0103 CANNOT ANALYZE ECG................................................................................ 6.6.13
0104 ELECTRODE(S) FAILURE...Repeat ECG is required..................................... 6.6.13
0201 ...Analysis based on intrinsic rhythm............................................................... 6.6.13
Appendix 1 Analysis Mode
Appendix 2 Analysis after Exercise
Appendix 3 Modified Minnesota Code

General..........................................................................................................................A.3.2
Code List........................................................................................................................A.3.3
Priority of Code Printing.................................................................................................A.3.7
Detailed Criteria.............................................................................................................A.3.8
C. User’s Guide ECAPS 12C

CONTENTS
Appendix 4 Minnesota Code 1982 Version 1

Overview........................................................................................................................A.4.2
Code Classification List.................................................................................................A.4.3 2
Priority of Code Printing.................................................................................................A.4.8
Detailed Criteria.............................................................................................................A.4.9
3
6-1
6-2
6-3
6-4
6-5
6-6
A-1
A-2
A-3
A-4

Section 1 Introduction 1
User’s Guide ECAPS 12C 1.1

1. INTRODUCTION
ECAPS 12C is the ECG analysis program for the NihonKohden’s instruments,
such as electrocardiographs. A computer analysis program is merely a collection
of ECG evaluation criteria created by physicians. It is not possible for a
computer program to correctly judge every unique ECG, so sometimes it makes
wrong interpretations where a physician could very easily read and interpret the
waveforms. The final decision can only be made by the qualified physicians. Use
this system only as a diagnostic aid, based on proper understanding of its features
and limitations.
This manual describes the criteria of the analysis results of the ECAPS 12C
output data.
For the detailed operation procedure of the system, refer to the operator’s manual
of the instrument.
NOTE
The contents of this manual are subject to change without prior notice for
improvement of analysis precision.
1.2 User’s Guide ECAPS 12C

1. INTRODUCTION
ADVISORY 1
The ECAPS 12C analysis program is applicable to ages 3 and older.
Ages below 3 years are treated according to the criteria for the age of
3 years.
Final determination of overall interpretation judgement, diagnosis and

treatment must be made by a qualified physican.
Patient Age and the Age Used for Analysis

• When classifying as adult or child:
Age Age which is used for analysis

Child (3-15) 12
Adult (>=16) 35
• When classifying in age range:
Age Age which is used for analysis

<=5 3
6-9 7
10-14 12
15-34 25
>=34 35
• When patient’s actual age is entered:

The patient’s actual age is used for analysis.

Section 2 Precautions (Discrepancies
2
between physician’s and
ECAPS 12C’s findings)

2. PRECAUTIONS
The causes for discrepancy between computer analysis and physician’s findings
and the countermeasures to be taken for these causes are given below.
Causes Countermeasures
Difference in judgement criteria between Refer to Section 6 “CRITERIA OF FINDINGS”
physician and computer program, or which list all the judgement criteria used by
lack of applicable findings by computer ECAPS 12C.
program.
The ECG waveform is on the borderline of Compare the measured data with the data in Section
the judgement criteria. 6 “CRITERIA OF FINDINGS”.
This may be the limit of computer analysis.
Patient data other than ECG should be taken into
consideration.
Artifact (EMG, AC interference, baseline Try to record ECG with as little artifact as possible.
wandering, etc.) not recognized, leading to
wrong interpretation.
Arrhythmia, etc. which are intrinsically This is a limit for computer analysis. The advice of
difficult for the computer to analyze. a physician should be obtained.

2. PRECAUTIONS
Although various means of eliminating errors and discrepancies between

computer analysis and physician’s findings are employed in the ECAPS 12C,
not all ECG diagnostic cases are incorporated, therefore, consider the following 2
points when using the computer’s analysis results.
(1) ECAPS 12C is not programmed to compensate for the influence of medicine.
Check the dosing record when reading the ECG. However, the influence of
digitalis is noted on the recording paper according to the presence of atrial
fibrillation.
(2) ECAPS 12C is not programmed to compensate for fluid balance such as
abnormal electrolytes. When interpreting ECG, read the QTc interval, T
waveform and U waveform, along with other relevant test results.
(3) ECAPS 12C does not further classify premature complex into trigeminy,
short-run, etc.
(4) ECAPS 12C is not programmed to identify escaped beats and pararrhythmia.
These may be interpreted as “undetermined rhythms”.
(5) ECAPS 12C is not programmed to identify LGL syndrome. Judge this
syndrome from “short PR interval”.
(6) ECAPS 12C does not identify wandering pacemakers.

Section 3 Outline of ECG Automatic
Recording 3
Entering Patient Data........................................................................................................................................... 3.3

Recording ECG Data............................................................................................................................................ 3.4
Improving Waveform Quality................................................................................................................................. 3.4
Measuring ECG Waveform................................................................................................................................... 3.6
General Measurement Values to Be Printed.................................................................................. 3.10
Classification and Printing ECG Data................................................................................................................. 3.11

3. OUTLINE OF ECG AUTOMATIC RECORDING
ECG Measurement Flowchart
START
Enter patient information. Refer to p. 3.3.
Record ECG. Refer to p. 3.4.
Remove AC interference and base line

wandering from ECG. Refer to p. 3.4.
Measure P, QRS and T waveforms. Refer to p. 3.6.
Analyze ECG. Refer to p. 3.7.
Print out analysis results (finding). Refer to p. 3.11.
END

Entering Patient Data
Enter the following data before acquiring ECG data. With some instruments, 3
some of these items cannot be entered. Refer to the operator’s manual of the
instrument for details of entering the patient data.
• Patient identification number (ID)

• Name
• Sex
• Birth Date
• Age
• Height
• Weight
• Blood pressure
• Medication
• Date*
• Hour*
* Date and hour are automatically set.
NOTE
• Among these items, only age and sex affect the analysis. Other items
have no effect on the analysis.
• If no age is input, the factory default setting of 35 is used. If no sex is
specified, the factory default setting of male is used.
• For accurate analysis results, input sex and age.

Recording ECG Data
The ECGs of all 12 standard leads are acquired simultaneously for 10 seconds at
an accuracy of 1.25 µV/bit and 500 samples/s.
Refer to the operator’s manual of the instrument for details of recording ECG.
NOTE
Recording ECG Data has the description that the ECGs of all 12
standard leads are acquired simultaneously for 10 seconds. However,
the electrocardiograph acquires and analyze ECG waveforms of 10 to 24
seconds.
When more than 24 seconds ECG waveforms are recorded in extended
sequence recording, the waveform for 24 seconds from the start of the
recording is analyzed.
There are instruments that can only record waveforms of 10 seconds and
instruments that can record waveforms of 10 to 24 seconds.
To check whether the instrument you are using can record waveforms of
more than 10 seconds, see the operator’s manual for the instrument.
Improving Waveform Quality
During ECG data acquisition, the quality of the ECG waveforms is improved
with digital filters and the adverse influence of baseline wandering due to
electrode potential drifting and AC interference is minimized.
• AC interference
A digital filter is used in the system to reduce the AC frequency components.
A digital filter eliminates adverse influence on the ECG waveform more than a
conventional analog filter.
Conventional analog filter Digital filter

• Baseline wandering
Shortening the time constant distorts the ST segments which reduces
diagnostic accuracy.
A digital filter is used to remove the components which cause baseline
wandering. 3
• High frequency noise

High cut filters of different frequencies are incorporated in the instruments.
The high cut filter cuts the high frequency components of ECG but reduces
the effect of EMG. The high cut filter attenuates the QRS amplitude although
the influence on judgement of LVH (left ventricular hypertrophy) is reduced
as much as possible. However, the ECAPS 12C program always analyzes the
ECG waveform acquired by 150 Hz filter. Therefore, some differences may
occur between the recorded waveform and the analysis result.

Measuring ECG Waveform
ECG waveforms are measured as shown below.
QRSs are classified by patterns and only the typical waveforms are
extracted and averaged for measurement.
The P waves for each heartbeat are searched and classified by

pattern.
The most characteristic P wave pattern among the classified

patterns is taken as the typical P wave.
P wave, QRS wave, T wave and ST segment are measured.

For the detailed measurement method, refer to the next page.
Rhythm is analyzed based on QRS wave and P wave waveform

measurement data.
Waveforms are measured as shown on the next page.

The reference point in measuring waveforms is the starting point of the QRS
wave.

(a) Waveform measurement parameters
(1000-R-R interval)
QTc interval=QT interval+
7
Some instruments can select the Bazett formula. 3

QT interval [ms]
PR interval QRS duration
QTc interval=
RR interval [s]
V.A.T. Some instruments can select the Fridericia formula.

QT interval [ms]
QTc interval= 3
RR interval [s]
QTc interval: QT interval changes with heart rate.

QTc interval is the converted value
when the heart rate is 60/min.
P duration
R amp.
STJ STM STE

P' amp. T amp.
P amp.
Q amp.
S amp.
1/16 R-R interval
Q duration R duration S duration
QT interval
R max amp.
R' amp.
R amp.
T amp.
S amp.
S max amp.
P' amp. P amp. S' amp. T' amp.
R duration R' duration
S' duration
S duration
QRS duration
Total QRS amplitude = R max. amp. + S max. amp.

Net QRS amplitude = R max. amp. − S max. amp.

STJ
(at V4 through V6)
Peak J amp
V1 through V3 Peak J40 amp
Peak J80 amp
40 ms
80 ms
J point on V4 through V6
(QRS end point)
ST min
V4 through V6
STJ (at V4 through V6): End point of QRS complex in V4 through V6 leads
Peak J amp: Peak value near the J point
Peak J40 amp: 40 ms after Peak J
Peak J80 amp: 80 ms after Peak J
ST min: Lowest point of ST segment
(b) QRS area

(c) Upward oriented T
T is upward oriented: C > 0.05 mV + (1.5 × STJ)
(d) Modified T amplitude (T amp. (mod))

To simplify the treatment of biphasic T wave, and to explain the T
amplitude when ST and T differ from the QRS starting point, T amplitude
is modified as below.
When T’ is present:
T amp. (mod) = (T amp. or T’ amp., whichever is smaller) − (STE or T
end, whichever is larger)
When T’ is not present:
T amp. (mod) = T amp. − (STE or T end, whichever is larger)

General Measurement Values to Be Printed
Printout Meaning
HR (Vent. rate) -- bpm Heart rate
PR int. -- ms PR interval
QRS dur. -- ms QRS duration
QT int. -- ms QT interval
QTc int. -- ms QTc interval (See p. 3-7(a))
P axis -- ° P axis deviation
QRS axis -- ° QRS axis deviation
T axis -- ° T axis deviation
RV5 amp -- mV R amplitude in V5
SV1 amp -- mV S amplitude in V1
When a measurement value cannot be measured, “***” is displayed.

Classification and Printing ECG Data
The ECGs are classified into the findings. 3

(For the details of the classification method, refer to Section 6 “CRITERIA OF
FINDINGS”.)
The findings are printed out as “Analysis Result”. Refer to the next section.

Section 4 Recorded Analysis Results

4. RECORDED ANALYSIS RESULTS
The analysis results of the system are printed out in the format selected by
the operator. The outline of the formats and the operation are described in the
operator’s manual of the instrument. The explanation of the common features
of the printout with typical examples are given below. These are factory default
settings.
Not all of the following items are printed with some instruments. For details,
refer to the operator’s manual of the instrument.
(1) Patient’s data and recording conditions

Data and Time
Name
ID No.
Room
Sex
Birth date and Age (in some formats, birth date is omitted):years
Height: cm/inch
Weight: kg/lb
Systolic BP: mmHg/kpa
Diastolic BP: mmHg/kpa
Medication
Vent. rate (Heart Rate)
Paper speed
Sensitivity
Lead name
NOTE
, , , and are automatically entered. Items to are
printed as entered by the operator. Room No., Physician name and
Technician name can be recorded according to the format.
(2) ECG waveform printout (In some formats, these are omitted.)
Dominant Ecg waveform (averaged)
Rhythm lead
Calibration wave
(3) Analysis result

Overall judgement
ECG findings name [criteria]
Measurement values
Physician’s signature (Reviewed)
NOTE
• The findings [criteria] are printed as a supplementary which is one of
the judgement criteria. For details, refer to Section 5 “How to Read
Analysis Results”.
• In some findings, [criteria] are not printed.

4. RECORDED ANALYSIS RESULTS

Section 5 How to Read Analysis
Results
ECG Findings....................................................................................................................................................... 5.3
Priority of ECG Findings....................................................................................................................................... 5.3 5
Criteria.................................................................................................................................................................. 5.4
Overall Judgement................................................................................................................................................ 5.4
Analysis Result When ECG Cannot Be Analyzed................................................................................................ 5.5

5. HOW TO READ ANALYSIS RESULTS
The analysis result printout, as shown below, contains the following data.
1. ECG findings
2. Criteria
3. Overall judgement
4. Measurement values

ECG Findings
The ECAPS 12C classifies the ECGs into about 200 findings by comparing the
features of the ECGs with the analysis criteria specified for each finding. The
analysis criteria are all taken from the judgement criteria used by the physicians
and arranged for computer processing.
For details, refer to Section 6 “Criteria of Findings”. 5
For the analysis process, refer to Section 3 “Outline of ECG Automatic

Recording”.
When the obtained ECG exactly conforms to the analysis criteria, the finding
name is classified as “determined”. However, there are findings which cannot
be determined definitely and findings which are on the borderline between
conformance and nonconformance, liable to be influenced by slight noises.
Those findings which are close to “determined” but not definite are classified
as “possible”, and those findings which may or may not conform but cannot be
completely ruled out are classified as “Cannot rule out”.
Some arrhythmia ECGs are difficult to classify into finding names; these are
classified as “undetermined rhythm”.
NOTE
When the ECG is classified as “undetermined rhythm” (1901, 1902, 1921,
1922, 1931, 1932), there is no further rhythm analysis.
Priority of ECG Findings
When the obtained ECG conforms to two or more findings criteria, only the most
important finding name is printed. For example, if “ischemia” is found to apply,
less important findings such as “nonspecific ST & T wave abnormality” or “ST
elevation” are not printed.
Further details of analysis are given as NOTE under the respective findings in
Section 6 “Criteria of Findings”.

Criteria
The analysis criteria can be printed out on the recording paper after the findings,
as shown on p. 5.2. They should serve as an aid in observing the ECG.
For example, when the instrument judges the ECG as abnormal junctional ST
depression because there is junctional ST depression of more than 0.1 mV in V5
and V6, the criteria is printed as “4023 Abnormal junctional ST depression [0.1 +
mV junctional ST depression (V5, V6)].
For reading convenience, the analysis findings and criteria are printed in
simplified form.
For further details of the analysis criteria, refer to Section 6 “Criteria of

Findings”.
Overall Judgement
The findings are classified into one of five overall judgements. The list of all
findings for each overall judgement is shown in Section 6 “Criteria of Findings”.
Overall Judgement Code

1 abnormal ECG 9150
2 abnormal rhythm ECG 9140
3 borderline ECG 9130
4 normal ECG 9110
5 atypical ECG 9120
Where two or more findings are output, only the highest priority finding is
printed.
Although only the highest priority finding is selected for judgement, the findings
requiring immediate treatment, such as “Myocardial infarction, possible acute”
are printed as “abnormal ECG” instead of “borderline ECG”. This is to raise
an alarm in case of emergency although there is actually little possibility of
danger. When an unusual ECG pattern is recognized as neither “normal ECG”
nor “abnormal ECG”, it is judged as “atypical ECG”. For example, “Low
QRS voltage”, “undetermined axis”, and “undetermined rhythm” are judged as
“atypical ECG”.

Analysis Result When ECG Cannot Be Analyzed
When a measurement value cannot be measured, “***” is displayed. When no

measurement values can be measured, the ECG cannot be analyzed and a “0103
CANNOT ANALYZE ECG” message is displayed. For recording example, refer
to “General Measurement Values to Be Printed” in Section 3.
5

Section 6 Criteria of Findings
Section 6-1 Arrhythmias.................................................................................................................................. 6.1.1

Section 6-2 Conductive Defect........................................................................................................................ 6.2.1
Section 6-3 Myocardial Infarction.................................................................................................................... 6.3.1
Section 6-4 ST-T Abnormality.......................................................................................................................... 6.4.1 6
Section 6-5 Ventricular Hypertrophy................................................................................................................ 6.5.1
Section 6-6 Atrial Enlargement, Abnormal Axis Deviation and Others............................................................ 6.6.1
User’s Guide ECAPS 12C 6.0.1

6. CRITERIA OF FINDINGS
Indication of Analysis Criteria
1. How to read analysis criteria

The analysis criteria are marked with (1), (2) and , .
(1) ...indicates AND
...indicates OR
[ Example 1 ]
(1) condition A
(2) condition B
(3) condition C Conditions A and B are satisfied, and either
condition D condition C or condition D are satisfied.
[ Example 2 ]
(1) condition A
Either condition A is satisfied, or both
(2) • condition B
conditions B and C are satisfied.
• condition C
2. Age reference tables

The following tables show the values used for certain analysis parameters
which vary according to age. The applicable items are marked with “*” in
the criteria column.
NOTE
• When no age is input in the patient information, the factory default
setting of age 35 is used.
• When the age is 2 or younger, the computer’s results may not be
accurate.
[ PR interval ] (%)
Age PR ratio
<=5 76
(Example)
<=9 83
<=11 85 PR interval = 170 ms
<=14 88 Age = 6 years old
PR criteria = PR int × PR ratio/100
<=18 91
= 170 × 83/100
>18 100 = 141 ms
6.0.2 User’s Guide ECAPS 12C

[ QRS duration ] (%)
Age QRS duration

<=5 82
(Example)
<=9 85
<=11 85 QRS duration: 0.12 s
<=14 92 Age = 10 years old
QRS criteria = QRS dur. × QRS dur (%)/100
<=18 95
= 0.12 × 85/100
>18 100 = 0.102 s
[ S duration: Lateral lead (I, aVL, V4, V5, V6) ] (s)

6
Age S duration S duration

0.040 (s) 0.060 (s)
<=5 0.031 0.047
<=9 0.034 0.051
<=11 0.037 0.056
<=14 0.039 0.059
<=18 0.039 0.059
>18 0.039 0.059
shows the parameters used in criteria for each finding.
[ R duration (V1, V2) ] (s)
Age R duration R duration

0.020 (s) 0.030 (s)
<=5 0.016 0.024
<=9 0.017 0.026
<=11 0.019 0.028
<=14 0.020 0.030
<=18 0.020 0.030
>18 0.020 0.030

[ R duration (I, aVL, V4, V5, V6) ] (s)
Age R duration R duration R duration

0.060 (s) 0.100 (s) 0.250 (s)
<=5 0.049 0.082 0.207
<=9 0.051 0.086 0.218
<=11 0.054 0.090 0.228
<=14 0.057 0.095 0.240
<=18 0.059 0.099 0.250
>18 0.059 0.099 0.250
[ Electrical axis (left axis) ] (degree)
LAXD1 LAXD2
Age
Male Female Male Female
<=5 15° 19° 5° 9°
<=9 9° 9° −1° −1°
<=11 4° 23° −6° 13°
<=14 5° 20° −5° 10°
<=18 −14° 13° −24° 3°
>18 −20° −20° −30° −30°
[ Electrical axis (right axis) ] (degree)
RAXD1 RAXD2
Age
Male Female Male Female
<=5 97° 101° 107° 111°
<=9 97° 97° 107° 107°
<=11 92° 100° 102° 110°
<=14 97° 97° 107° 107°
<=18 99° 100° 109° 110°
>18 90° 90° 100° 100°

[ R amplitude (V1) ] (mV)
Age Male Female

<=5 2.20 1.75
<=9 1.65 1.60
<=11 1.30 1.40
<=14 1.60 1.20
<=18 1.40 1.15
>18 1.00 1.00
[ Average R amplitude (V1) ] (mV)

6
Age Male Female

<=5 0.90 0.85
<=9 0.75 0.65
<=11 0.60 0.55
<=14 0.70 0.45
<=18 0.60 0.40
>18 0.40 0.30
[R amplitude (V6) ] (mV)
Age Male Female

<=5 1.45 1.45
<=9 1.70 1.65
<=11 1.65 1.50
<=14 1.60 1.35
<=18 1.50 1.20
>18 1.20 1.00

[ S depth (V1) ] (mV)
Age Male Female

<=5 1.20 1.25
<=9 1.20 1.25
<=11 1.35 1.30
<=14 1.50 1.15
<=18 1.65 1.15
>18 1.20 0.95
[ S depth (V6) ] (mV)
Age Male Female

<=5 0.54 0.54
<=9 0.65 0.60
<=11 0.61 0.61
<=14 0.47 0.35
<=18 0.50 0.36
>18 0.40 0.30
[R/S (V1) ratio]
Age Male Female

<=5 2.7 2.0
<=9 1.8 1.8
<=11 2.3 1.3
<=14 2.2 1.6
<=18 1.3 1.7
>18 1.0 1.0

[ VAT (V1) ] (s)
Age Male Female

<=5 0.037 0.039
<=9 0.033 0.029
<=11 0.045 0.028
<=14 0.041 0.032
<=18 0.039 0.034
>18 0.050 0.050
[ Heart Rate ] (BPM) - For arrhythmia analysis -

6
Age Bradycardia base Tachycardia base

<=5 65 140
<=8 60 135
<=12 55 130
<=16 50 120
>16 50 100
BPM : Beats per minute

Section 6-1 Arrhythmias
Rhythm analysis................................................................................................................................................ 6.1.2

1002 Marked rhythm irregularity, possible non-conducted PAC, SA block, AV block, or sinus pause.......... 6.1.12
1100 Sinus rhythm......................................................................................................................................... 6.1.3
1102 Sinus arrhythmia................................................................................................................................. 6.1.13 6
1108 Marked sinus arrhythmia..................................................................................................................... 6.1.13
1120 Sinus tachycardia.................................................................................................................................. 6.1.3 6-1
1130 Sinus bradycardia.................................................................................................................................. 6.1.3
1200 Atrial rhythm.......................................................................................................................................... 6.1.4
1210 Atrial fibrillation...................................................................................................................................... 6.1.7
12101 Atrial fibrillation with rapid ventricular response.................................................................................... 6.1.7
12102 Atrial fibrillation with slow ventricular response..................................................................................... 6.1.7
12103 Atrial fibrillation with aberrant conduction, or ventricular premature complexes.................................. 6.1.18
12108 Atrial fibrillation with rapid ventricular response with aberrant conduction, or ventricular premature
complexes........................................................................................................................................... 6.1.18
12109 Atrial fibrillation with slow ventricular response with aberrant conduction, or ventricular premature
complexes........................................................................................................................................... 6.1.18
1220 Rapid atrial rhythm................................................................................................................................ 6.1.4
1250 Atrial flutter............................................................................................................................................ 6.1.8
12503 Atrial flutter with aberrant conduction, or ventricular premature complexes........................................ 6.1.19
12505 Cannot rule out atrial flutter................................................................................................................... 6.1.8
12506 Atrial fibrillation or flutter........................................................................................................................ 6.1.8
12507 Atrial fibrillation or flutter with aberrant conduction, or ventricular premature complexes................... 6.1.19
1300 Junctional rhythm.................................................................................................................................. 6.1.5
1320 Rapid junctional rhythm......................................................................................................................... 6.1.5
1400 Undetermined rhythm (Possible supraventricular rhythm)..................................................................... 6.1.6
1420 Undetermined rhythm (Possible supraventricular tachycardia)............................................................. 6.1.6
1430 Undetermined rhythm (Possible supraventricular bradycardia)............................................................. 6.1.6
1470 with occasional supraventricular premature complexes...................................................................... 6.1.14
1474 with frequent supraventricular premature complexes.......................................................................... 6.1.14
1475 with frequent supraventricular premature complexes in a pattern of bigeminy................................... 6.1.14
1570 with occasional ventricular premature complexes............................................................................... 6.1.15
15708 with occasional ventricular premature complexes (Unreliable analysis due to noise)......................... 6.1.15
1574 with frequent ventricular premature complexes................................................................................... 6.1.15
15748 with frequent ventricular premature complexes (Unreliable analysis due to noise)............................. 6.1.15
1575 with frequent ventricular premature complexes in a pattern of bigeminy............................................ 6.1.15
15758 with frequent ventricular premature complexes in a pattern of bigeminy (Unreliable analysis due
to noise).............................................................................................................................................. 6.1.15
1577 with couplet ventricular premature complexes.................................................................................... 6.1.15
15778 with couplet ventricular premature complexes (Unreliable analysis due to noise).............................. 6.1.15
16006 Electronic atrial pacemaker................................................................................................................... 6.1.9
16007 Electronic ventricular pacemaker.......................................................................................................... 6.1.9
16008 Electronic atrial pacemaker (Unreliable analysis due to noise)............................................................. 6.1.9
16009 Electronic ventricular pacemaker (Unreliable analysis due to noise).................................................... 6.1.9

1901 Undetermined regular rhythm.............................................................................................................. 6.1.10

1902 Undetermined rhythm.......................................................................................................................... 6.1.10
1921 Undetermined regular rhythm (tachycardia)........................................................................................ 6.1.10

1922 Undetermined rhythm (tachycardia).................................................................................................... 6.1.10
1931 Undetermined regular rhythm (bradycardia)....................................................................................... 6.1.10
1932 Undetermined rhythm (bradycardia).................................................................................................... 6.1.10
1938 Extreme bradycardia........................................................................................................................... 6.1.11
1970 with occasional ectopic premature complexes.................................................................................... 6.1.17
19708 with occasional ectopic premature complexes (Unreliable analysis due to noise).............................. 6.1.17
1974 with frequent ectopic premature complexes........................................................................................ 6.1.17
19748 with frequent ectopic premature complexes (Unreliable analysis due to noise).................................. 6.1.17
1975 with frequent ectopic premature complexes in a pattern of bigeminy................................................. 6.1.17
Rhythm analysis
Arrhythmia analysis is divided into three major categories; “basic rhythm analysis”, “basic rhythm fluctuation analysis”,
and “premature complex analysis”. In the basic rhythm analysis, the presence of P wave and P wave axis are important
factors. The connection between P waves and QRS waves is an important factor in classifying the waveform into basic
rhythm, basic rhythm fluctuation and premature complex.

6-1. ARRHYTHMIAS
1. Basic rhythm analysis

(1) With P wave
• Sinus
Code Findings [Criteria] Judgement

1100 Sinus rhythm normal ECG
1120 Sinus tachycardia abnormal rhythm ECG
1130 Sinus bradycardia abnormal ECG
Analysis criteria
6
Findings Criteria
(1) Electronic atrial pacemaker is not used. 6-1
(2) P waveform; constant, PR interval; regular
Sinus rhythm
(3) −30° <= P axis < 120°
(4) 50 <= heart rate < 100*
(1) Electronic atrial pacemaker is not used.
Sinus tachycardia
(3) −30° <= P axis < 120°
(4) 100 <= heart rate*
Sinus bradycardia
(3) −30° <= P axis < 120°
(4) 50 > heart rate*
NOTE
The values marked with “*” vary with age. For details, refer to p.6.0.7.
50/minute 100/minute
Bradycardia Sinus rhythm Tachycardia

• Atrial

1200 Atrial rhythm abnormal rhythm ECG
1220 Rapid atrial rhythm abnormal rhythm ECG
Analysis criteria
Findings Criteria
(3) 120° <= P axis <= 240°
−30° > P axis >= −60°
Atrial rhythm
(1) PR interval > 0.14s
(2) 120° <= P axis <= 270°
−30° > P axis >= −90°
(4) Heart rate <= 70
(3) 120° <= P axis <= 240°
−30° > P axis >= −60°
Rapid atrial rhythm
(1) PR interval > 0.14 s
(2) 120° <= P axis <= 270°
−30° > P axis >= −90°
(4) 70 < heart rate
70/minute
Atrial rhythm Rapid

6-1. ARRHYTHMIAS
• AV junction

1300 Junctional rhythm abnormal rhythm ECG
1320 Rapid junctional rhythm abnormal rhythm ECG
Analysis criteria
Findings Criteria
(2) P waveform; constant, PR interval; regular PR <= 0.14 s
6
(3) −60° > P axis > −90°
Junctional rhythm
240° < P axis <= 270° 6-1
(4) Heart rate <= 70 (age > 3 years)
Heart rate <= 80 (age <= 3 years)
(2) P waveform; constant, PR interval; regular PR <= 0.14 s
(3) −60° > P axis > −90°
Rapid junctional rhythm
240° < P axis <= 270°
(4) 70 < heart rate (age > 3 years)
80 < heart rate (age <= 3 years)
70/minute
Junctional rhythm Rapid

(2) Without P wave

• Without atrial fibrillation or without atrial flutter

Undetermined rhythm (Possible supraventricular
1400 abnormal rhythm ECG
rhythm)
tachycardia)
bradycardia)
Analysis criteria
When the P wave is not joined to the QRS, the following criteria are used for
classification.
Findings Criteria
Undetermined rhythm (Possible (2) Atrial fibrillation and atrial flutter are not present.
supraventricular rhythm) (3) QRS duration < 120 ms*
(4) 50 <= heart rate < 100*
supraventricular tachycardia) (3) QRS duration < 120 ms*
(4) heart rate >= 100*
supraventricular bradycardia) (3) QRS duration < 120 ms*
(4) heart rate < 50*
NOTE
• The values marked with “*” vary with age. For details, refer to p.6.0.3
and 6.0.7.
• When these findings are recognized, other less important findings are
not printed on the recording paper.
Bradycardia Supraventricular rhythm Tachycardia

6-1. ARRHYTHMIAS
• With atrial fibrillation or with atrial flutter

1210 Atrial fibrillation abnormal rhythm ECG
12101 Atrial fibrillation with rapid ventricular response abnormal rhythm ECG
12102 Atrial fibrillation with slow ventricular response abnormal rhythm ECG
Analysis criteria
Findings Criteria
(1) (1) P wave is not present 6

(2) RR interval deviation > 0.125 × mean RR interval
Atrial fibrillation (3) Random RR interval 6-1
Fibrillation wave (f wave) is detected.
(2) 50 <= heart rate < 100*
(1) (1) P wave is not present

Atrial fibrillation with rapid (2) RR interval deviation > 0.125 × mean RR interval
ventricular response (3) Random RR interval
Fibrillation wave (f wave) is detected
(2) 100 <= heart rate*
(1) (1) P wave is not present

Atrial fibrillation with slow (2) RR interval deviation > 0.125 × mean RR interval
ventricular response (3) Random RR interval
Fibrillation wave (f wave) is detected
(2) 50 > heart rate*
NOTE
The values marked with “*” vary with age. For details, refer to p.6.0.7.
Bradycardia Atrial fibrillation Tachycardia


1250 Atrial flutter abnormal rhythm ECG
12505 Cannot rule out atrial flutter abnormal rhythm ECG
12506 Atrial fibrillation or flutter abnormal rhythm ECG
Analysis criteria
• When “Analysis” on the “System Setup” screen is set to “Advanced” or
“Advanced (Screening)”
Findings Criteria
(1) Flutter wave (including fibrillation or flutter wave) is present.
Atrial flutter
(2) A certain regularity is found between RR intervals.
Cannot rule out atrial flutter P wave is similar to the characteristics of F wave or f wave.
(1) Flutter wave (including flutter or fibrillation wave) is present.
Atrial fibrillation or flutter
(2) A certain regularity cannot be found between RR intervals.
• When “Analysis” on the “System Setup” screen is set to “Standard” or

“Standard (Screening)” or the cardiograph has no “Analysis” on the “System
Setup” screen
Findings Criteria
Atrial flutter (1) Flutter wave (including fibrillation or flutter wave) is present.
Atrial flutter with aberrant (1) Atrial flutter is present.
conduction, or venticular (2) Ectopic QRS is not pacemaker waveform.
premature complexes (3) Ectopic QRS with duration > 0.12 s*
NOTE
The values marked with “*” vary with age. For details refer to p. 6.0.3.

6-1. ARRHYTHMIAS
(3) With pacemaker

16006 Electronic atrial pacemaker atypical ECG
16007 Electronic ventricular pacemaker atypical ECG
Electronic atrial pacemaker (Unreliable analysis due to
16008 atypical ECG
noise)
Electronic ventricular pacemaker (Unreliable analysis due
16009 atypical ECG
to noise)
Analysis criteria 6
Findings Criteria 6-1
(1) QRS is dominant waveform.
(2) Pacemaker pulse recognized within 0.08 s before and after
Electronic atrial pacemaker
the beginning of the P wave
rhythm
(3) Three or more heartbeats satisfying above two conditions
are present.
Electronic ventricular
Pacemaker pulse and dominant QRS are joined.
pacemaker rhythm
NOTE
• When there is any detached electrode or noise during analysis, “16008”
or “16009” appear in the findings column even if the above conditions
are satisfied.
• If spontaneous systoles occur during ECG observation, the ECG
system analyzes the spontaneous systoles. In this case, “0201
Analysis based on intrinsic rhythm” is additionally printed out in the
findings column.

2. Basic rhythm fluctuation analysis

1901 Undetermined regular rhythm atypical ECG
1902 Undetermined rhythm atypical ECG
1921 Undetermined regular rhythm (tachycardia) atypical ECG
1922 Undetermined rhythm (tachycardia) atypical ECG
1931 Undetermined regular rhythm (bradycardia) atypical ECG
1932 Undetermined rhythm (bradycardia) atypical ECG
Analysis criteria
Findings Criteria
(1) Normal P wave is not present.
(2) QRS duration >= 0.12 s*
(3) Atrial fibrillation is not present.
(4) Atrial flutter is not present.
Undetermined regular rhythm
(5) Electronic pacemaker is not used.
(6) All QRSs are dominant type.
(7) Maximum RR interval - Minimum RR interval < 1/8 mean
RR interval
(1) Normal P wave is not present.
(3) Atrial fibrillation is not present.
Undetermined rhythm
(4) Atrial flutter is not present.
(5) Electronic pacemaker is not used.
(6) Regular rhythm is not present.
Undetermined regular rhythm (1) Cannot determine the rhythm (PR interval; regular)
(tachycardia) (2) 100* <= Heart rate
Undetermined rhythm (1) Cannot determine the rhythm
(tachycardia) (2) 100* <= Heart rate
Undetermined regular rhythm (1) Cannot determine the rhythm (PR interval; regular)
(bradycardia) (2) 50* > Heart rate
Undetermined rhythm (1) Cannot determine the rhythm
(bradycardia) (2) 50* > Heart rate
NOTE
The values marked with “*” vary with age. For details refer to p. 6.0.3 and
6.0.7.

6-1. ARRHYTHMIAS

1938 Extreme bradycardia abnormal rhythm ECG
Analysis criteria
Findings Criteria
(1) 40 > Heart rate
Extreme bradycardia
(2) 2° AV block (Mobitz type II) is not present.
6-1

• With abnormal rhythm

Marked rhythm irregularity, possible non-conducted PAC,
SA block, AV block, or sinus pause
Analysis criteria
Findings Criteria
Marked rhythm irregularity, (1) 2° AV block is not present.
possible non-conducted PAC, (2) Heart rate < 100
SA block, AV block or sinus (3) Random RR interval
pause

6-1. ARRHYTHMIAS

1102 Sinus arrhythmia normal ECG
1108 Marked sinus arrhythmia normal ECG
Analysis criteria
When sinus rhythm, sinus tachycardia and sinus bradycardia are judged and
satisfy the below conditions, then the classification is as below.
Findings Criteria
(1) Premature complexes are not present. 6
Sinus arrhythmia (2) Marked rhythm irregularity is not present.
(3) RR interval deviation > 0.2 × mean RR interval 6-1
(1) Premature complexes are not present.
Marked sinus arrhythmia (2) Marked rhythm irregularity is not present.
(3) RR interval deviation > 0.4 × mean RR interval
NOTE
“Premature complexes: absent” and “Marked rhythm irregularity: absent”
are analyzed according to their analysis criteria on p. 6.1.14 to 6.1.17.

3. Premature complex analysis
(1) Supraventricular

1470 with occasional supraventricular premature complexes abnormal rhythm ECG
1474 with frequent supraventricular premature complexes abnormal rhythm ECG
with frequent supraventricular premature complexes in a
pattern of bigeminy
Analysis criteria
Findings Criteria
(1) Intermittent WPW is not present.
(2) 2° AV block is not present.
(3) Marked rhythm irregularity is not present.
(4) RR interval < mean RR interval × 3/4
• P wave is not sinus-induced
with occasional • RR interval < mean RR interval − mean RR interval
supraventricular premature × 1/10 (maximum 100 ms)
complexes • The second heartbeat on the recording paper.
Or, when the heartbeat is the third or later on the
recording paper; the RR interval of the previous
heartbeat ≥ RR interval + 10 ms. Or, when the
heartbeat is the third or later on the recording paper;
the previous heartbeat is premature complexes.
Three or more supraventricular premature complexes given
with frequent supraventricular
above (code 1470) and/or ectopic premature complexes are
premature complexes
present.
with frequent supraventricular
Supraventricular premature complexes given above (code
premature complexes in a
1470) and dominant waveform appear alternately.
pattern of bigeminy

6-1. ARRHYTHMIAS
(2) Ventricular

1570 with occasional ventricular premature complexes abnormal rhythm ECG
1574 with frequent ventricular premature complexes abnormal rhythm ECG
with frequent ventricular premature complexes in a
pattern of bigeminy
1577 with couplet ventricular premature complexes abnormal rhythm ECG
with occasional ventricular premature complexes
(Unreliable analysis due to noise)
with frequent ventricular premature complexes
15748 abnormal rhythm ECG 6
with frequent ventricular premature complexes in a
15758 abnormal rhythm ECG 6-1
pattern of bigeminy (Unreliable analysis due to noise)
with couplet ventricular premature complexes

Analysis criteria
Findings Criteria
(1) Intermittent WPW is not present.
(2) Ectopic QRS duration > 0.12 s*
(3) For the first heartbeat on the recording paper:
• P wave does not precede QRS-complexes
• next RR interval − 40 ms > mean RR interval
For the first heartbeat on the recording paper:
• P wave precedes QRS-complex
• next RR interval − 100 ms > mean RR interval
When the heartbeat is the second or later:
with occasional ventricular
• P wave does not precede QRS-complexes
premature complexes
• RR interval + 40 ms < mean RR interval
When the heartbeat is the second or later:
• P wave precedes QRS-complexes
• RR interval < mean RR interval − mean RR interval × 1/10 (maximum
100 ms)
• The second heartbeat on the recording paper. Or, when the heartbeat is
the third or later on the recording paper; the RR interval of the previous
heartbeat ≥ RR interval + 10 ms. Or, when the heartbeat is the third
or later on the recording paper; the previous heartbeat is premature
complexes.
with frequent ventricular Three or more ventricular premature complexes given above (code 1570) are
premature complexes present.
with frequent ventricular
The ventricular premature complexes given above (code 1570) and dominant
premature complexes in a pattern
waveform appear alternately.
of bigeminy
with couplet ventricular More than two ventricular premature complexes given above (code 1570) appear
premature complexes consecutively.
with occasional ventricular
Analysis criteria for code 1570 is satisfied and there is electrode detachment or noise
premature complexes (Unreliable
during analysis.
analysis due to noise)
during analysis.
premature complexes in a pattern Analysis criteria for code 1575 is satisfied and there is electrode detachment or noise
of bigeminy (Unreliable analysis during analysis.
due to noise)
with couplet ventricular
during analysis.
NOTE
• When any of above conditions is satisfied and there is any electrode
detached or noise exists during analysis, “15708”, “15748”, “15758”, or
“15778” appears in the finding column.
• The value marked with “*” varies with age. For details, refer to p. 6.0.3.

6-1. ARRHYTHMIAS
(3) Ectopic

1970 with occasional ectopic premature complexes abnormal rhythm ECG
1974 with frequent ectopic premature complexes abnormal rhythm ECG
with frequent ectopic premature complexes in a pattern
of bigeminy
with occasional ectopic premature complexes
with frequent ectopic premature complexes (Unreliable
6
Analysis criteria 6-1
Findings Criteria
(1) Satisfies all criteria for ventricular premature complexes
with occasional ectopic
other than ectopic QRS
premature complexes
(2) 0.06 s < ectopic QRS duration <= 0.12 s
with frequent ectopic premature Three or more ectopic premature complexes given above are
complexes present.
with frequent ectopic premature
Above occasional ectopic premature complexes and dominant
complexes in a pattern of
waveform appear alternately.
bigeminy
NOTE
• When either the conditions 1970 or 1974 is satisfied and there is any
electrode detached or noise exists during analysis, “19708” or “19748”
appears in the finding column.
• Ectopic premature complexes do not appear in the finding column when
it is judged together with the occasional supraventricular premature
complexes. This is because the instrument judges it to be occasional
supraventricular premature complexes with abberant conduction.

(4) With atrial fibrillation or with atrial flutter

Atrial fibrillation with aberrant conduction, or ventricular
premature complexes
Atrial fibrillation with rapid ventricular response with
aberrant conduction, or ventricular premature complexes
Atrial fibrillation with slow ventricular response with
aberrant conduction, or ventricular premature complexes
Analysis criteria
Findings Criteria
Atrial fibrillation with aberrant (1) Atrial fibrillation is present.
conduction, or ventricular (2) Ectopic QRS is not pacemaker waveform
premature complexes (3) Ectopic QRS with interval >= 0.12 s*
Atrial fibrillation with rapid (1) Atrial fibrillation with rapid ventricular response is
ventricular response with aberrant present.
Atrial fibrillation with slow (1) Atrial fibrillation with slow ventricular response is
ventricular response with aberrant present.
NOTE
• For “Atrial fibrillation”, “Atrial fibrillation with rapid ventricular response”
and “Atrial fibrillation with slow ventricular response”, the same analysis
criteria given on p. 6.1.7 are used.
• The values marked with “*” vary with age. For details, refer to p. 6.0.3.

6-1. ARRHYTHMIAS

Atrial flutter with aberrant conduction, or ventricular
premature complexes
Atrial fibrillation or flutter with aberrant conduction, or
ventricular premature complexes
Analysis criteria
Findings Criteria
Atrial flutter with aberrant (1) Atrial flutter is present. 6
premature complexes (3) Ectopic QRS with interval >= 0.12 s* 6-1
Atrial fibrillation or flutter with (1) Atrial fibrillation or flutter is present.
aberrant conduction, or venticular (2) Ectopic QRS is not pacemaker waveform.
premature complexes (3) Ectopic QRS with interval > 0.12 s*
NOTE
• For “Atrial flutter”, the same analysis criteria given on p. 6.1.8 is used.
• The values marked with “*” varies with age. For details, refer to p. 6.0.3.

Section 6-2 Conductive Defect
2210 Short PR interval................................................................................................................................... 6.2.2

2216 Type-A Wolff-Parkinson-White syndrome.............................................................................................. 6.2.3
2217 Type-B Wolff-Parkinson-White syndrome.............................................................................................. 6.2.3
2218 Atypical Wolff-Parkinson-White syndrome............................................................................................ 6.2.3 6
2219 Intermittent Wolff-Parkinson-White syndrome....................................................................................... 6.2.3
2231 First degree AV block............................................................................................................................ 6.2.5

2232 2nd degree AV block, Mobitz type I....................................................................................................... 6.2.5 6-2
2233 2nd degree AV block, Mobitz type II...................................................................................................... 6.2.5
2234 Possible 3rd degree AV block................................................................................................................ 6.2.5
2320 Nonspecific intraventricular conduction delay..................................................................................... 6.2.10
2330 Nonspecific intraventricular conduction block...................................................................................... 6.2.10
2420 RSR (QR) in lead V1/V2, consistent with right ventricular conduction delay......................................... 6.2.6
2440 Incomplete right bundle branch block.................................................................................................... 6.2.6

2450 Right bundle branch block..................................................................................................................... 6.2.6
24501 Right bundle branch block, plus possible RVH...................................................................................... 6.2.6
2540 Incomplete left bundle branch block...................................................................................................... 6.2.8
2550 Left bundle branch block....................................................................................................................... 6.2.8
2630 Left anterior fascicular block.................................................................................................................. 6.2.9
2730 Left posterior fascicular block................................................................................................................ 6.2.9

1. A-V conductive defect

2210 Short PR interval atypical ECG
Analysis criteria
Findings Criteria
(1) Pacemaker is not used.
(2) P waveform and PR interval are both constant.
Short PR interval
(3) −60° <= P axis <= 240°
(4) PR interval < 0.12 s*
NOTE
The value marked with “*” varies with age. Refer to p. 6.0.2.

6-2. CONDUCTIVE DEFECT
• Wolff-Parkinson-White syndrome

2216 Type-A Wolff-Parkinson-White syndrome abnormal ECG
2217 Type-B Wolff-Parkinson-White syndrome abnormal ECG
2218 Atypical Wolff-Parkinson-White syndrome abnormal ECG
2219 Intermittent Wolff-Parkinson-White syndrome abnormal ECG
Analysis criteria
Findings Criteria
6
(1) • PR interval <= 0.12 s*
• Delta waves are recognized in at least two leads.
• PR interval <= 0.14 s*
• Delta waves are recognized in at least three leads. 6-2
Type-A WPW syndrome
Delta waves are recognized in at least five leads.
• Q wave is not present and VAT > 0.08s in at least two leads
(2) Maximum R amplitude > Maximum S amplitude in V1
(1) 1 • QRS area ratio > 0.4 in at least two leads among I, V5 and V6
• R duration > 0.03s in V2
Type-B WPW syndrome • PR interval <= 0.14 s*
• Delta waves are recognized in at least three leads.
(2) Maximum R amplitude <= Maximum S amplitude in V1
Atypical WPW
• Delta waves are recognized in at least three leads.
syndrome
(1) Four or more ectopic QRS without pacemaker pulses are present.
(2) Heart rate < 120
(3) RR interval of the ectopic beat + 0.16s > RR interval of dominant beat
Intermittent WPW (4) Delta waves are recognized in at least two leads
syndrome (5) PR interval of the ectopic beat < 0.14 s*
(6) PR interval of the ectopic beat < Mean PR interval of the dominant QRS-
0.02 s
(7) PJ interval of the ectopic beat > PJ interval of the dominant QRS-0.02 s

NOTE
(1) If any of the following is satisfied, WPW check is not done.
P wave is not the same type as the dominant beat’s.
PR interval > 0.17 s*
QRS duration < 0.10 s*
QRS duration > 0.20 s*
Heart rate > 120*
(2) If WPW is determined by the above analysis criteria, other waveform
analysis will be omitted.
(3) The values marked with “*” vary with age. Refer to p. 6.0.2, 6.0.3 and
6.0.7.
(4) PJ interval is the time between the starting point of P wave to the end
point of QRS wave (STJ point).

• AV block

2231 First degree AV block abnormal ECG
2232 2nd degree AV block, Mobitz type I abnormal ECG
2233 2nd degree AV block, Mobitz type II abnormal ECG
2234 Possible 3rd degree AV block abnormal ECG
Analysis criteria
Findings Criteria
6
First degree AV block (1) No pacemaker is used.
(2) P waveform and PR interval are both constant.
(3) −60° <= P axis <= 240°
(4) PR interval >= 0.21 s* 6-2
2nd degree AV block, Mobitz type I (1) 2nd degree AV block (Mobitz type II) is not present.
(2) Both the preceding and current heartbeats are in
dominant waveform.
(3) QRS dropout (which is characteristic of Mobitz type I)
exists which is calculated from RR interval.
2nd degree AV block, Mobitz type II QRS dropout (which is characteristic of Mobitz type II)
exists which is calculated from RR interval.
Possible 3rd degree AV block (1) P wave is not present.
(2) Heart rate < 50
(3) Differences between RR intervals are less than 2% of
the mean RR interval.
NOTE
The values marked with “*” vary with age. Refer to p. 6.0.2.

2. Intra-ventricular conductive defect

• Right bundle branch block

RSR (QR) in lead V1/V2 consistent with right
2420 borderline ECG
ventricular conduction delay
2440 Incomplete right bundle branch block borderline ECG
2450 Right bundle branch block abnormal ECG
24501 Right bundle branch block, plus possible RVH abnormal ECG
Analysis criteria
Findings Criteria
In V1 or V2
• R amplitude > 0.1 mV
RSR (QR) in lead V1/V2
• R duration > 0.02 s*
consistent with right
• S wave is not present.
ventricular conduction delay
• R’ amplitude > 0.1 mV
• R’ duration > 0.02 s*
(1) 0.09 s < QRS duration < 0.12 s*
Incomplete right bundle
(2) In two leads among I, a VL, V4, V5 and V6, S duration >= 0.04 s*
branch block
(3) Right ventricular conduction delay is present.
(2) QRS area > 0 in V1
(3) S duration > 0.04 s* in 2 or more leads among I, aVL, V4, V5, V6
(4) R duration < 0.10 s* in 4 or more leads among I, aVL, V4, V5, V6
(5) Does not end with S or S’ wave in V1
Right bundle branch block
Or
(2) S duration > 0.06 s* in 3 or more leads among I, aVL, V4, V5, V6
(3) R or R’ duration > 0.06 s* in V1
(4) QRS area > 0 in V1

Findings Criteria
(1) RBBB is present.
(2) • Age >= 1 year old
Right bundle branch block, • R or R’ amplitude > 1.5 mV in V1
plus possible RVH R or R’ amplitude > 2.0 mV in V1
(3) 110° < QRS axis <= 270° (> 14 years old)
120° < QRS axis <= 270° (<= 14 years old)
NOTE
6
• The values marked with “*” vary with age. Refer to p. 6.0.3 and 6.0.4.
• When RBBB is recognized, no right axis deviation is judged.
• With right bundle branch conduction defects, the terminating vector
is directed towards the anterior and right and it is extended. In the 6-2
ECAPS 12C criteria, not only QRS duration but also the presence of R
at V1, and of wide S in at least two lateral leads are required.
• Previously, QRS duration over 0.12 second was a criterion for bundle
branch blocks.
However, since QRS duration over 0.105 second with wide S in the
lateral leads and wide R in V1 appearing is also judged as RBBB, this
case has been included in the ECAPS 12C program.

• Left bundle branch block

2540 Incomplete left bundle branch block abnormal ECG
2550 Left bundle branch block abnormal ECG
Analysis criteria
Findings Criteria
(1) QRS duration > 0.105 s*
(2) Net QRS amplitude < 0 in V1, V2
Incomplete left bundle branch
(3) Q/S duration >= 0.080 s* in V1, V2
block
(4) Q wave is not present in at least 2 leads among I, V5, V6
(5) R duration >= 0.060 s* in at least 2 leads among I, aVL, V5, V6
(1) Incomplete LBBB is present.
(2) R + R’ duration >= 0.1 s* in any leads among I, aVL, V6
(3) QRS area ratio > 0.25 in I or V6
Left bundle branch block • QRS duration >= 0.14 s*
• total of each R + R’ duration >= 0.25 s* in I, aVL, V6
QRS duration >= 0.12 s*
• total of each R + R’ duration >= 0.25 s* in I, aVL, V6
• QRS area ratio > 0.4 in at least 2 leads among I, aVL, V6
NOTE
• The values marked with “*” vary with age. Refer to p. 6.0.3 and 6.0.4.
• When “incomplete LBBB” is judged, “Moderate level left axis deviation”
is not printed out.
• When “LBBB” is judged, “Moderate level left axis deviation”, “Left
anterior fascicular block”, and “Left posterior fascicular block” are not
printed out.
• QRS area in the analysis criteria for LBBB means the area from the
start to the end of QRS. Refer to p. 3.8 (b). This area increases through
R type, expansion, notch, etc. Therefore, the boundary values are
determined on the basis of typical LBBB cases. This value is used
instead of R wave to classify between the true LBBB and R pattern
where R wave is expanded by nonspecific slur at the end of the wave.
• There is no specific definition for incomplete LBBB in ECG analysis. In
the ECAPS 12C program, incomplete LBBB is defined very narrowly,
and whenever other findings are applicable, such as left posterior
fascicular block, then one of those findings is taken.

• Fascicular block

2630 Left anterior fascicular block abnormal ECG
2730 Left posterior fascicular block abnormal ECG
Analysis criteria
Findings Criteria
(1) −90° < QRS axis <= −45°
(2) R amplitude > Q amplitude in I and aVL
Left anterior fascicular block 6
(3) Q wave is present in I
(4) S or S’ amplitude > maximum R amplitude in II
(1) Age >= 1 year old
(2) S pattern is not present. 6-2
(3) Right atrial enlargement is not present.
(4) Lung disease is not recognized.
Left posterior fascicular block
(5) 110° <= QRS axis <= 270° (> 14 years old)
120° <= QRS axis <= 270° (<= 14 years old)
(6) R amplitude > Q amplitude (III and aVF)
(7) Q wave is present (III and aVF).
NOTE
• When “Left anterior fascicular block” is judged, “Moderate left axis
deviation” and “Left axis deviation” are not printed out.
• When “Left posterior fascicular block” is judged, “Moderate right axis
deviation” and “Right axis deviation” are not printed out.

• Nonspecific

2320 Nonspecific intraventricular conduction delay borderline ECG
2330 Nonspecific intraventricular conduction block abnormal ECG
Analysis criteria
Findings Criteria
Nonspecific intraventricular (1) Block-related findings are not present.
conduction delay (2) QRS duration > 0.11 s*
Nonspecific intraventricular (1) Criteria for RBBB and LBBB are not satisfied.
conduction block (2) QRS duration > 0.13 s*
NOTE
• The values marked with “*” vary with age. Refer to p. 6.0.3.
• Intraventricular conduction delay is judged when the criteria on p. 6.2.5
to 6.2.8 are not satisfied, and QRS duration is not large enough to be
judged as blocks.

Section 6-3 Myocardial Infarction
Analysis Criteria...................................................................................................................................... 6.3.2

Anterior Myocardial Infarction.................................................................................................................. 6.3.5
Septal Myocardial Infarction.................................................................................................................... 6.3.8
Lateral Myocardial Infarction................................................................................................................. 6.3.10 6
Inferior Myocardial Infarction................................................................................................................. 6.3.12
Children................................................................................................................................................. 6.3.14
Inferior Q Wave...................................................................................................................................... 6.3.15
Poor R Wave Progression..................................................................................................................... 6.3.16
6-3

Analysis Criteria
Myocardial infarction arises from the stricture and obstruction of coronary
arteries and death of heart muscles. It is mainly caused by coronary
arteriosclerosis. It is said that myocardial infarction shows a characteristic ECG
waveform.
1. Features and analysis method of ECG of myocardial infarction

The Q wave duration is commonly taken as the main factor for judging the
presence of myocardial infarction and likewise, ECAPS 12C also checks the
Q wave duration. In addition to Q wave duration, repolarization abnormality
that is sometimes reported to accompany “acute” or “recent” cases of
myocardial infarction is also considered to be useful in detecting myocardial
infarction. For example, elevated ST junctions and negative T waves are
very clear signs of myocardial infarction, even when significant Q waves are
absent.
When abnormal repolarization is taken into consideration, both the

sensitivity and discrimination level of analysis are improved for acute and
recent cases. For old cases, observing the QRS amplitude and duration
improves the analysis precision.
With this program, these factors are integrated into “equivalent Q duration”
for analysis processing.
The use of this new factor does not differ greatly from conventional analysis.
It measures and processes age, sex, Q duration, Q amplitude QRS duration
and QRS amplitude as a whole to improve the precision level of analysis.
This “equivalent Q duration” is used in the analysis criteria unless stated
otherwise.

6-3. MYOCARDIAL INFARCTION
The ECAPS 12C analysis program classifies ECGs for myocardial infarction
diagnostic purposes as follows:
Item Division Criteria Description

Acute (?)
ST elevation
Recent (?)
Varies with the extent of ST
Age classification Old (?) No ST elevation
elevation
Age cannot be
Age undetermined
determined.
Equivalent Q duration: Classified by eq. Q duration
Determined
40 ms ~ (Eq. Q duration is one
Level classification 6
Possible 35 ~ 39 ms corrected for Q amp., R amp.
Cannot rule out 30 ~ 34 ms and QRS duration.)
(1) Age classification

It is said that after the occurrence of myocardial infarction, the T wave
6-3
increases height and ST elevates within several hours, and then, with some
delay, abnormal Q waves appear. It is also said that the coronary T wave
starts to appear while the ST elevation is improving (2 days to 1 week) and
remains for a long period of time. Although the time division, “acute (?)”,
“recent (?)”, “age undetermined” and “old (?)”, is classified according to the
ST elevation level, this is a classification of ECG diagnosis, not a clinical
diagnosis.
In atypical instances, ST elevation may be observed for more than a few
months.
(2) Level classification

Abnormal Q wave is the most important factor in identifying myocardial
infarction. The divisions “determined”, “possible” and “cannot rule out”
given here according to the durations of abnormal Q waves are the terms
expressing the level of definiteness of the ECG features or the level
of computer analysis, and they are not directly related to the level of
seriousness in clinical diagnosis.

2. Diagnosis of infarct portion by abnormal Q wave

The locations of infarction are classified according to the leads showing
abnormal Q waves:
I II III aVR aVL aVF V1 V2 V3 V4 V5 V6
Anterior V V V V
Septal ∆1 V
Lateral V V V V
Inferior V V
Posterior inferior V V ∆2 ∆2
Anterolateral V V V V V V
Anteroseptal ∆1 V V V V
1: Q wave is present 2: By R duration
The program analyzes the infarct portions in the following sequence:
3. Other features
(1) Abnormal Q waves may appear in cases of “LBBB”, “WPW syndrome”,
“pulmonary embolism”, “LVH”, and “RVH”.
(2) Sometimes the characteristic ECG of infarction does not appear at all
depending on the time after the nosogenesis, the size and portion of the
infarction. Clinical reviews including chemical blood tests (GOT, GPT,
LDH, CPK) are recommended.
(3) An intermixed EMG or AC noise is sometimes mistaken for small R
waves. This program is designed to use the typical heartbeat waves that
contain Q waves with priority among all typical heartbeat waves, but
record favorable waveforms by eliminating artifact as much as possible.

Anterior Myocardial Infarction

When the following criteria are satisfied, anterior myocardial infarction is not
analyzed.
• LBBB
• QRS duration > 140 ms, negative net QRS amplitude at V1
Analysis criteria
Age classification Criteria Other

STM > 0.2 mV in V3 and V4 6
Acute (?) and STE > 0.2 mV in V3 and V4
and Modified T amplitude >= 0* in V3 and V4
STM > 0.05 mV in V3 or V4
Recent (?) and STE > 0.05 mV in same leads as above
and Modified T amplitude < 0* in V3 or V4
6-3
STM < 0.03 mV in V3 and V4 Acute (?) Recent (?) are not
Old (?)
and Modified T amplitude >= 0* in V3 and V4 satisfied.
Age undetermined Acute (?), recent (?) and Old (?) are not satisfied.
* Refer to p. 3.9 (d) for measurement method.

Level
Criteria Other
classification
Q duration >= 30 ms in V2 and V3, or V3
and V4, or V4 and V5
Cannot rule out
or
R amplitude < 0.2 mV in V4
Q duration >= 30 ms in V2 or V4
and Q duration >= 35 ms in V3
Possible or LVH is not present.
Q duration >= 30 ms in V2 or V4 LVH is not present.
and Q duration >= 40 ms in V3 Chest lead low voltage is not
present.
Nonspecific intraventricular
conduction block is not
(Determined)
or present.
or Acute (?) or Recent (?) is
“Cannot rule out” is satisfied satisfied.
Code and findings

3113 Cannot rule out anterior myocardial infarction, probably old abnormal ECG
3114 Cannot rule out anterior myocardial infarction, age undetermined abnormal ECG
3121 Possible anterior myocardial infarction, possibly acute abnormal ECG
3122 Possible anterior myocardial infarction, probably recent abnormal ECG
3123 Possible anterior myocardial infarction, probably old abnormal ECG
3124 Possible anterior myocardial infarction, age undetermined abnormal ECG
3131 Anterior myocardial infarction, possibly acute abnormal ECG
3132 Anterior myocardial infarction, probably recent abnormal ECG
3133 Anterior myocardial infarction, probably old abnormal ECG
3134 Anterior myocardial infarction, age undetermined abnormal ECG
3213 Cannot rule out anteroseptal myocardial infarction, probably old abnormal ECG
3214 Cannot rule out anteroseptal myocardial infarction, age undetermined abnormal ECG
3221 Possible anteroseptal myocardial infarction, possibly acute abnormal ECG
3222 Possible anteroseptal myocardial infarction, probably recent abnormal ECG
3223 Possible anteroseptal myocardial infarction, probably old abnormal ECG
3224 Possible anteroseptal myocardial infarction, age undetermined abnormal ECG
3231 Anteroseptal myocardial infarction, possibly acute abnormal ECG
3232 Anteroseptal myocardial infarction, probably recent abnormal ECG
3233 Anteroseptal myocardial infarction, probably old abnormal ECG
3234 Anteroseptal myocardial infarction, age undetermined abnormal ECG
3313 Cannot rule out anterolateral myocardial infarction, probably old abnormal ECG
Cannot rule out anterolateral myocardial infarction, age
3314 abnormal ECG
undetermined
3321 Possible anterolateral myocardial infarction, possibly acute abnormal ECG
3322 Possible anterolateral myocardial infarction, probably recent abnormal ECG
3323 Possible anterolateral myocardial infarction, probably old abnormal ECG


3324 Possible anterolateral myocardial infarction, age undetermined abnormal ECG
3331 Anterolateral myocardial infarction, possibly acute abnormal ECG
3332 Anterolateral myocardial infarction, probably recent abnormal ECG
3333 Anterolateral myocardial infarction, probably old abnormal ECG
3334 Anterolateral myocardial infarction, age undetermined abnormal ECG
6-3

Septal Myocardial Infarction

When the following criteria are satisfied, septal myocardial infarction is not
analyzed.
• LBBB
• QRS duration > 140 ms and net QRS amplitude is negative in V1.
• Cannot rule out anterior infarction and Q wave is not present in V1.
Analysis criteria

STM and STE > 0.2 mV in V2
Acute (?)
and Modified T amplitude >= 0* in V2
STM and STE > 0.05 mV in V2
Recent (?)
and Modified T amplitude < 0* in V2
STM < 0.05 mV in V2 Acute (?) and Recent (?) is
Old (?)
and Modified T amplitude >= 0* in V2 satisfied.
Acute (?), Recent (?) and Old (?) are not
Age undetermined
satisfied.
Level
Criteria Other
classification
Q duration >= 30 ms in V2
Cannot rule out
or Q duration > 20 ms in V2 RBBB is present.
Possible Q duration >= 35 ms in V2 LVH is not present.
(Determined) Q duration >= 40 ms in V2 LVH is not present.

Code and findings

3411 Cannot rule out septal myocardial infarction, possibly acute abnormal ECG
3412 Cannot rule out septal myocardial infarction, probably recent abnormal ECG
3413 Cannot rule out septal myocardial infarction, probably old abnormal ECG
3414 Cannot rule out septal myocardial infarction, age undetermined abnormal ECG
3421 Possible septal myocardial infarction, possibly acute abnormal ECG
3422 Possible septal myocardial infarction, probably recent abnormal ECG
3423 Possible septal myocardial infarction, probably old abnormal ECG
3424 Possible septal myocardial infarction, age undetermined abnormal ECG
3431 Septal myocardial infarction, possibly acute abnormal ECG 6
3432 Septal myocardial infarction, probably recent abnormal ECG
3433 Septal myocardial infarction, probably old abnormal ECG
3434 Septal myocardial infarction, age undetermined abnormal ECG
6-3

Lateral Myocardial Infarction

Analysis criteria

STM and STE > 0.2 mV in V5 and V6
Acute (?) and STM and STE > 0.1 mV in I and aVL
and Modified T amplitude >= 0* in I, aVL, V5 and V6
STM and STE > 0.05 mV in one lead among I,
aVL, V5 and V6
Recent (?)
and Modified T amplitude < 0* in one lead among I,
aVL, V5 and V6
STM < 0.03 mV in I, aV1, V5 and V6 Acute (?) and Recent
Old (?)
and Modified T amplitude >= 0* in I, aVL, V5 and V6 (?) are not satisfied.
Age undetermined Acute (?), Recent (?) and Old (?) are not satisfied.
Level
Criteria Other
classification
Cannot rule out Q duration >= 30 ms in 2 leads among I, aVL, V5 and V6
Q duration >= 35 ms in one lead among I, V5 and V6 Cannot rule out is
Possible
satisfied.
Q duration >= 40 ms in one lead among I, V5 and V6 Cannot rule out is
or Cannot rule out satisfied.
(Determined)
Acute (?) and Recent
(?) are satisfied.

Code and findings

3513 Cannot rule out lateral myocardial infarction, probably old abnormal ECG
3514 Cannot rule out lateral myocardial infarction, age undetermined abnormal ECG
3521 Possible lateral myocardial infarction, possibly acute abnormal ECG
3522 Possible lateral myocardial infarction, probably recent abnormal ECG
3523 Possible lateral myocardial infarction, probably old abnormal ECG
3524 Possible lateral myocardial infarction, age undetermined abnormal ECG
3531 Lateral myocardial infarction, possibly acute abnormal ECG
3532 Lateral myocardial infarction, probably recent abnormal ECG
3533 Lateral myocardial infarction, probably old abnormal ECG 6
3534 Lateral myocardial infarction, age undetermined abnormal ECG
6-3

Inferior Myocardial Infarction

Analysis criteria

STM and STE > 0.1 mV in II and aVF
Acute (?)
and Modified T amplitude >= 0* in II and aVF
STM and STE > 0.05 mV in II or aVF
Recent (?)
and Modified T amplitude < 0* in II or aVF
STM < 0.03 mV in II and aVF Acute (?) and Recent
Old (?)
and Modified T amplitude >= 0* in II and aVF (?) are not satisfied.
Age undetermined Acute (?), Recent (?) and Old (?) are not satisfied.
Level classification Criteria Other

Q duration >= 30 ms in II or aVF
and Q amplitude (I) < Q amplitude (II)
Cannot rule out or
Q duration >= 30 ms in II or aVF
and Q amplitude (I) < Q amplitude (aVF)
Cannot rule out is
Possible Q duration >= 35 ms in II or aVF
satisfied.
Cannot rule out is satisfied
and Q duration >= 40 ms in II or aVF
or
(Determined)
and Recent (?) is satisfied
or
and Acute (?) is satisfied.
Findings Criteria
Any of the inferior myocardial infarction is satisfied.
and complete RBBB is not present.
and Q amplitude = 0 mV (in V1 and V2)
Posterior Extension
and R duration >= 40 ms (in V1 and V2)
or R duration >= 35 ms and Net QRS amplitude > 0 mV (in V1 or V2)
or R duration >= 30 ms and Net QRS > 0 (in V1 and V2)
* Refer to p. 3.9 (c) and (d) for measurement method.

Code and findings

3613 Cannot rule out inferior myocardial infarction, probably old abnormal ECG
Cannot rule out inferior myocardial infarction with posterior
36132 abnormal ECG
extension, probably old
3614 Cannot rule out inferior myocardial infarction, age undetermined abnormal ECG
Cannot rule out inferior myocardial infarction with posterior
36142 abnormal ECG
extension, age undetermined
3621 Possible inferior myocardial infarction, possibly acute abnormal ECG
Possible inferior myocardial infarction with posterior extension,
36212 abnormal ECG 6
possibly acute
3622 Possible inferior myocardial infarction, probably recent abnormal ECG
36222 abnormal ECG
probably recent
3623 Possible inferior myocardial infarction, probably old abnormal ECG
36232 abnormal ECG 6-3
probably old
3624 Possible inferior myocardial infarction, age undetermined abnormal ECG
Possible inferior myocardial infarction with posterior extension, age
36242 abnormal ECG
undetermined
3631 Inferior myocardial infarction, possibly acute abnormal ECG
Inferior myocardial infarction with posterior extension, possibly
36312 abnormal ECG
acute
3632 Inferior myocardial infarction, probably recent abnormal ECG
Inferior myocardial infarction with posterior extension, probably
36322 abnormal ECG
recent
3633 Inferior myocardial infarction, probably old abnormal ECG
36332 Inferior myocardial infarction with posterior extension, probably old abnormal ECG
3634 Inferior myocardial infarction, age undetermined abnormal ECG
Inferior myocardial infarction with posterior extension, age
36342 abnormal ECG
undetermined

Children
With children under 18 years old, the following analysis are executed. The
criteria are the same as the myocardial infarction. When the last number of
the code (right) is 1, see the criteria for the code with the same first 4 numbers.
When the last number is 3, see the criteria for the code with the same first 4
numbers but with the last (fifth) number 2.
For example, for the criteria of 31211 see the code 3121. For 36213, see the
code 36212.
Code and findings

31211 Abnormal Q wave in lead V3/V4, cannot rule out cardiomyopathy abnormal ECG
32211 Abnormal Q wave in lead V2 + V3/V4, cannot rule out cardiomyopathy abnormal ECG
Abnormal Q wave in lead I/a VL/V3-V6, cannot rule out
33211 abnormal ECG
cardiomyopathy
33221 abnormal ECG
cardiomyopathy
33311 abnormal ECG
cardiomyopathy
33321 abnormal ECG
cardiomyopathy
34111 Abnormal Q wave in lead V2, cannot rule out cardiomyopathy abnormal ECG
Abnormal Q wave in lead I/a VL/V5/V6, cannot rule out
35211 abnormal ECG
cardiomyopathy
35221 abnormal ECG
cardiomyopathy
35311 abnormal ECG
cardiomyopathy
35321 abnormal ECG
cardiomyopathy
36211 Abnormal Q wave in lead II/aVF, cannot rule out cardiomyopathy abnormal ECG

Inferior Q Wave
To judge the following findings, set the Analysis mode to “Advanced” or
“Advanced (Screening)” on the electrocardiograph.
Analysis criteria
Findings Criteria
This finding is not made in the following cases.
• Findings related to “inferior myocardial infarction” are present.
• Atrial flutter is present.
• Atrial fibrillation or flutter is present.
• A patient is 18 years old and under. 6
This finding is made, if any of the following criteria is met.
In lead II, equivalent Q duration ≥ 20 ms and Q amplitude ≥ 100
μV and modified T amplitude ≤ 50 μV
In lead aVF, equivalent Q duration ≥ 20 ms and Q amplitude ≥
100 μV and modified T amplitude ≤ 0 μV
Inferior Q wave
In lead aVF, equivalent Q duration ≥ 25 ms and Q amplitude/
6-3
maximum R amplitude ≥ 1/3 and STJ of aVL lead ≤ –30 μV
In lead II, R duration ≤ 20 ms and R amplitude ≤ 50 μV and S
duration ≥ 20 ms and S amplitude ≥ 150 μV, absence of Q wave
In lead aVF, R duration ≤ 20 ms and R amplitude ≤ 50 μV and S
duration ≥ 35 ms and S amplitude ≥ 300 μV, absence of Q wave
In lead III, equivalent Q duration ≥ 30 ms, and equivalent Q
duration of lead II + equivalent Q duration of aVF ≥ 30 ms and
modified T amplitude of lead II + modified T amplitude of aVF
lead ≤ 0 μV.
Code and findings

3604 Inferior Q wave abnormal ECG

Poor R Wave Progression

Analysis criteria
This finding is not made in the following cases.

• Myocardial infarction other than “inferior myocardial infarction”
is present.
• R wave amplitude in leads V1, V2 and V3 is 300 μV or higher.
• R’ amplitude in leads V1, V2 or V3 exceeds 300 μV.
• The total of the maximum R and S amplitude is 600 μV or lower in
3 ore more leads in V1 through V6.
Poor R wave progression
• R wave is decreasing right before the transitional zone.
• Transitional zone is present.
This finding is made, if either of the following criteria is met.
(1) Transitional zone is not present, or RS ratio is drastically
changed in the adjacent leads.
Low R wave amplitude in leads V1 through V3
R wave reduction in leads V1 through V3
Code and findings

3104 Poor R wave progression borderline ECG

Section 6-4 ST-T Abnormality
ST Depression......................................................................................................................................... 6.4.2
Injury....................................................................................................................................................... 6.4.4
Subendocardial Ischemia........................................................................................................................ 6.4.8
Early Repolarization.............................................................................................................................. 6.4.11 6
Pericarditis............................................................................................................................................. 6.4.12
T Wave Abnormality.............................................................................................................................. 6.4.13
Nonspecific ST Elevation....................................................................................................................... 6.4.15
Right Precordial ST-Segment Elevation................................................................................................ 6.4.16
ST Elevation, Cannot Rule Out Inferior Injury....................................................................................... 6.4.17
6-4

ST Depression When any of these

findings is recognized,
Analysis criteria the process of “(2) ST
(1) • Nonspecific intraventricular conduction block depression classification”
• RBBB* is omitted.
• LBBB However, when the
• ST elevation* findings marked with
“*” are recognized, ST
• Possible acute pericarditis
depression classification
• RVH (with repolarization abnormality)* is performed, but
• LVH (with repolarization abnormality) for RBBB and RVH
(repolarization
abnormality), leads V1
and V2 are not analyzed.
(2) ST depression classification
Processing the data of all the leads except for a VR and III, the system
adopts the finding uniformly judged by the data of two or more leads.
When the age is less than 16, V1 and V2 leads are not considered for “ST
depression, possible digitalis effect” and “Minimal ST depression”.
Classification STJ STM STE

Junctional ST depression, probably
< −0.1 mV >= 0 mV
normal
< 0 mV and
Abnormal junctional ST depression < −0.1 mV
>= STJ/2
< STJ and
< −0.05 mV
ST depression, possible digitalis effect
< STJ and
< −0.05 mV
Minimal ST depression < −0.025 mV < −0.025 mV < −0.025 mV
< −0.05 mV < 0 mV
< STJ and < STM
Moderate ST depression
and
< −0.05 mV
*Marked ST depression, possible
< −0.1 mV < −0.1 mV < −0.1 mV
subendocardial injury
Marked ST depression consistent with
< −0.2 mV < −0.2 mV < −0.2 mV
NOTE
• When the finding marked with “*”, i.e. “marked ST depression, possible
subendocardial injury” is judged, and at the same time “atrial fibrillation”
is found, “possible digitalis effect” is added to the findings.
• When any of the ST depression findings is recognized, “nonspecific ST
elevation” is not analyzed.

6-4. ST-T ABNORMALITY
Code and findings

40106 ST depression, possible digitalis effect abnormal ECG
4011 Minimal ST depression borderline ECG
40116 Minimal ST depression, probably digitalis effect borderline ECG
4012 Moderate ST depression abnormal ECG
40126 Moderate ST depression, probably digitalis effect abnormal ECG
4016 Marked ST depression, possible subendocardial injury abnormal ECG
40166 Marked ST depression, possible subendocardial injury or digitalis effect abnormal ECG
4017 Marked ST depression, consistent with subendocardial injury abnormal ECG
4021 Junctional ST depression, probably normal borderline ECG 6
4023 Abnormal junctional ST depression borderline ECG
6-4

Injury
Analysis criteria
(1) • Left bundle branch block When any of these
• Right bundle branch block findings is recognized,
• Nonspecific ventricular conductive defect subendocardial injury is not
• Possible acute percarditis analyzed.
(2) Injury Classification
Portion Finding Judgement Criteria Lead

All of the following conditions are satisfied:
(1) STJ ≥ J threshold value. Refer to the table 1.
(2) STE – STJ ≤ JE threshold value. Refer to the table 2.
(3) Inclination from STJ to STM is –1.0 μV/ms to 3.5 μV/ms.
(4) The difference between the inclination from STJ to STM
and the inclination from STE to Tpeak is –0.8 μV/ms to
2.5 μV/ms.
2 leads consecutive
(5) T wave is not upward oriented.
Possible injury in V2, V3, V4, and
(6) The findings of possible left ventricular hypertrophy or
V5
Anterior left ventricular hypertrophy are not present.
(7) The findings of anterior myocardial infarction are not
present.
(1) STJ ≥ 450 μV and inclination from STJ to STM is
positive.
(2) R amplitude × 1.8 < S amplitude, or S amplitude = 0
All of the following conditions are satisfied: 2 leads or more
Injury (1) The criteria of possible anterior injury is met. among V2, V3, V4,
(2) STJ > Total QRS amplitude/4 V5
(1) The criteria of possible anterior injury is met.
Possible injury
(2) The criteria of possible septal injury is met.
(3) The criteria of possible anterolateral injury is not met.
Anteroseptal –
(1) The criteria of possible anteroseptal injury is met.
(2) The criteria of septal injury is met.
Injury
(2) The criteria of anterior injury is met.
Possible injury (1) The criteria of possible anterior injury is met.
(2) The criteria of possible lateral injury is met.
Anterolateral (1) The criteria of possible anteroseptal injury is met. –
(2) The criteria of anterior injury is met.
Injury
(2) The criteria of lateral injury is met.

Portion Finding Judgement Criteria Lead

2.5 μV/ms.
Possible injury
(6) The findings of possible left ventricular hypertrophy or
Septal left ventricular hypertrophy are not present. V1 and V2
(7) The findings of septal myocardial infarction are not 6
present.
(1) STJ ≥ 450 μV and inclination from STJ to STM is
positive.
(2) R amplitude × 1.8 < S amplitude, or S amplitude = 0
Injury (1) The criteria of possible septal injury is met.
(2) STJ > Total QRS amplitude/4
All of the following conditions are satisfied: 6-4
2.5 μV/ms.
V5 and V6
(6) The findings of lateral myocardial infarction are not
present.
Possible injury (1) STJ ≥ 450 μV and inclination from STJ to STM is
positive.
Lateral (2) R amplitude × 1.8 < S amplitude, or S amplitude = 0
(1) STJ > STLMT/2
present. I and aVL
present.
All of the following conditions are satisfied: 2 leads or more
Injury (1) The criteria of possible lateral injury is met. among I, aVL, V5,
(2) STJ > Total QRS amplitude/4 V6
(1) STJ > STLMT/2
(3) The findings of inferior myocardial infarction are not
Possible injury present.
Inferior II and aVF
(2) The findings of inferior myocardial infarction are not
present.
Injury (1) The criteria of possible inferior injury is met.

The threshold values of STJ and the threshold of potential difference between
STJ and STM are as follows.
Table 1: J threshold values
Age Lead Threshold value (μV)

18 years or less No Judgement
19 to 29 years V1 195
V2 208
V3, V4, V5 and V6 221
30 to 39 years V1 180
V2 192
V3, V4, V5 and V6 204
40 years or more V1 150
V2 160
V3, V4, V5 and V6 170
Table 2: JE threshold values
Lead Threshold value (μV)

V1 200
V2 300
V3, V4, V5 and V6 320
STLMT is used for comparison of STJ. The values are below

limb leads: STLMT = 0.3 mV
NOTE
(1) When injury or possible injury is found, the following findings are not
printed out:
• ST elevation, probably early repolarization
• Early repolarization
• ST elevation consistent with epicardial injury, pericarditis, or early
repolarization
• Nonspecific ST elevation
(2) Relationship between injury portion and leads
The portion of the injury is judged by the relationship between the
standard 12 leads and heart portions as shown in the table below.
(3) For the method of measuring upward oriented T, refer to p. 3.9 (c) of
the ECAPS12C user’s guide.
(4) For the method of measuring total QRS amplitude and net QRS
amplitude, refer to p. 3.7 of the ECAPS12C user’s guide.

Portion I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Anterior * * * *
Anteroseptal * * * * *
Anterolateral * * * * * * *
Septal * *
Lateral * * * *
Inferior * *
6
Code and findings

4136 Possible anterior injury or acute infarct abnormal ECG
4137 Anterior injury or acute infarct abnormal ECG
4236 Possible anteroseptal injury or acute infarct abnormal ECG
4237 Anteroseptal injury or acute infarct abnormal ECG
6-4
4336 Possible anterolateral injury or acute infarct abnormal ECG
4337 Anterolateral injury or acute infarct abnormal ECG
4436 Possible septal injury or acute infarct abnormal ECG
4437 Septal injury or acute infarct abnormal ECG
4536 Possible lateral injury or acute infarct abnormal ECG
4537 Lateral injury or acute infarct abnormal ECG
4636 Possible inferior injury or acute infarct abnormal ECG
4637 Inferior injury or acute infarct abnormal ECG

Subendocardial Ischemia
Analysis criteria
(1) The new version has some changes in the criteria to withhold judgement of T
wave abnormality (possible subendocardial ischemia).
The criteria changes are underlined.
When any of the following findings is present, T wave abnormality (possible

subendocardial ischemia) is not judged.
• Nonspecific intraventricular conduction block
• LBBB
• Myocardia infarction in relevant portion
• Subendocardial injury in relevant portion
• Possible subendocardial injury in relevant portion
• Possible acute pericarditis
• Marked ST depression consistent with subendocardial injury
• RVH (repolarization abnormality)
• LVH (repolarization abnormality)
(2) T wave abnormality and ST-T wave abnormality classification
Portion Finding Criteria Lead Judgement criteria

Cannot rule out anterior
V3 and V4 myocardial infarction is
T wave not satisfied.
abnormality Cannot rule out anterior
modified T amplitude
(Possible myocardial infarction is
< −0.1 mV two or more leads
subendocardial not satisfied.
among V2, V3 and
ischemia) Complete RBBB is not
V4
satisfied.
Age >= 16 years old
Anterior
Possible anterior
V3 or V4 subendocardial ischemia is
satisfied
T wave
Possible anterior
abnormality modified T amplitude
subendocardial ischemia is
(subendocardial < −0.5 mV
and of V2, V3 and satisfied
ischemia)
V4 Complete RBBB is not
satisfied.
Age >= 16 years old
two or more leads Cannot rule out lateral
among I, V4, V5 myocardial infarction is
< −0.1 mV
T wave and V6 not satisfied.
abnormality maximum R amplitude aVL
Lateral (Possible > 0.5 mV
Cannot rule out lateral
subendocardial
myocardial infarction is
ischemia) modified T amplitude at least two in I,
not satisfied.
< −0.1 mV aVL, V4, V5 and
V6

Portion Finding Criteria Lead Judgement criteria

Possible lateral
modified T amplitude any of I, V5 and
subendocardial ischemia is
< −0.5 mV V6
T wave satisfied
abnormality maximum R amplitude aVL
Lateral
(subendocardial > 0.5 mV Possible lateral
ischemia) subendocardial ischemia is
modified T amplitude any of I, aVL, V5 satisfied
< −0.5 mV and V6
modified T amplitude II and aVF
6
< 0 mV Cannot rule out inferior
modified T amplitude II not satisfied.
T wave < −0.1 mV
abnormality modified T amplitude II and aVF
(Possible < 0 mV
subendocardial
Cannot rule out inferior
ischemia) modified T amplitude aVF 6-4
< −0.1 mV
not satisfied.
Inferior
Net QRS amplitude aVF
> 0 mV
Possible inferior
II or aVF subendocardial ischemia is
< −0.5 mV
T wave satisfied
abnormality Net QRS amplitude aVF
(subendocardial > 0 mV Possible inferior
ischemia) subendocardial ischemia is
modified T amplitude aVF satisfied
< −0.5 mV
NOTE
• When atrial fibrillation is judged together with subendocardial ischemia,
“possible digitalis effect” is added to the findings.
• When both anterior ischemia and lateral ischemia are judged,
anterolateral ischemia is printed out.

Code and findings

4164 T wave abnormality, possible anterior ischemia abnormal ECG
41646 T wave abnormality, possible anterior ischemia or digitalis effect abnormal ECG
4165 T wave abnormality, consistent with anterior ischemia abnormal ECG
4364 T wave abnormality, possible anterolateral ischemia abnormal ECG
43646 T wave abnormality, possible anterolateral ischemia or digitalis effect abnormal ECG
4365 T wave abnormality, consistent with anterolateral ischemia abnormal ECG
4564 T wave abnormality, possible lateral ischemia abnormal ECG
45646 T wave abnormality, possible lateral ischemia or digitalis effect abnormal ECG
4565 T wave abnormality, consistent with lateral ischemia abnormal ECG
4664 T wave abnormality, possible inferior ischemia abnormal ECG
46646 T wave abnormality, possible inferior ischemia or digitalis effect abnormal ECG
4665 T wave abnormality, consistent with inferior ischemia abnormal ECG

Early Repolarization
Analysis criteria
(1) • QTc interval > 450 ms
• Nonspecific intraventricular conduction block When any of these
• RBBB
the analysis processes
• LBBB
of (2) and (3) are not
• Myocardial infarction executed.
• LVH
(2) When following two conditions are satisfied, the total number of the leads 6
and the total amplitude of STJ are used to classify the ECG data as shown in
(3).
• Chest lead: STJ and STM amplitude > 0.075 mV (age >= 20 years old)
STJ and STM amplitude > 0.150 mV (age < 20 years old)
• Limb lead: STJ and STM amplitude > 0.049 mV (age >= 20 years old)
STJ and STM amplitude > 0.099 mV (age < 20 years old)
6-4
(3) Classification
Findings No. of leads Total STJ amplitude T waveform*

>= 0.45 mV
ST elevation consistent with
(Age >= 20 years old)
subepicardial, pericarditis, or 3 or more not upward
>= 0.90 mV
early repolarization
(Age < 20 years old)
>= 0.45 mV
upward in more than
ST elevation, probably early (Age >= 20 years old)
3 or more half the number of leads
repolarization >= 0.90 mV
satisfied (2)
(Age < 20 years old)
Early repolarization 6 or more >= 0.45 mV
* For the method of measuring upward T waveform, refer to p. 3.9 (c).
Code and findings

40302 ST elevation, probably early repolarization borderline ECG
40303 Early repolarization normal ECG
ST elevation, consistent with subepicardial injury, pericarditis, or early
40371 abnormal ECG
repolarization

Pericarditis
Analysis criteria
(1) • Nonspecific intraventricular conduction block When any of these
• RBBB findings is recognized,
• LBBB the analysis processes
• Myocardial infarction of (2), (3) and (4) are
• LVH not executed.
(2) The number of leads that satisfy the following conditions is counted.
• STJ and STM amplitude > 0.075 mV (in I, II, aVF)
• STJ and STM amplitude > 0.09 mV (in V2 ~ V6)
(3) The number of leads that satisfy the following conditions is counted.
• STJ and STM amplitude > 0.09 mV (in I, II, aVF)
• STJ and STM amplitude > 0.11 mV (in V2 ~ V6)
(4) Classification
Findings STJ amplitude × 4 STJ and STM amplitude No. of leads

> T amplitude > 0 mV 4
Possible acute > -0.1 mV
or more leads among I, 5 or more leads in (2)
pericarditis (40304) All leads other than aVR
II, V4, V5, V6
> T amplitude > 0 mV 4
Possible acute > -0.1 mV
or more leads among I, 5 or more leads in (3)
pericarditis (40305) All leads other than aVR
II, V4 V5, V6
NOTE
When “possible acute pericarditis” is found, the following findings are not
printed out.
• ST elevation, probably early repolarization
• Early repolarization
• ST elevation, consistent with subendocardial injury, pericarditis, or early
repolarization
• Nonspecific ST elevation
Code and findings

40304 Possible acute pericarditis abnormal ECG
40305 Possible acute pericarditis abnormal ECG

T Wave Abnormality
Analysis criteria
(1) • Nonspecific intraventricular conduction block
• RBBB
• LBBB
• Myocardial infarction When any of these
• Possible acute pericarditis findings is recognized,
• ST elevation
of (2) and (3) are not
• Subendocardial injury executed.
• Subendocardial ischemia 6
• RVH (repolarization abnormality)
(2) Classification 1
Modified T Maximum R ST
Findings Tall T wave
amplitude* amplitude abnormality
< T min 2 or more leads
Nonspecific T wave > 0.5 mV 6-4
among I, II, aVL, aVF,
abnormality In same leads as left
V3 to V6
< T min 2 or more leads
Nonspecific ST&T > 0.5 mV
among I, II, aVL, aVF, Present Absent
abnormality In same leads as left
V3 to V6
Here, T min is defined as follows:

1: Net QRS amplitude > 0 mV: T min = 0.025 mV + Net QRS amplitude/20
2: Net QRS amplitude < 0 mV: T min = 0.025 mV
* For the method of measuring modified T amplitude, refer to p. 3.9 (d).

(3) Classification 2
When QTc <= 0.45 s, the following analysis is made.
Findings T amplitude
(1) > 1.0 mV > R amplitude/2
Tall T wave, possible 3 or more leads among I, II, V1 to V6
hyperkalemia (2) > 1.5 mV > R amplitude/2
any lead among I, II, V1 to V6
NOTE
When “nonspecific T wave abnormality” or “nonspecific ST&T wave
abnormality” is recognized with “atrial fibrillation”, “probably digitalis effect”
is added to the findings.
Code and findings

4048 Nonspecific ST&T wave abnormality normal ECG
40486 Nonspecific ST&T wave abnormality, probably digitalis effect borderline ECG
4050 Tall T waves, possible hyperkalemia abnormal ECG
4068 Nonspecific T wave abnormality borderline ECG
40686 Nonspecific T wave abnormality, probably digitalis effect borderline ECG

Nonspecific ST Elevation
Analysis criteria
(1) • Nonspecific intraventricular conduction block
• RBBB When any of these
• LBBB
• Myocardial infarction
for (2), is not executed.
(2) STJ >= 0.049 mV (Age >= 20 years old):

2 or more leads in I, II, III,
aVF, V3, V4, V5 and V6 6
STJ >= 0.099 mV (Age < 20 years old):

STM >= 0.049 mV (Age >= 20 years old):
In same leads as above.
STM >= 0.099 mV (Age < 20 years old):
STE >= 0.049 mV (Age >= 20 years old):

6-4
In same leads as above.
STE >= 0.099 mV (Age < 20 years old):

T wave is not upward*: In same leads as above.
* For measurement method, refer to p. 3.9 (c).
Code and findings

4038 Nonspecific ST elevation normal ECG

Right Precordial ST-Segment Elevation

Analysis criteria
Findings Criteria
Saddleback type ST-segment Lead V1, V2 or V3 satisfies all of the following conditions
elevation (1) STJ (at V4 through V6) ≥ 0.2 mV
(right precordial lead) (2) STJ (at V4 through V6) > ST min
(3) ST min > 0 mV
(4) Satisfies either of the following
1 When T wave is positive and ST min > 0 mV
2 T wave is biphasic and ST min ≥ 0.1 mV
Coved type ST-segment Lead V1, V2 or V3 satisfies all of the following conditions
elevation (1) STJ (at V4 through V6) ≥ 0.2 mV
(right precordial lead) (2) Peak J > Peak J40 > Peak J80
(3) T wave is negative or on the baseline
(4) Peak J – Peak J40 ≤ 0.4 mV
Coved type slight ST-segment Lead V1, V2 or V3 satisfies all of the following conditions
elevation (1) 0.2 mV > STJ (at V4 through V6) ≥ 0.1 mV
(right precordial lead) (2) Peak J > Peak J40 > Peak J80
(3) T wave is negative or on the baseline
(4) 0.04 mV ≤ Peak J – Peak J40 ≤ 0.4 mV
(5) 0.04 mV ≤ Peak J40 ≤ Peak J80
Code and findings
Code Findings Judgement

42381 Saddleback type ST-segment elevation (right precordial lead) abnormal ECG
42481 Coved type ST-segment elevation (right precordial lead) abnormal ECG
42482 Coved type slight ST-segment elevation (right precordial lead) borderline ECG

ST Elevation, Cannot Rule Out Inferior Injury

Analysis criteria
Finding Judgement Criteria

ST elevation, cannot rule out inferior This finding is not made in the following cases.
injury • Left bundle branch block is present.
• Right bundle branch block is present and STJ of aVL lead > –70 μV
• Nonspecific intraventicular conduction block is present.
• Possible acute pericarditis is present.
• Atrial flutter is present.
• Atrial fibrillation or flutter is present.
• Findings related to “inferior myocardial infarction” are present. 6
• Inferior subendocardial injury is present.
• A patient is 18 years old and under.
This finding is made, if any of the following criteria is met.
STJ > 150 μV in 2 or more leads in leads II, III and aVF
STJ > total QRS amplitude/6 and total QRS amplitude ≥ 500 μV and
STJ of aVL ≤ –50 μV in 2 or more leads in leads II, III and aVF
Total STM in leads II, III and aVF ≥ 200 μV, total STJ in leads II,III
and aVF ≥ 200 μV, STM ≥ 0 μV in leads II, III and aVF, and total STM
of leads I and aVL ≤ –50 μV 6-4
Code and findings
Code Findings Judgement

4635 ST elevation, cannot rule out inferior injury abnormal ECG

Section 6-5 Ventricular Hypertrophy
Point Score System........................................................................................................................................... 6.5.2

Analysis Criteria for RVH................................................................................................................................... 6.5.2
5120 Possible right ventricular hypertrophy.............................................................................................. 6.5.4
5130 Right ventricular hypertrophy........................................................................................................... 6.5.4 6
5134 Right ventricular hypertrophy, probably repolarization abnormality . ............................................... 6.5.5
Analysis Criteria for LVH.................................................................................................................................... 6.5.6
5211 Minimal voltage criteria for LVH, may be normal variant.................................................................. 6.5.7
5220 Possible left ventricular hypertrophy................................................................................................. 6.5.7
5222 Moderate voltage criteria for LVH, may be normal variant............................................................... 6.5.7
5233 Voltage criteria for LVH..................................................................................................................... 6.5.7
5234 Left ventricular hypertrophy with repolarization abnormality............................................................ 6.5.7
6-5

Point Score System

For judging cardiac hypertrophy, the major identifying features such as
amplitude, QRS duration and repolarization abnormality are given points that
vary with age and sex, and their total is used as the criteria.
Analysis Criteria for RVH

Analysis criteria When any of
Complete RBBB these findings is
Complete LBBB recognized, the
QRS duration > 140 ms, net QRS duration < 0 mV (V1) analysis of RVH
is not executed.
• Judgement criteria for ages 17 years old and below
No. Judgement Points

In V1 : Q amplitude > 0.04 mV
1 R amplitude > 0.7 mV 3
S amplitude < 0.5 mV
2 In V1 : R amplitude > 1.0 mV* 3
3 In V6 : S amplitude > 0.4 mV* 3
Right ventricular conduction delay is present
and S amplitude (V1) < 0.5 mV,
4 and 2
R’ amplitude > 1.0 mV (V1) (Age >= 1 year old)
or R’ amplitude > 1.5 mV (V1)
5 T amplitude (V1) >= 0, Age <= 9 years old 2
6 (RV1 + SV5) / (SV1 + RV5) > 1.0 (Age >= 3 years old) 3
7 Right axis deviation is present 2
8 Moderate right axis deviation is present 1
Moderate right axis deviation is present or Right axis deviation is
9 1
present, and Incomplete right bundle branch block is present.
NOTE
When the below condition is satisfied, right ventricular hypertrophy is not
analyzed:
maximum S depth > 2 × maximum R height (V1)
The values marked with “*” vary with age. Refer to p. 6.0.5 and 6.0.6.

6-5. VENTRICULAR HYPERTROPHY
• Judgement criteria for 18 years and over
No. Judgement Point

1 R or R’ amplitude > 0.5 mV in V1 1
2 Net QRS amplitude > 0 mV in V1 1
3 Net QRS amplitude > 0.5 mV in V1 1
Net QRS amplitude < 0 mV in V5 or V6
4 1
and S amplitude > 0.5 mV in V5 or V6
5 QRS axis >= 90° (no unidentified axis) 1
8 Possible Right atrial enlargement is present 1 6
9 S pattern is present 1
10 Age > 30 years old 1
11 Unidentified axis is present 1
However, when the following conditions are satisfied, right ventricular

hypertrophy is not analyzed.
Q, S, S’ amplitude < 0.25 mV in I
QRS axis < 60°
Maximum S amplitude > 1 mV (in V1)
6-5


Possible right ventricular hypertrophy [Some/all of; prominent R in V1,
5120 borderline ECG
late transition, RAD, RAE, SSS]
Right ventricular hypertrophy [Some/all of; prominent R in V1, late
5130 abnormal ECG
transition, RAD, RAE, SSS]
Analysis criteria
Findings Criteria
Possible RVH Points >= 4
RVH Points >= 6
NOTE
When possible RVH is found, the following findings are not analyzed.
• Nonspecific intraventricular conduction delay
• RSR (QR) in lead V1/V2 consistent with right ventricular conduction
delay
• Left posterior fascicular block
• Moderate right axis deviation
• Abnormal right axis deviation
• S1-S2-S3 pattern, consistent with pulmonary disease, RVH, or normal
variant
• Low QRS voltage
• Low QRS voltage in limb leads
• Low QRS voltage in chest leads


Right ventricular hypertrophy with repolarization abnormality [Some/all
5134 of; prominent R in V1, late transition, RAD, RAE, SSS, ST depression in abnormal ECG
lead V1, V2, V3]
Analysis criteria
Findings Criteria
(1) RVH or possible RVH : present
(2) STJ > STM > STE : in V1, V2, V3 6
Right ventricular hypertrophy
• STM < −0.1 mV : in V1, V2, V3
with repolarization
• STE < −0.1 mV
abnormality
T amplitude < –0.1 mV : in V1, V2, V3
(3) QRS duration < 120 ms*
NOTE
The value marked with “*” varies with age. Refer to p. 6.0.3.
6-5

Analysis Criteria for LVH

(1) LBBB is present
When either of these findings is
QRS duration > 0.14 s* and
recognized, LVH is not analyzed.
Net QRS amplitude < 0 mV in V1
*The value marked with * varies with age. Refer to p. 6.0.3.
(2) Point score calculation and classification

The following four items are analyzed and the points are calculated.
Obtained point scores and the respective finding analysis criteria are used to
identify the findings given on p. 6.5.8.
Item Lead Judgement Points

2 points, 1 point added at
1. R or R’ amplitude aVL > 1.1 mV
every + 0.1 mV
2. S or S’ amplitude V1 > Threshold value***
every + 0.2 mV*
3. R or R’ amplitude V5 > Threshold value***
every + 0.2 mV*
4. R or R’ amplitude + S V5 or V6 2 points, 1 point added at
> Threshold value***
or S’ amplitude V1 every + 0.3 mV**
* The values marked with “*” are used for 17 years old and over.
1 point is added at every another 0.3 mV when 16 years old and under.
** The values marked with “**” is used for 17 years old and over.
1 point is added at every another 0.45 mV when 16 years old and under.
*** Threshold values for age groups are given below.
R (V5) S (V1) R (V5 / V6) +S (V1)

YEARS MALE FEMALE MALE FEMALE MALE FEMALE
3 to 5 3.50 mV 3.50 mV 2.50 mV 2.50 mV 6.00 mV 6.00 mV
6 to 8 3.50 mV 3.50 mV 2.75 mV 2.75 mV 6.00 mV 6.00 mV
9 to 12 3.75 mV 3.50 mV 3.00 mV 3.00 mV 6.00 mV 5.30 mV
13 to 16 3.75 mV 3.00 mV 3.75 mV 3.00 mV 6.00 mV 4.80 mV
17 to 19 3.75 mV 3.00 mV 3.75 mV 3.00 mV 6.00 mV 4.50 mV
20 to 23 3.75 mV 3.00 mV 3.75 mV 3.00 mV 5.55 mV 4.50 mV
24 to 29 3.50 mV 3.00 mV 3.50 mV 3.00 mV 5.00 mV 4.50 mV
>= 30 3.00 mV 3.00 mV 3.00 mV 3.00 mV 4.50 mV 4.50 mV


5211 Minimal voltage criteria for LVH, may be normal variant borderline ECG
5220 Possible left ventricular hypertrophy abnormal ECG
5222 Moderate voltage criteria for LVH, may be normal variant borderline ECG
5233 Voltage criteria for LVH abnormal ECG
5234 Left ventricular hypertrophy with repolarization abnormality abnormal ECG
Analysis criteria
Findings Criteria
6
Minimal voltage criteria for
Point >= 2
LVH
Moderate voltage criteria for
Point >= 3
LVH
Voltage criteria for LVH Point >= 5
(1) Point >= 2
Possible left ventricular (2) Maximum change point of inclination – QRS start point > 68 ms
hypertrophy (V5)*
Left atrial enlargement or Possible right atrial enlargement.
(1) Point >= 2 6-5
(2) Atrial fibrillation is not present
Left ventricular hypertrophy
(3) T amplitude (V1) > T amplitude (V6) + 0.2 mV
with repolarization
• STE height < STJ height in any lead among I, aVL, V4, V5, V6
abnormality
• STE height < −0.05 mV in same lead as above
• R amplitude > 1.1 mV in same lead as above
NOTE
• When left ventricular hypertrophy with repolarization abnormality is
found, “Nonspecific intraventricular conduction delay”, “Incomplete left
bundle branch block” and “ST-T Abnormality” are not analyzed.
• The value marked with “*” varies with age. Refer to p. 6.0.3.

Section 6-6 Atrial Enlargement,
Abnormal Axis Deviation
and Others
6120 Possible right atrial enlargement........................................................................................................... 6.6.2
6130 Right atrial enlargement........................................................................................................................ 6.6.2 6
6220 Possible left atrial enlargement............................................................................................................. 6.6.3
6230 Left atrial enlargement.......................................................................................................................... 6.6.3
7100 Abnormal right axis deviation................................................................................................................ 6.6.4

7102 Moderate right axis deviation................................................................................................................ 6.6.4
7200 Abnormal left axis deviation.................................................................................................................. 6.6.4
7202 Moderate left axis deviation................................................................................................................... 6.6.4
7300 Indeterminate axis................................................................................................................................. 6.6.4
7400 S1-S2-S3 pattern, consistent with pulmonary disease, RVH, or normal variant................................... 6.6.6
7500 Abnormal QRS-T angle......................................................................................................................... 6.6.7
6-6
8003 Consistent with pulmonary disease....................................................................................................... 6.6.8
8100 Low QRS voltage.................................................................................................................................. 6.6.9
8101 Low QRS voltage in limb leads............................................................................................................. 6.6.9
8102 Low QRS voltage in chest leads........................................................................................................... 6.6.9
8200 Dextrocardia........................................................................................................................................ 6.6.10
8304 Long QTc interval................................................................................................................................ 6.6.11
8305 Short QTc interval............................................................................................................................... 6.6.11
0101 Possible arm leads reversed, check lead requested........................................................................... 6.6.12

0102 ARTIFACT PRESENT......................................................................................................................... 6.6.13
0103 CANNOT ANALYZE ECG.................................................................................................................... 6.6.13
0104 ELECTRODE(S) FAILURE...Repeat ECG is required......................................................................... 6.6.13
0201 ...Analysis based on intrinsic rhythm................................................................................................... 6.6.13

Atrial Enlargement

6120 Possible right atrial enlargement borderline ECG
6130 Right atrial enlargement abnormal ECG
Analysis criteria
Findings Criteria
(1) Heart rate < 120/minute
Possible right atrial enlargement (2) P amplitude > 0.25 mV in any lead among II, III, aVF,
V1, V2
(1) Heart rate < 120/minute
Right atrial enlargement (2) P amplitude > 0.3 mV in any lead among II, III, aVF,
V1, V2
NOTE
• The reason for not analyzing when heart rate is over 120/minute is
that at such a high heart rate, the increased P wave height may not
definitely be caused by atrial enlargement.
• As shown in (2) in the table, when the P wave amplitude is 0.25 to 0.3
mV, the finding is marked “possible”.

6-6. ATRIAL ENLARGEMENT, ABNORMAL AXIS DEVIATION AND OTHERS

6220 Possible left atrial enlargement borderline ECG
6230 Left atrial enlargement abnormal ECG
Analysis criteria
Findings Criteria
(1) Negative P amplitude < −0.1 mV in V1
Possible left atrial enlargement
(2) Negative P area >= 4.0 mV × ms in same lead as above
Left atrial enlargement 6
(2) Negative P area >= 6.0 mV × ms in same lead as above
NOTE
As shown in (1) in the table, when the negative P amplitude is between
−0.15 and −0.1 mV, the finding is marked “possible”.
6-6

Abnormal Axis Deviation

7100 Abnormal right axis deviation borderline ECG
7102 Moderate right axis deviation normal ECG
7200 Abnormal left axis deviation borderline ECG
7202 Moderate left axis deviation normal ECG
7300 Indeterminate axis atypical ECG
Analysis criteria
Findings Criteria
Moderate right axis deviation 90° < QRS axis <= 100° (RAXD1)*
Abnormal right axis deviation 100° < QRS axis <= 270° (RAXD2)*
Moderate left axis deviation −30° <= QRS axis < −20° (LAXD1)*
Abnormal left axis deviation −90° <= QRS axis < −30° (LAXD2)*
Indeterminate axis Net QRS amplitude < 33% of total QRS amplitude in I, II, III
NOTE
• The values marked with “*” vary with age. Refer to p. 6.0.4.

• When the measured values are at the boundary, the expression “moderate” is
added to the findings.
• Since measuring the axis is irrelevant when the net QRS amplitude in I,
II and III is smaller than 1/3 of the total QRS amplitude, the expression
“indeterminate” is used.
(For net QRS amplitude and total QRS amplitude, refer to p. 3.7.)
6-6


S1-S2-S3 pattern, consistent with pulmonary disease, RVH, or normal
7400 borderline ECG
variant
Analysis criteria
When QRS duration >= 120 ms*, S pattern is not analyzed.
The value marked with * varies with age. Refer to p. 6.0.3.
Findings Criteria
(1) R < S (amplitude) in I, II, III
• S > 0.3 mV in I
• S > 0.4 mV in II
S1-S2-S3 pattern • S > 0.7 mV in III
(2) R’ wave is not present in I, II, III
(3) S > 0.2 mV in I, II, III
(4) Age >= 16 years old


7500 Abnormal QRS-T angle borderline ECG
Analysis criteria
• RBBB
• LBBB
• ST elevation When any of
these findings are 6
• Subendocardial injury
recognized, the
• Acute pericarditis
abnormal QRS-T
• RVH (with repolarization abnormality) angle is not analyzed.
• LVH (with repolarization abnormality)
• Possible marked ST depression consistent with
• Age < 1 year old
Criteria
Findings
QRS axis − T axis T axis
Abnormal QRS-T angle 1 > 60° < 0°
6-6
2 < −60° > 90°

Others

8003 Consistent with pulmonary disease abnormal ECG
Analysis criteria
Findings Criteria
(1) QRS duration < 120 ms*
Consistent with pulmonary disease
(2) Total points >= point 4
NOTE
Pulmonary disease is judged from the points representing the features
of pulmonary diseases. The point scores are calculated as shown in the
table below. This logic is not enough to identify pulmonary diseases, but
if 4 or more of these features in the table are present in the ECGs, the
probability of pulmonary diseases can be said to be fairly high.
Features Points
1. Right atrial enlargement or possible right atrial enlargement 1
2. −90° <= QRS axis < LAXD2* 1
3. RAXD1* < QRS axis <= 270° 1
4. Indeterminate axis 1
5. S1-S2-S3 pattern 1
6. Low QRS voltage in limb leads 1
7. Low QRS voltage in chest leads 1
8. (1) Net QRS amplitude < 0 mV in V5
3
(2) R (and R’) amplitude < 0.5 mV in V6


8100 Low QRS voltage abnormal ECG
8101 Low QRS voltage in limb leads atypical ECG
8102 Low QRS voltage in chest leads atypical ECG
Analysis criteria
Findings Criteria
(1) QRS duration < 0.12 s*
Low QRS voltage (2) Total QRS amplitude < 0.5 mV in all limb leads
6
(3) Total QRS amplitude < 1.0 mV in all chest leads
Low QRS voltage in limb leads
(2) Total QRS amplitude < 0.5 mV in all limb leads
Low QRS voltage in chest leads
(2) Total QRS amplitude < 1.0 mV in all chest leads
NOTE
The values marked with “*” vary with age. Refer to p. 6.0.3.
6-6


8200 Dextrocardia atypical ECG
Analysis criteria
Findings Criteria
(1) 90° < QRS axis <= 270°
(2) 90° < P axis <= 270°
(3) PR interval >= 110 ms*
• Q wave is not present in I
Dextrocardia
• R amplitude < 0.15 mV in I
(5) R amplitude < 0.5 mV in V6
(6) Net QRS amplitude <= 0 mV in V6
(7) P amplitude < 0.02 mV in V6
NOTE
• Refer to “0101 Possible arm leads reversed, check lead requested”.
• The values marked with “*” varies with age. Refer to p. 6.0.2.


8304 Long QTc interval abnormal ECG
8305 Short QTc interval abnormal ECG
Analysis criteria
• RBBB
• LBBB
• ST elevation (Subendocardial injury) When any of these 6
findings are recognized,
• Subendocardial ischemia
long QTc interval is not
• Possible Acute pericarditis analyzed.
• Marked ST depression (Subendocardial injury)
• RVH (with repolarization abnormality)
• LVH (with repolarization abnormality)
• Age < 1 year old
Findings Criteria
Long QTc interval QTc interval > 0.45 s
(1) QTc interval < 0.36 s
Short QTc interval 6-6
(2) heart rate < 140/minute
NOTE
QTc formula can be selected from “ECAPS”, “Bazett”, “ECAPS+Fridericia”
and “Bazett+Fridericia”. When “ECAPS+Fridericia” or “Bazett+Fridericia”
is selected, the QTc interval calculated by ECAPS or Bazett formula is
used for analysis; the QTc interval from Fridericia formula is not used.


0101 Possible arm leads reversed, check lead requested ---
Analysis criteria
Findings Criteria
(1) 90° < QRS axis <= 270°
(2) 90° < P axis <= 270°
(3) PR interval >= 110 ms*
• Q wave is not present in I
ARM LEADS REVERSED
• R amplitude < 0.15 mV in I
(5) R amplitude >= 0.5 mV at V6
R amplitude > S amplitude in V6
P amplitude >= 0.02 mV in V6
Negative P amplitude >= −0.02 mV in V6
NOTE
• In properly recorded ECGs, the P and QRS waves of Lead I are not
expected to appear in negative simultaneously. If the type of QRS
wave is Qr (or rSr’), the most probable cause is either dextrocardia
or reversed arm lead electrodes. If the V6 lead shows the typical
upward-oriented waveform, the probability of reversed electrode is high,
otherwise, the probability for dextrocardia is high.
• Pulmonary disease tends to show right axis deviation in both P wave
and QRS wave, and the rS type occurs. The same is true with other
diseases which show right axis deviation. A Qr type rarely appears in
myocardial infarction, but an inverted P is not expected to appear at the
same time.
• Both “Arm leads reversed” and “Dextrocardia” have “inverted P and
QRS wave” as criteria, but in the actual decision, the Qr or rSr type of
QRS wave is taken as a significant factor.


0102 ARTIFACT PRESENT ---
Artifact on waveform.
Artifact may cause incorrect analysis. Remove artifacts and record ECG again.

0103 CANNOT ANALYZE ECG ---
ECG could not be analyzed because

6
• Artifact on waveform, or
• Heart beats are too small, or
• The ECG has less than 3 heart beats which the instrument can measure.

ELECTRODE(S) DETACHED…Repeat ECG is
0104 ---
required.
Electrode detachment
Attach electrodes correctly and record ECG again.

6-6
0201 …Analysis based on intrinsic rhythm ---
Both artificial pacemaker rhythm and intrinsic heart beats are in ECG recording
and the instrument analyzed intrinsic heart beats.
Refer to p. 6.1.9 “(3) With pacemaker”.

Appendix 1 Analysis Mode
A-1
User’s Guide ECAPS 12C A.1.1

APPENDIX 1. ANALYSIS MODE
NOTE
• The items in appendix do not apply to some instruments.
To check whether an item applies to the instrument you are using, see
the operator’s manual for the instrument.
• In screening mode, some criteria of findings of the ECAPS 12C are
changed. The CRITERIA OF FINDINGS in the ECAPS 12C User’s
Guide does not mention this difference.
The ECAPS 12C ECG Interpretation Program has a screening mode.

In screening, most examinees are healthy with no subjective symptoms.
Therefore, the ECAPS 12C screening mode lowers the detection sensitivity to
reduce false positives.
To select screening mode, refer to the electrocardiograph operator’s manual.

Some instruments do not support the screening mode.
In screening mode, the overall judgement is printed as follows.

- The code (9xxx) has 1 as the right most digit, i.e. 9xx1.
- One more * is added to the right of the judgement name.
Example: ** normal ECG ***
This * means that screening mode is
selected.
In screening mode, the ST-T findings listed below are not printed.
40302 ST elevation, probably early repolarization
40303 Early repolarization
40371 ST elevation, consistent with subepicardial injury, pericarditis, or
early repolarization
4038 Nonspecific ST elevation
4050 Tall T waves, possible hyperkalemia
For criteria of each finding, refer to “ST-T Abnormality” in Section 6-4.
A.1.2 User’s Guide ECAPS 12C

Appendix 2 Analysis after Exercise
A-2

APPENDIX 2. ANALYSIS AFTER EXERCISE
The After Exercise analysis result of the ECAPS 12C is made by comparing Rest
ECG analysis result with After Exercise ECG analysis result.
Some instruments do not support Rest ECG analysis.
(1) Cautions in making exercise tests

Be sure to analyze the rest ECG before attempting exercise tests. If any of
the following findings is present in the rest ECG, exercise test should be
prohibited, or made with sufficient care.
Contraindications to Exercise Testing

Absolute
• Acute myocardial infarction (within 2 d)
• Unstable angina not previously stabilized by medical therapy*
• Uncontrolled cardiac arrhyhmias causing symptoms or hemodynamic
compromise
• Symptomatic severe aortic stenosis
• Uncontrolled symptomatic heart failure
• Acute pulmonary embolus or pulmonary infarction
• Acute myocarditis or pericarditis
• Acute aortic dissection
Relative
• Left main coronary stenosis
• Moderate stenotic valvular heart disease
• Electrolyte abnormalities
• Severe arterial hypertension
• Tachyarrhythmias or bradyarrhythmias
• Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
• Mental or physical impairment leading to inability to exercise adequately
• High-degree atrioventricular block
* Appropriate timing of testing depends on level of risk of unstable angina, as
defined by AHCPR Unstable Angina Guidelines. Relative contraindications
can be superseded if the benefits of exercise outweigh the risks. In the absence
of definitive evidence, the committee suggests systolic blood pressure of >
200 mm Hg and/or diastolic blood pressure of > 110 mm Hg. Modified from
Fletcher et al.
ACC/AHA Guidelines for Exercise Testing (1997)

APPENDIX 2. ANALYSIS AFTER EXERCISE
(2) Printing of Analysis Result

After Exercise analysis is made by comparing Rest ECG analysis result with
After Exercise ECG analysis result. Rest ECG and After Exercise ECG are
analyzed by the same analysis method.
The After Exercise ECG analysis result consists of overall judgement,
ECG findings, measurement values, physician’s signature and exercise
information. “+” beside the ECG findings indicates that the ECG findings
did not appear in Rest ECG analysis result but appeared in After Exercise
analysis result. “+” does not appear when there is no change between Rest
ECG and After Exercise ECG.
(3) Overall Judgement

Overall judgement is either positive ECG or negative ECG, according to
the ECG findings which is not in Rest ECG analysis result but is in After
Exercise analysis result. If the ECG findings is in positive ECG, the overall
judgement is positive ECG. If the ECG findings is in negative ECG, the
overall judgement is negative ECG. Refer to (4).
(4) If the ECG findings which appear in After Exercise analysis result are in
positive ECG as present below, the overall judgement is positive ECG. For
the criteria of each findings, refer to User’s Guide ECAPS 12C Section 7
“CRITERIA OF FINDINGS”.
Positive ECG
Atrial fibrillation
Atrial flutter A-2
With occasional supraventricular premature complexes
With occasional ventricular premature complexes
With occasional ectopic premature complexes
Ventricular tachycardia
Short PR interval
Wolff-Parkinson-White syndrome
First degree AV block
Second degree AV block
Third degree AV block
Incomplete right bundle branch block
Right bundle branch block
Incomplete left bundle branch block
Left bundle branch block
Myocardial infarction
Possible myocardial infarction
Cannot rule out myocardial infarction
Abnormal Q wave
Myocardial ischemia
Subepicardial injury (cardiac muscle injury)
ST & T abnormality
Negative ECG
ECG findings not included in “Positive ECG”
When no ECG findings is added in After Exercise analysis result.

Appendix 3 Modified Minnesota Code
General..............................................................................................................................................................A.3.2
Code List...........................................................................................................................................................A.3.3
Priority of Code Printing....................................................................................................................................A.3.7
Detailed Criteria.................................................................................................................................................A.3.8
A-3

APPENDIX 3. MODIFIED MINNESOTA CODE
General
The Minnesota code is a classification of adult ECG waveforms according to a

certain criteria for the purpose of disease research. This criteria is adopted by
WHO.
In Japan, the Japanese Association for Cerebro-Cardiovascular Disease Control
arranged classification criteria of Minnesota code under consideration for the
Japanese body size (modified Minnesota code).
The electrocardiograph uses a modified Minnesota code which has been adopted
by the Japanese Association for Cerebro-Cardiovascular Disease Control.
The modified Minnesota code after exercise is coded by comparing the code
for rest ECG with the code for After Exercise ECG. Therefore, to print out the
modified Minnesota code after exercise, be sure to analyze the rest ECG before
attempting exercise tests.
Up to 8 codes can be printed at the same time.

Modified Minnesota code for rest ECG is 1-n to 9-n, modified Minnesota code
after exercise is 11-n to 16-n.
For classification criteria, refer to page 3.2 and later.
Some instruments do not print out modified Minnesota codes.
For the procedure to print out modified Minnesota code, refer to the
electrocardiograph operator’s manual.
NOTE
• The modified Minnesota code classifies ECG waveform according to
a criteria different from that of the ECAPS12C. Therefore, the analysis
result of ECAPS12C and the classification by the modified Minnesota
code may differ.
• The ECAPS12C classifies averaged waveforms according to the
modified Minnesota code.

Code List
1-0 Normal
1. Q and QS patterns
1-1 Class1 1-1-1 1-1-5
1-1-2 1-1-6
1-1-3 1-1-7
1-1-4
1-2 Class2 1-2-1 1-2-5
1-2-2 1-2-6
1-2-3 1-2-7
1-2-4 1-2-8
1-3 Class3 1-3-1 1-3-4
1-3-2 1-3-5
1-3-3 1-3-6
2. QRS Axis Deviation

2-1 Left axis deviation
2-2 Right axis deviation
2-4 Extreme axis deviation
2-5 Indetermination axis
3. High Amplitude R Waves

3-1 Left: High amplitude R waves
3-2 Right: High amplitude R waves* A-3
3-3 Left: Moderate high amplitude R waves**
* S amplitude > R amplitude in either V2, V3, V4, V5 or V6
R amplitude > 0.5 mV and R amplitude > S amplitude in V1
(If criteria for 3-2 is met, 7-3 is not coded.)
** For easy understanding, 3-3 is divided into 3-3-1, 3-3-2 and 3-3-3.
4. ST Junction (J) and Segment Depression

4-1* 4-3
4-2 4-4
* For easy understanding, 4-1 is divided into 4-1-1 and 4-1-2 according to
degree of phenomenon.
5. T-Wave Items
5-1 5-4
5-2 5-5
5-3
6. A-V Conduction Defect

6-1 Complete (third degree) A-V block
6-2* Partial (second degree) A-V block
6-3 First degree A-V block

6-4* Wolff-Parkinson-White Pattern (WPW)

6-5 Short P-R interval
6-8 Artificial pacemaker
* 6-2 is divided into 6-2-1 (Mobitz type II) and 6-2-3 (Wenckebach’s
phenomenon)
* 6-4 is divided into 6-4-1 (WPW pattern, persistent) and 6-4-2 (WPW
pattern, intermittent)
7. Ventricular Conduction Defect

7-1 Complete left bundle branch blcok
7-2 Complete right bundle branch blcok
7-3 Incomplete right bundle branch block
7-4 Intraventricular block
7-5 R-R’ pattern
7-6 Incomplete left bundle branch block
8. Arrhythmias
8-1* with frequent premature complexes
8-2 Ventricular tachycardia
8-3* Atrial fibrillation or atrial flutter
8-4 Supraventricular tachycardia
8-5 Ventricular rhythm
8-6 Atrioventricular (A-V) nodal rhythm
8-7 Sinus tachycardia
8-8 Sinus bradycardia
8-9 other arrhythmias
* 8-1 is divided into 8-1-1 (supraventricular) and 8-1-2 (ventricular)
* 8-3 is divided into 8-3-1 (Atrial fibrillation) and 8-3-2 (Atrial flutter).
9. Miscellaneous Items
9-1* Low QRS amplitude
9-2 ST elevation
9-3-1 Tall P waves
9-3-2 Widened P waves
9-4-1 Transition zone
9-4-2 Transition zone
9-5 Tall T waves
9-6 Dextrocardia
9-8 Measurement failure because of technical problems
(electrode detached, arm leads reversed)
* 9-1 is divided into 9-1-1 (limb leads and chest leads) , 9-1-2 (limb leads),
9-1-3 (chest leads)
10. ST Items after Exercise

11-1 No ST Junction (J) and Segment Depression code (4-x) is present in
rest ECG and 4-1 appears after exercise.


11-5 Any ST Junction (J) and Segment Depression code present in rest
ECG changes to a lower ST Junction (J) and Segment Depression
code after exercise.
11-6 Any ST Junction (J) and Segment Depression code present in rest
ECG changes to a higher ST Junction (J) and Segment Depression
code after exercise.
11-7 Any ST Junction (J) and Segment Depression code is present in rest
ECG and the same ST Junction (J) and Segment Depression code
appears after exercise.
11-8 Any ST Junction (J) and Segment Depression code is present in rest
ECG and no ST Junction (J) and Segment Depression code appears
after exercise.
11-9 both 11-x and 9-8
11. T Items after Exercise

12-1 No T-wave Items code (5-x) is present in rest ECG and 5-1 appears
after exercise.
after exercise.
after exercise.
12-4 Any T-wave Items code present in rest ECG changes to a lower T-
wave Items code after exercise.
A-3
12-5 Any T-wave Items code present in rest ECG changes to a higher T-
wave Items code after exercise.
12-6 Any T-wave Items code is present in rest ECG and the same T-wave
Items code appears after exercise.
12-7 Any T-wave Items code is present in rest ECG and no T-wave Items
code appears after exercise.
12-8 both 12-x and 9-8
12. A-V Conduction after Exercise

13-1 No A-V Conduction Defect code (6-x) is present in rest ECG and
Complete (third degree) A-V block appears after exercise.
13-2 No A-V Conduction Defect code (6-x) is present in rest ECG and
Partial (second degree) A-V block appears after exercise.
13-3 No A-V Conduction Defect code (6-x) is present in rest ECG and First
degree A-V block (P-R interval >= 0.22 sec) appears after exercise.
13-4 No A-V Conduction Defect code (6-x) is present in rest ECG and 6-4-
1 (WPW pattern, persistent) appears after exercise.
13-5 6-3 or 6-2 present in rest ECG changes to any other A-V Conduction
Defect code after exercise.
13-6 Any A-V Conduction Defect code is present in rest ECG and the same
code appears after exercise.

13-7 Any A-V Conduction Defect code is present in rest ECG and no A-V
Conduction Defect code appears after exercise.
13. Ventricular Conduction after Exercise

14-1 No Ventricular Conduction Defect code (7-x) is present in rest ECG
and complete left bundle branch blocks (7-1) appears after exercise.
and complete right bundle branch block (7-2) appears after exercise.
and incomplete right bundle branch block (7-3) appears after exercise.
and intraventricular block appears after exercise.
14-5 7-1, 7-2, 7-3, 7-4, 7-5 or 7-6 present in rest ECG changes to another
Ventricular Conduction Defect code after exercise.
14-6 Any Ventricular Conduction Defect code is present in rest ECG and
the same code appears after exercise.
14-7 7-1, 7-2, 7-3, 7-4, 7-5 or 7-6 is present in rest ECG and no Ventricular
Conduction Defect code appears after exercise.
14. Arrhythmia after Exercise

Sinus arrhythmia, sinus tachycardia (8-7) and sinus bradycardia (8-8) are
excluded from judgement, but when sinus bradycardia (8-8) in rest ECG
changes to atrioventricular (A-V) nodal rhythm (8-6) after exercise, this is
included regardless transient or persistent.
15-1 No Arrhythmias code (8-x) in rest ECG and any of Arrhythmias code
15-2 Any Arrhythmias code (8-x) present in rest ECG changes to another
Arrhythmias code after exercise.
15-3 Any Arrhythmias code (8-x) is present in rest ECG and the same code
15-4 Any Arrhythmias code (8-x) is present in rest ECG and no
Arrhythmias code appears after exercise.
15. Miscellaneous Items after Exercise

16-1 ST elevation code (9-2) is not present in rest ECG and 9-2 (ST
elevation) appears after exercise.
16-2 ST elevation code (9-2) is present in rest ECG and it appears after
exercise too.
16-3 ST elevation code (9-2) is present in rest ECG and it does not appear
after exercise.
NOTE
The judgement criteria in this section are extracted from the handbook
by the Japan Association for Cerebro-Cardiovascular Disease Control.
These criteria were not written for computer analysis. Where the
computer needs more detailed criteria for analysis, Nihon Kohden has
added some criteria.

Priority of Code Printing
1) For each top level group 1 to 5, only the highest priority item is coded.
Example (1) 1-1-1 suppresses 1-2-4 and 1-3-2 In this case only 1-1-1 is
coded and 1-2-4 and 1-3-2 are ignored.
Example (2) When 1-1-1, 1-2-4, 2-1 and 3-1 are present in analysis, only
1-1-1, 2-1 and 3-1 are coded.
2) For 6 to 9, two or more codes are coded together among each 6 to 9. All the
present codes in analysis result are coded.
Example (1) When 8-1 and 8-3 are present, both 8-1 and 8-3 are coded. For
6, 7, 8 and 9, each group is coded separately.
3) Q and QS patterns (1-x)

Do not code if 6-4 or 7-1 is present. Q wave < 0.1 mV is not coded.
4) QRS axis deviation (2-x)

Do not code if 6-4, 7-1, 7-2, 7-4 or 9-1 is present.
5) High amplitude R waves (3-x)

Do not code if 6-4, 7-1, 7-2 or 7-4 is present.
6) ST Junction (J) and Segment Depression (4-x)

7) T-wave Items (5-x) A-3


Detailed Criteria
1. Q and QS patterns
1-1 Class1
1-1-1 Q/R amplitude ratio >= 1/3, plus Q duration >=0.03 sec in any of
leads I, II, V2, V3 ,V4, V5, V6.
1-1-2 Q duration >= 0.04 sec in any of lead I, II, V1, V2, V3 ,V4, V5, V6.
1-1-3 Q duration >= 0.04 sec, plus R amplitude >= 0.3 mV in lead aVL.
1-1-4 Q duration >= 0.05 sec in lead III, plus Q amplitude >= 0.1 mV in
lead aVF.
1-1-5 Q duration >= 0.05 sec in lead aVF.
1-1-6 QS pattern when initial R-wave is present in adjacent lead to the right
on the chest wall, in any of leads V2, V3 ,V4, V5, V6.
1-1-7 QS pattern in all of leads V1-V4 ,V1-V5 or V1-V6.
1-2 Class2
1-2-1 Q/R amplitude ratio >= 1/3, plus Q duration >=0.02 sec and < 0.03
sec in any of leads I, II, V2, V3 ,V4, V5, V6.
1-2-2 Q duration >= 0.03 sec and < 0.04 sec in any leads of I, II, V2, V3,
V4, V5, V6.
1-2-3 QS pattern in lead II.
1-2-4 Q duration >= 0.04 sec and < 0.05 sec in lead III, plus a Q-wave >=
0.1 mV in lead aVF.
1-2-5 Q duration >= 0.04 sec and < 0.05 sec in lead aVF.
1-2-6 Q amplitude >= 0.5 mV in leads III or aVF.
1-2-7 QS pattern in all of leads V1, V2, and V3.
1-2-8 Initial R amplitude decreasing to 0.2 mV or less in every beat (and
absence of codes 3-2, 7-2, 7-3) between any of leads V2 and V3, V3
and V4, V4 and V5, V5 and V6. All beats in the lead immediately to
the right on the chest must have an initial R > 0.2 mV.
1-3 Class3
1-3-1 Q/R amplitude ratio >= 1/5 and < 1/3 plus Q duration >=0.02 sec and
< 0.03 sec in any of leads I, II, V2, V3 ,V4, V5, V6.
1-3-2 QS pattern in lead V1 and V2. (Do not code in the presence of 3-1,
6-4, 7-1.)
1-3-3 Q duration >= 0.03 sec and < 0.04 sec, plus R amplitude >= 0.3 mV
in lead aVL.
1-3-4 Q duration >= 0.03 sec and < 0.04 sec in lead III, plus a Q-wave >=
0.1 mV in lead aVF.
1-3-5 Q duration >= 0.03 sec and < 0.04 sec in lead aVF.
1-3-6 QS pattern in each of leads III and aVF.


2-1 Left axis deviation:
QRS axis from −30° through −90° in leads I, II, III. (The algebraic
sum of major positive and major negative QRS waves must be
positive in I, zero or negative in II and negative in III.)
2-2 Right axis deviation:
QRS axis from +120° through -150° . (the algebraic sum of major
positive and major negative QRS waves must be negative in I, zero
or positive in III, and the sum in I must be one-half or more of the
sum in III.)
2-3 Right axis deviation:
QRS axis from + 90° through +119° . (The algebraic sum of major
positive and major negative QRS waves must be zero or negative in I
and positive in II and III.)
2-4 Extreme axis deviation (usually S1-S2-S3 pattern)
QRS axis from −91° through −149° . (The algebraic sum of major
positive and major negative QRS waves must be negative in each of
leads I, II and III.)
2-5 Indeterminate axis:
(The algebraic sum of major positive and major negative QRS waves
is zero in each of leads I, II and III.)
3. High amplitude R waves

R amplitude > 2.6 mV in either V5 or V6, or R amplitude > 2.0 mV
in either I, II, III, aVF, or R amplitude > 1.2 mV in lead aVL.
3-2 Right: High amplitude R waves
A-3
R amplitude >= 0.5 mV and R amplitude >= S amplitude in lead
V1, when S amplitude is > R amplitude somewhere to the left on the
chest of V1 (Code as 3-2 if criteria for 3-2 and 7-3 are met. Do not
code 1-2-8 in the presence of 3-2)
3-3-1 Left: Moderate high amplitude R waves
R amplitude >= 1.5 mV but <= 2.0 mV in lead I.
R amplitude in lead V5 plus S amplitude in lead V1 >= 3.5 mV
R amplitude in lead V6 plus S amplitude in lead V1 >= 3.5 mV.

4-1-1 STJ depression >= 0.2 mV and ST segment is horizontal or
downward sloping in any of leads I, II, aVL, aVF, V1, V2, V3, V4,
V5, V6.
4-1-2 STJ depression >= 0.1 mV but < 0.2 mV, and ST segment is
horizontal or downward sloping in any of leads I, II, aVL, V1, V2,
V3, V4, V5, V6.
4-2 STJ depression >= 0.05 mV and < 0.1 mV and ST segment is
horizontal or downward sloping in any of leads I, II, aVL, V2, V3,
V4, V5, V6.

4-3 No STJ depression as much as 0.05 mV but ST segment downward

sloping and segment or T-wave nadir >= 0.05 mV below P-R
baseline, in any of leads I, II, aVL, V2, V3, V4, V5, V6.
4-4 STJ depression >= 0.1 mV, and ST segment upward sloping or U-
shaped, in any of leads I, II, aVL, aVF, V1, V2, V3, V4, V5, V6.
5. T Wave Items
5-1 T amplitude negative 0.5 mV or more in any of leads I, II, V2, V3,
V4, V5, V6, or in lead aVL when R amplitude is >= 0.5 mV, or in
lead aVF when QRS is mainly upright.
5-2 T amplitude negative or diphasic (negative-positive or positive-
negative type) with negative phase at least 0.1 mV but not as deep
as 0.5 mV in any of leads I, II, V2, V3, V4, V5, V6, or in lead aVL
when R amplitude is >= 0.5 mV, or in lead aVF when QRS is mainly
upright.
5-3 T amplitude zero (flat) or negative or diphasic (negative-positive
type) with less than 0.1 mV negative phase, in any leads of I, II, V3,
V4, V5, V6, or in lead aVL when R amplitude is >= 0.5 mV. (Do not
code in lead aVF.)
5-4 T amplitude positive and T/R amplitude ratio < 1/20 in any of leads I,
II, aVL, V3, V4, V5, V6: R wave amplitude must be >= 1.0 mV.
5-5 T amplitude positive and T/R amplitude ratio < 1/10 and >= 1/20 in
any of leads I, II, aVL, V3, V4, V5, V6: R wave amplitude must be
>= 1.0 mV.
6. A-V Conduction Defect

6-1 Complete (third degree) A-V block (permanent or intermittent) in any
lead.
6-2 Partial (second degree) A-V block (permanent or intermittent, 2:1 or
3:1 block, Wenckebach’s phenomenon) in any lead.
6-2-1 Mobitz Type II
6-2-3 Wenckebach’s phenomenon
6-3 P-R (P-Q) interval >= 0.22 sec in any of leads I, II, III, aVL, aVF.
6-4-1 Wolff-Parkinson-White Pattern (WPW)
P-R interval < 0.12 sec, plus QRS duration >= 0.12 sec, plus R peak
duration >= 0.06 sec, coexisting in the same beat and present in all
beats in any of leads I, II, aVL, V4, V5, V6.
6-4-2 Wolff-Parkinson-White Pattern (WPW), intermittent
P-R interval < 0.12 sec, plus QRS duration >= 0.12 sec, plus R peak
duration >= 0.06 sec, coexisting in the same beat and present in some
beats in any of leads I, II, aVL, V4, V5, V6.
6-5 Short P-R interval:
P-R (P-Q) interval < 0.12 sec in all beats of any two of leads I, II, III,
aVL, aVF. (in the absence of 8-6, 8-7)
6-8 Artificial pacemaker:
Artificial pacemaker pulse is present.


7-1 Complete left bundle branch block (Do not code in presence of 6-4)
QRS duration >= 0.12 sec in any of leads I, II, III, aVL, aVF, plus
R peak duration >= 0.06 sec and a codable Q-wave is not present in
any of leads I, II, aVL,V5, V6.
7-2 Complete right bundle branch block (Do not code in the presence of
6-4)
QRS duration >= 0.12 sec in any of leads I, II, III, aVL, aVF, plus:
R’ > R or R peak duration >= 0.06 sec in V1 or V2.
7-3 Incomplete right bundle branch block:
QRS duration < 0.12 sec in each of leads I, II, III, aVL, aVF, and R’
> R in either of leads V1, V2. (Code as 3-2 if criteria for 3-2 is met.)
7-4 Intraventricular block (Do not code in presence of 6-4, 7-1, 7-2)
QRS duration >= 0.12 sec.
7-5 R-R’ pattern:
R-R’ pattern which do not meet the criteria of 7-2 and 7-3 in V1 or
V2
7-6 Incomplete left bundle branch block:
QRS duration >= 0.10 sec but < 0.12 sec and codable Q-wave is not
present in leads I, aVL and either V5 or V6.
8. Arrhythmias
8-1 with frequent atrial, junctional or ventricular premature complexes
(10% or more of recorded complexes)
8-1-1 with frequent supraventricular premature complexes (10% or more of
recorded complexes)
8-1-2 with frequent ventricular premature complexes (10% or more of
A-3
recorded complexes)
If supraventricular or ventricular is undetermined, code as 8-1.
8-2 Ventricular tachycardia (>= 100/min)
8-3-1 Atrial fibrillation
8-3-2 Atrial flutter
8-4 Supraventricular tachycardia (>= 100/min)
8-5 Ventricular rhythm (<= 100/min)
8-6 atrioventricular (A-V) nodal rhythm (<= 100/min)
Negative P in aVF, and P-R interval <= 0.12 sec in any of leads I, II,
III, aVL, aVF.
8-7 Sinus tachycardia (>= 100/min)
8-8 Sinus bradycardia (<= 50/min)
8-9 other arrhythmias
9-1 Low QRS amplitude:
9-1-1 Low QRS amplitude: QRS peak-to-peak amplitude < 0.5 mV in all
beats in each of leads I, II, III, and < 1.0mV in all beats in each of
leads V1, V2, V3, V4, V5, V6.
beats in each of leads I, II, III.

beats in each of leads V1, V2, V3, V4, V5, V6.
9-2 ST segment elevation >= 0.1 mV in any of leads I, II, III, aVL, aVF,
V5, V6, or >= 0.2 mV in any of leads V1, V2, V3, V4. (Do not code
in the presence of 6-4, 7-1, 7-2 or 7-4)
9-3-1 P-wave amplitude >= 0.25 mV in any of leads II, III, aVF.
9-3-2 P-wave duration >= 0.10 sec in any of leads I, II, aVL.
9-4-1 QRS Transition zone to the right of V3 on the chest wall. (Do not
code in the presence of 6-4, 7-1, 7-2 or 7-4)
9-4-2 QRS Transition zone at V4 or to the left of V4 on the chest wall. (Do
not code in the presence of 6-4, 7-1, 7-2 or 7-4)
9-5 T wave amplitude > 1.2 mV in any of leads I, II, III, aVL, aVF, V1,
V2, V3, V4, V5, V6. (Do not code in the presence of 6-4, 7-1, 7-2 or
7-4)
9-6 Dextrocardia
9-8 Measurement failure because of electrode detachment or reversed
arm leads.

Appendix 4 Minnesota Code 1982
Version
Overview............................................................................................................................................................A.4.2
Code Classification List.....................................................................................................................................A.4.3
Priority of Code Printing....................................................................................................................................A.4.8
Detailed Criteria.................................................................................................................................................A.4.9
A-4

APPENDIX 4. MINNESOTA CODE 1982 VERSION
Overview
The Minnesota Code is a classification system for adult ECG waveforms in

accordance with certain criteria for the purpose of disease research. It does not
serve as criteria for clinical practices. These criteria have been adopted by WHO.
The Minnesota Code was modified in 1982. At that time, codes in accordance
with this modification were added.
Regarding analysis contents, 1-n through 9-n are assigned for rest ECG
Minnesota Codes, and 11-n through 16-n are assigned for after-exercise
Minnesota Codes.
After-exercise Minnesota Codes are coded by comparing the rest ECG codes
with after-exercise ECG codes. Therefore, to print out the Minnesota Code after
exercise, it is necessary to analyze the rest ECG before attempting exercise tests.
This analysis program performs code classifications that are Up to 12 codes can
be printed at one time.
For classification criteria, refer to the following pages.
Some instruments do not print out modified Minnesota codes.
For the procedure to print out modified Minnesota codes, refer to the operator’s
manual for the instrument.
NOTE
• The Minnesota Code classifies ECG waveforms according to criteria
that differ from those of the ECAPS12C. Therefore, the analysis results
of the ECAPS12C and the classification according to the Minnesota
Code may differ.
• The ECAPS12C classifies averaged waveforms according to the
modified Minnesota code.
* The Minnesota Code 1982 version has been broken down according to
location. Codes that are printed on recording paper are as follows:
A: Anterior
L: Anterolateral
I: Inferior
[Example] 1-1-1(A)

Code Classification List
1-0 Normal
1. Q or QS patterns
1-1 Class 1 1-1-1 1-1-5
1-1-2 1-1-6
1-1-3 1-1-7
1-1-4
1-2 Class 2 1-2-1 1-2-5
1-2-2 1-2-6
1-2-3 1-2-7
1-2-4 1-2-8
1-3 Class 3 1-3-1 1-3-5
1-3-2 1-3-6
1-3-3
1-3-4
2. QRS axis deviation

2-4 Extreme axis deviation
2-5 Indeterminate axis
3. High amplitude R waves

3-1 Left: High amplitude R wave
3-2 Right: High amplitude R wave*
A-4
3-3-1 Left: Moderate high amplitude R wave
3-3-2 Left: Moderate high amplitude R wave
3-3-3 Left: Moderate high amplitude left-type R wave
3-4 Criteria for both 3-1 and 3-2 are met
* S amplitude > R amplitude (one of the leads to the left of the V1 lead)
R amplitude >= 0.5 mV; S amplitude >= R amplitude (V1 lead)
(If the criteria for 3-2 are met, 7-3 will not be coded.)
4. ST junction (J) and segment depression

4-1-1
4-1-2
4-2
4-3
4-4
5. T-wave items
5-1 5-4
5-2 5-5
5-3

6. A-V conduction defect

6-1 Third-degree complete A-V block
6-2-1 Mobitz type II A-V block
6-2-3 Wenckebach’s Phenomenon A-V
6-3 Prolonged P-R (P-Q) interval
6-4-1 Wolff-Parkinson-White Pattern
6-5 Short P-R (P-Q) interval
6-8 Artificial pacemaker
7. Ventricular conduction defect

7-1-1 Complete left bundle branch block
7-2-1 Complete right bundle branch block
7-3 Incomplete right bundle branch block
7-4 Intraventricular block
7-5 Tendency toward incomplete right bundle branch
block
7-6 Incomplete left bundle branch block
7-7 Left anterior hemiblock
7-8 Criteria for both 7-7 and 7-2 are met.
(However, QRS duration >= 0.12 sec)
8. Arrhythmias
8-1-1 Presence of frequent atrial premature beats or
frequent junctional premature beats
8-1-2 Presence of frequent ventricular premature beats
8-1-3 Presence of frequent atrial premature beats or
frequent junctional premature beats along with the
presence of frequent ventricular premature beats
8-1-6 Presence of frequent both atrial premature beats
which do not correspond to 8-1-1
8-1-7 Presence of frequent ventricular premature beats
which do not correspond to 8-1-2
8-2-2 Persistent ventricular rhythm
8-3-1 Atrial fibrillation (persistent)
8-3-2 Atrial flutter (persistent)
8-4-1 Supraventricular rhythm
8-7 Sinus tachycardia
8-8 Sinus bradycardia
8-9-2 Sinus arrhythmias
8-9-4 Coronary sinus rhythm
8-9-7 Tachycardia (arrhythmia)
8-9-8 Bradycardia (arrhythmia)
8-9-9 Other arrhythmias
9. Miscellaneous items
9-1 Low QRS amplitude*
9-2-1 ST segment elevation
9-2-2 ST segment elevation
9-2-3 Brugada ECG

9-2-4 Brugada ECG

9-3-1 Tall P waves
9-3-2 Widened P waves
9-4-1 Counterclockwise rotation
9-4-2 Clockwise rotation
9-5 Tall T waves
9-7 Dextrocardia
9-8-1 Measurement failure because of technical problems
9-9-1 Prolonged QT interval
* 9-1 is divided into 9-1-1 (limb leads and chest leads), 9-1-2 (limb leads),
and 9-1-3 (chest leads).
10. After-exercise ST items

11-1 No ST junction (J) and segment depression codes (4-x) are present in
rest ECG and 4-1 appears after exercise
11-5 Any ST junction (J) and segment depression codes present in rest
ECG changes to lower ST junction (J) and segment depression codes
after exercise
11-6 Any ST junction (J) and segment depression codes present in rest
ECG changes to higher ST junction (J) and segment depression codes
after exercise
11-7 Any ST junction (J) and segment depression codes are present in rest
A-4
ECG and the same ST junction (J) and segment depression codes
appear after exercise
11-8 Any ST junction (J) and segment depression codes are present in rest
ECG and no ST junction (J) and segment depression codes appear
after exercise
11-9 Both 11-x and 9-8
11. After-exercise T items

12-1 No T-wave items code (5-x) is present in rest ECG and 5-1 appears
after exercise
after exercise
after exercise
12-4 Any T-wave items code (5-x) present in rest ECG changes to a lower
T-wave items code after exercise
12-5 Any T-wave items code (5-x) present in rest ECG changes to a higher
T-wave items code after exercise

12-6 Any T-wave items code is present in rest ECG and the same T-wave
items code appears after exercise
12-7 Any T-wave items code is present in rest ECG and no T-wave items
code appears after exercise
12-8 Both 12-x and 9-8
12. After-exercise A-V conduction

13-1 No A-V conduction defect code (6-x) is present in rest ECG and
complete (third degree) A-V block appears after exercise
13-2 No A-V conduction defect code (6-x) is present in rest ECG and
partial (second degree) A-V block appears after exercise
13-3 No A-V conduction defect code (6-x) is present in rest ECG and first
degree A-V block (P-R interval >= 0.22 sec) appears after exercise
13-4 No A-V conduction defect code (6-x) is present in rest ECG and 6-4-1
(WPW pattern, persistent) appears
13-5 6-3 or 6-2 present in rest ECG changes to any other A-V conduction
defect code after exercise
13-6 Any A-V conduction defect code (6-x) is present in rest ECG and the
same code appears after exercise
13-7 Any A-V conduction defect code (6-x) is present in rest ECG and no
A-V conduction defect code appears after exercise
13. After-exercise ventricular conduction

14-1 No ventricular conduction defect code (7-x) is present in rest ECG and
complete left bundle branch block (7-1) appears after exercise
complete left bundle branch block (7-2) appears after exercise
incomplete left bundle branch block (7-3) appears after exercise
intraventricular block (7-4) appears after exercise
14-5 7-1, 7-2, 7-3, 7-4, 7-5, or 7-6 present in rest ECG changes to a
different ventricular conduction defect code after exercise
14-6 Any ventricular conduction defect code is present in rest ECG and the
same code appears after exercise
14-7 7-1, 7-2, 7-3, 7-4, 7-5, or 7-6 is present in rest ECG and no ventricular
conduction defect code appears after exercise

14. After-exercise arrhythmias

15-1 No arrhythmias code (8-x) in rest ECG and any arrhythmias code
appears after exercise
15-2 Any arrhythmias code (8-x) present in rest ECG changes to a different
arrhythmias code after exercise
15-3 Any arrhythmias code (8-x) is present in rest ECG and the same code
appears after exercise
15-4 Any arrhythmias code (8-x) is present in rest ECG and no arrhythmias
code appears after exercise
* Detailed judgment rules for arrhythmias

Sinus arrhythmias (8-9-2), sinus tachycardia (8-7), and sinus bradycardia
(8-8) are excluded from judgment; however, when sinus bradycardia
(8-8) in rest ECG changes to supraventricular rhythm after exercise, it is
included regardless of whether it is transient or persistent.
15. After-exercise miscellaneous items

16-1 ST elevation code (9-2) is not present in rest ECG and ST elevation
(9-2) appears after exercise
16-2 ST elevation code is present in rest ECG and also appears after
exercise
16-3 ST elevation code is present in rest ECG and does not appear after
exercise
NOTE
The judgment criteria in this section are extracted from the handbook of
the Japanese Association for Cerebro-Cardiovascular Disease Control.
These criteria were not written for computer analysis. In cases where a
A-4
computer requires more detailed criteria for analysis, added criteria can
be obtained from Nihon Kohden

Priority of Code Printing
1) Code priority
For each top level group of 1, 4, and 5, codes with a smaller code number
within each group take precedence for each lead group. Therefore, 2 or
more codes are not coded together in the same lead group.
[Example] 1-1-1 suppresses 1-2-4 and 1-3-2. In this case, only 1-1-1 is
coded and 1-2-4 and 1-3-2 are ignored.
2) Coexistence of codes
For 6 through 9, two or more codes are coded together from among each
number of 6 through 9. All of the codes present in the analysis results are
coded.
[Example] When 8-1and 8-3 are present, both 8-1 and 8-3 are coded.
For 6, 7, 8, and 9, each group is coded separately.
3) Q or QS patterns
As a general rule, Q or QS amplitude >= 0.1 mV and Q duration >= 0.02 sec.
However, 7-7 and 7-8 are excluded.
Do not code if 6-1, 6-4-1, 6-8, or 8-4-1 are present and the heart rate is 140
or higher.
Do not code if 1-2-3, 1-2-7, 1-2-8, 1-3-2, or 1-3-6 are present when 7-1-1 is
present. If any Q or QS patterns code other than the ones described above is
present, change 7-1-1 to 7-4 and code the Q or QS patterns.
4) QRS axis deviation

Do not code if 6-1, 6-4-1, 6-8, 7-1-1, 7-2-1, 7-4, 7-8, 8-2-2, or 8-4-1 are
present when the heart rate is 140 or higher and 9-1 is present.
5) High amplitude R waves

Do not code if 6-1, 6-4-1, 6-8, 7-1-1, 7-2-1, 7-4, 7-8, or 8-4-1 are present and
the heart rate is 140 or higher.
6) ST junction (J) and segment depression

7) T-wave items

Detailed Criteria
1. Q or QS Patterns
1-1 Class1
1-1-1 Q/R amplitude ratio >= 1/3 and Q duration >= 0.03 sec
(Anterolateral: lead I or V6; Inferior: lead II or; Anterior: lead V2,
V3, V4, or V5)
1-1-2 Q duration >= 0.04 sec
(Anterolateral: lead I or V6; Inferior: lead II Anterior: any of leads
V1, V2, V3, V4, or V5)
1-1-3 Q duration >= 0.04 sec, plus R amplitude >= 0.3 mV
(Anterolateral: lead aVL)
1-1-4 Q duration >= 0.05 sec, plus Q amplitude >= 0.1 mV in the beats of
the aVF lead
(Inferior: leads III and aVF)
1-1-5 Q duration >= 0.05 sec
(Inferior: lead aVF)
1-1-6 QS pattern and R waves are present in adjacent lead located to the
right of the chest wall
(Anterolateral: lead V6; Anterior: leads V2, V3, V4, and V5)
1-1-7 QS pattern
(Anterior: leads V1 through V4, or all leads V1 through V5)
1-2 Class 2
1-2-1 Q/R amplitude ratio >= 1/3, plus Q duration >= 0.02 sec and < 0.03
sec
(Anterolateral: lead I or V6; Inferior: lead II)
A-4
Anterior: any of leads V2, V3, V4 or V5)
1-2-2 Q duration >= 0.03 sec and <= 0.04 sec
(Anterolateral: lead I or V6; Inferior: lead II
Anterior: any of leads V2, V3, V4, or V5)
1-2-3 QS pattern (Do not code if 7-1-1 is present.)
(Anterolateral: lead I; Inferior: lead II)
1-2-4 Q duration >= 0.04 sec and < 0.05 sec in lead III, plus Q amplitude
>= 0.1 mV regardless of duration in lead aVF (not necessary that it
be 0.02 sec or greater)
(Inferior: lead III and lead aVF)
1-2-5 Q duration >= 0.04 sec and < 0.05 sec
1-2-6 Q amplitude >= 0.5 mV regardless of duration (not necessary that it
be 0.02 sec or greater)
(Inferior: lead III or lead aVF)
(Anterior: all of leads V1, V2, and V3)
1-2-8 Initial R > 0.2 mV is a derivative of the right side of Initial R <= 0.2
mV. (Do not encode if 3-2, 7-1-1, 7-2-1, 7-3, or 7-8 are present.)
(Anterolateral: leads V5 and V6; Anterior: any of leads V2, V3, V4,
or V5)
1-3 Class 3
1-3-1 Q/R amplitude duration >= 1/5 and < 1/3, plus Q duration >= 0.02
sec and < 0.03 sec
(Anterolateral: lead I or V6; Inferior: lead II; Anterior: any of leads
V2, V3, V4, or V5)
1-3-2 QS pattern (Do not code if 3-1 or 7-1-1 are present.)
(Anterior: leads V1 and V2)
1-3-3 Q duration >= 0.03 sec and < 0.04 sec, plus R amplitude >= 0.3 mV
(Anterolateral: lead aVL)
1-3-4 Q duration >= 0.03 sec and < 0.04 sec, plus Q amplitude >= 0.1 mV
regardless of duration (not necessary that it be 0.02 sec or greater)
(Inferior: Q duration in lead III, Q amplitude in lead aVF)
1-3-5 Q duration >= 0.03 sec and < 0.04 sec
(Inferior: lead III and lead aVF)

2-1 Left axis deviation: QRS axis from −30° through −90° in leads I, II,
and III
must be zero or positive in lead I, negative in lead III, and zero or
negative in lead II.)
2-2 Right axis deviation: QRS axis from +120° through −150° in leads I,
II, and III
(The algebraic sum of major positive and major negative QRS
waves must be negative in lead I, zero or positive in lead III, and the
absolute value of lead I must be 1/2 or greater than that of lead III.)
2-3 Right axis deviation: QRS axis from +90° through +119° in leads I,
II, and III
must be zero or negative in lead I and positive in leads II and III.)
2-4 Extreme axis deviation: (usually S1-S2-S3 pattern)
QRS axis from −91° through −149°
must be negative in all of leads I, II, and III.)
2-5 Indeterminate axis:
QRS axis is approximately 90° from the frontal plane
(The algebraic sum of major positive and major negative QRS wave
amplitude is zero in all of leads I, II, and III, or information from
these 3 leads is not consistent.)

3. High Amplitude R Waves

R amplitude > 2.6 mV in either lead V5 or lead V6, or R amplitude >
2.0 mV in any of leads I, II, III, or aVF, or R amplitude > 1.2 mV in
lead aVL
3-2 Right: High amplitude R waves
R amplitude >= 0.5 mV and R amplitude >= S amplitude in lead V1
when S amplitude is > R amplitude in any of the leads to the left of
lead V1
(Code as 3-2 if criteria for 3-2 and 7-3 are met.)
R amplitude > 1.5 mV but <= 2.0 mV in lead I

4-1-1 ST-J depression >= 0.2 mV and ST segment is horizontal or
downward-sloping
(Anterolateral: either lead I, aVL or lead V6; Inferior: lead II or lead
aVF; Anterior: any of leads V1 through V5)
4-1-2 ST-J depression >= 0.1 mV but < 0.2 mV, and ST segment is
horizontal or downward-sloping
(Anterolateral: lead I, aVL, or V6; Inferior: lead II or lead aVF;
Anterior: any of leads V1 through V5)
4-2 ST-J depression >= 0.05 mV but < 0.1 mV and ST segment is
horizontal or downward-sloping
A-4
(Anterolateral: any of leads I, aVL, or V6 Inferior: lead II or aVF;
Anterior: any of leads V1 through V5)
4-3 ST-J depression < 0.05 mV and ST segment or T wave nadir >= 0.05
mV below P-R baseline
(Anterolateral: any of leads I, aVL, or V6; Inferior: lead II; Anterior:
any of leads V2 through V5)
4-4 ST-J depression <= 0.1 mV and ST segment is upward-sloping or U-
shaped
(Anterolateral: any of leads I, aVL, or V6; Inferior: lead II; Anterior:
any of leads V1 through V5)
5. T Wave Items
5-1 Negative T wave <= −0.5 mV
(Anterolateral: leads I and V6, or in lead aVL when R amplitude is
>= 0.5 mV
Inferior: in lead II or lead aVF when QRS wave is mainly upright;
Anterior: any of leads V2, V3, V4, or V5)
5-2 T amplitude negative or diphasic (positive-negative or negative-
positive type) with negative phase at least 0.1 mV
but not as low as −0.5 mV

(Anterolateral: in leads I and V6 or in lead aVL when R amplitude is

>= 0.5 mV;
Inferior: in lead II or in lead aVF when QRS is mainly
upright;Anterior: in any of leads V2, V3, V4, or V5)
5-3 T amplitude zero (flat), negative, or diphasic (only negative-positive
type) with T wave negative phase less than 0.1 mV
(Anterolateral: in leads I and V6 or in lead aVL when R amplitude is
>= 0.5 mV
Inferior: in lead II (Do not code in lead aVF.)
Anterior: in any of leads V3, V4, or V5)
5-4 T amplitude positive and T/R amplitude ratio < 1/20. R amplitude
must be >= 1.0 mV
(Anterolateral: in any of leads I, V6, or aVL
Inferior: in lead II; Anterior: in any of leads V3, V4, or V5)
5-5 T amplitude positive and T/R amplitude ratio < 1/10 and >= 1/20. R
amplitude must be >= 1.0 mV
(Anterolateral: in any of leads I, V6, or aVL
Inferior: lead II; Anterior: in any of leads V3, V4, or V5)
6. AV Conduction Defect
6-1 Complete (third degree) A-V block (permanent or intermittent) in any
lead
6-2-1 Mobitz Type II A-V block:
P-R (P-Q) interval is constant, sometimes lacking QRS and T waves
6-2-3 Wenckebach’s Phenomenon A-V:
P-R (P-Q) interval increases with every beat, followed by dropped
QRS and T waves
6-3 Prolonged P-R (P-Q) interval:
P-R (P-Q) interval >= 0.22 sec in any of leads I, II, III, aVL, or aVF
6-4-1 Wolff-Parkinson-White Pattern, persistent:
Findings of sinus P wave, P-R (P-Q) interval < 0.12 sec, QRS
duration >= 0.12 sec, and R peak duration >= 0.06 sec coexist (in any
of leads I, II, aVL, V4 through V6)
6-5 Short P-R (P-Q) interval:
P-R (P-Q) interval < 0.12 sec in two leads from among leads I, II, III,
aVL, and aVF (Do not code if 8-4-1 is present and the heart rate is
>= 100.)
6-8 Artificial pacemaker:
Artificial pacemaker pulse is present

7-1-1 Complete left bundle branch block:
QRS duration >= 0.12 sec in any of leads I, II, III, aVL, or aVF, plus
R peak duration >= 0.06 sec in any of leads I, II, aVL,V5, or V6
(If any code for a Q pattern other than 1-2-3, 1-2-7, 1-2-8, 1-3-2 or 1-
3-6 coexists with 7-1-1, code the Q pattern and change 7-1-1 to 7-4.)

7-2-1 Complete right bundle branch block:

QRS >= 0.12 sec in any of leads I, II, III, aVL, or aVF, plus:
R’ > R and S >= 0.025 mV in lead V1 or lead V2
R peak duration >= 0.06 sec when QRS is mainly upright in lead
V1 or V2
S duration > R duration in lead I or lead II
7-3 Incomplete right bundle branch block: (Do not code in the presence
of 7-2-1.)
QRS duration < 0.12 sec in all of leads I, II, III, aVL, and aVF, R’ >
R, R’ >= 0.1 mV, and R and S >= 0.025 mV In either lead V1 or V2
(Also code as 3-2 if criteria for 3-2 is met)
7-4 Intraventricular block: (Do not code in the presence of 7-1-1 and 7-2-
1.)
QRS duration >= 0.12 sec in any of leads I, II, III, aVL, or aVF
7-5 Tendency toward incomplete right bundle branch block: (Do not code
in the presence of 7-2-1 and 7-3.)
R-R’ pattern, R’ <= R in either lead V1 or V2 (R, R’ >= 0.025 mV; S
>= 0.025 mV).
7-6 Incomplete left bundle branch block: (Do not code in the presence of
7-1-1.)
QRS duration >= 0.10 sec but <= 0.12 sec in leads I, aVL, and either
V5 or V6 (when no codable Q wave is present)
7-7 Left anterior hemiblock:
QRS duration < 0.12 sec in any of leads I, II, III, aVL, or aVF, plus
Q amplitude >= 0.025 mV, Q duration < 0.03 sec in lead I, when left
axis deviation more than −45° is present
(Code as 7-8 if 7-2 is present and electrical axis is < −45° when Q
pattern of lead I meets the above criteria.)
A-4
(However, QRS duration >= 0.12 sec)
8. Arrhythmias
8-1-1 Presence of frequent atrial premature beats or frequent junctional
premature beats. However, the number of premature beats must be
10% or more of all recorded waveforms.
8-1-2 Presence of frequent ventricular premature beats. However, the
number of premature beats must be 10% or more of all recorded
waveforms.
8-1-3 Coexistence of frequent atrial premature beats or frequent junctional
premature beats and frequent ventricular premature beats. However,
code if the total number of premature beats is 10% or more of all
recorded waveforms, even if the number of premature beats for each
is less than 10%.
8-1-6 Presence of frequent both atrial premature beats that do not meet the
criteria for 8-1-1
8-1-7 Presence of frequent ventricular premature beats that do not meet the
criteria for 8-1-2

8-2-2 Persistent ventricular rhythm

8-3-1 Atrial fibrillation (persistent)
8-3-2 Atrial flutter (persistent)
8-4-1 Supraventricular rhythm: No P waves appear or abnormal negative
P waves are present in any of leads II, III, or aVF. QRS duration is <
0.12 sec, P-R (P-Q) interval is < 0.12 sec, and rhythm is normal.
8-7 Sinus tachycardia: 100/min or higher
8-8 Sinus bradycardia: 50/min or lower
8-9-2 Sinus arrhythmias:
8-9-4 Coronary sinus rhythm: P waves are not present or abnormal
(negative or flat in lead aVF), and QRS duration < 0.12 sec, P-R (P-
Q) interval is >= 0.12 sec. Rhythm is normal.
8-9-7 Tachycardia (arrhythmia): 100/min or higher
8-9-8 Bradycardia (arrhythmia): 50/min or lower
8-9-9 Other arrhythmias
NOTE
Do not code 9 when 6-1, 6-4-1, 6-8, 8-2-2, or 8-4-1 are present and the
heart rate is >= 140.
9-1-1 QRS peak-to-peak amplitude < 0.5 mV in all of leads I, II, and III,
and < 1.0 mV in all of leads V1, V2, V3, V4, V5, and V6
9-1-2 QRS peak-to-peak amplitude < 0.5 mV in all of leads I, II, and III
9-1-3 QRS peak-to-peak amplitude < 1.0 mV in all of leads V1, V2, V3,
V4, V5, and V6
9-2-1 ST segment elevation (Do not code when 7-1-1, 7-2-1, 7-2-4, or 7-8
are present in addition to the codes mentioned in note 1.):
ST-J elevation >= 0.1 mV. ST segment sloping after the J point may
be upward, flat, or downward; however, downward inclination must
be 0.05 mV or less per each 0.08 sec.
(Anterolateral: in any of leads I, aVL, or V6
Inferior: in any of leads II, III, or aVF)
9-2-2 ST segment elevation (Do not code when 7-1-1, 7-2-1, 7-2-4, or 7-8
are present in addition to the codes mentioned in note 1.):
Anterior: ST-J elevation >= 0.2 mV in any of leads V1, V2, V3, or
V4, or ST-J elevation >= 0.2 mV in lead V5. ST segment sloping
after the J point may be upward, flat, or downward; however,
downward inclination must be 0.05 mV or less per each 0.08 sec.
Though, an exception is 9-2-3.
9-2-3 Brugada ECG:
A J wave with a J point amplitude >= 0.2 mV is present in any of
leads V1, V2, or V3. However, downward inclination of the J wave
must be 0.05 mV or less per each 0.08 sec.

9-2-4 Brugada ECG:

A J wave with a J point amplitude >= 0.02 mV is present in any of
leads V1, V2, or V3. However, downward inclination of the J wave
must be greater than 0.05 mV per each 0.08 sec.
9-3-1 Tall P waves:
P amplitude >= 0.25 mV in any beat of leads II, III, or aVF
9-3-2 Widened P waves:
P duration >= 0.12 sec in either lead I or lead II
9-4-1 Counterclockwise rotation:
QRS transition zone is V3 or to the right of lead V3
(Do not code if 7-1-1, 7-2-1, 7-4, or 7-8 are present in addition to the
code mentioned in note 1.)
9-4-2 Clockwise rotation:
QRS transition zone is V4 or to the left of lead V4
9-5 Tall T waves:
T wave amplitude > 1.2 mV in any of leads I, II, III, aVL, aVF, V1,
V2, V3, V4, V5, or V6
9-7 Dextrocardia
9-8-1 Cannot be coded due to technical recording problems or some codes
being questionable.
9-9-1 Prolonged QT interval
QTc exceeds 0.44 sec
However, QTc is calculated according to the setting of the ECG
machine being used.
A-4

Manufacturer
NIHON KOHDEN CORPORATION
1-31-4 Nishiochiai, Shinjuku-ku
Tokyo 161-8560, Japan
Phone +81 (3) 5996-8036
Fax +81 (3) 5996-8100
Sales
USA Asia
NIHON KOHDEN AMERICA, INC. NIHON KOHDEN TRADING (SHANGHAI)
90 Icon Street, Foothill Ranch, CA 92610, USA CO., LTD
Phone +1 (949) 580-1555 7th Floor, Dawning Centre Tower A No.500
Fax +1 (949) 580-1550 Hongbaoshi Road, Changning District
Shanghai 201103, China
Europe Phone +86 (21) 6270-0909
Fax +86 (21) 6270-9700
European Representative
NIHON KOHDEN EUROPE GmbH Beijing Branch
Room 1701, East Ocean Centre
Raiffeisenstrasse 10
No. 24A JianGuoMenWai Street, Beijing, 100004
D-61191 Rosbach v.d.H., Germany
Phone 010-6515-5750
Phone +49 6003 827-0 Fax 010-6515-5758
Fax +49 6003 827-599
Guangzhou Branch
NIHON KOHDEN ITALIA S.r.l. Room 2514, Yian Plaza
Via Fratelli Bronzetti 28 No. 33 Jian She Liu Ma Road, Guangzhou, 510060
I-24124 Bergamo, Italy Phone 020-8363-3737
Phone +39 035 219 543 Fax 020-8363-3807
Fax +39 035 232 546
NIHON KOHDEN SINGAPORE PTE LTD
NIHON KOHDEN FRANCE SARL 1 Maritime Square, #10-34 (Lobby C), Harbour Front Centre
8, rue Francois Delage, 94230 Cachan, France Singapore 099253
Phone +33 1 49 08 05 50 Phone +65 6376-2210
Fax +33 1 49 08 93 32 Fax +65 6376-2264
NIHON KOHDEN IBERICA S.L. NIHON KOHDEN KOREA, INC.

C/Ulises 75A Hannam Tower Annex Bldg. Suite 203
E-28043 Madrid, Spain 730 Hannam-dong, Yongsan-gu, Seoul, Korea 141-210
Phone +34 917 161 080 Phone +82 (2) 3273-2310
Fax +34 913 004 676 Fax +82 (2) 3273-2352
NIHON KOHDEN UK LTD

Tolworth Tower, Ewell Road, Surbiton Production
Surrey KT6 7EL, UK Reagent Production
Phone +44 20-8390-8622
Fax +44 20-8390-4675 NIHON KOHDEN FIRENZE S.r.l.
Via Torta 72/74
I-50019 Sesto Fiorentino Firenze, Italy
Phone +39 055 3045 1
Fax +39 055 308548
The model and serial number of your instrument are identified on the rear or bottom of the unit.
Write the model and serial number in the spaces provided below. Whenever you call your representative concerning
this instrument, mention these two pieces of information for quick and accurate service.
Model Serial number
Your Representative

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USER’S GUIDE

Section 3 Outline of ECG Automatic Recording 6-2

Section 6 Criteria of Findings

User’s Guide ECAPS 12C C.

C. User’s Guide ECAPS 12C

Section 6-2 Conductive Defect............................................................................... 6.2.1 1

Section 6-4 ST-T Abnormality................................................................................. 6.4.1

Section 6-5 Ventricular Hypertrophy...................................................................... 6.5.1

User’s Guide ECAPS 12C C.

Analysis Criteria for LVH................................................................................................ 6.5.6

7100 Abnormal right axis deviation............................................................................ 6.6.4

8003 Consistent with pulmonary disease................................................................... 6.6.8

0101 Possible arm leads reversed, check lead requested....................................... 6.6.12

Appendix 1 Analysis Mode

Appendix 2 Analysis after Exercise

Appendix 3 Modified Minnesota Code

C. User’s Guide ECAPS 12C

Appendix 4 Minnesota Code 1982 Version 1

User’s Guide ECAPS 12C C.

User’s Guide ECAPS 12C 1.1

1.2 User’s Guide ECAPS 12C

Final determination of overall interpretation judgement, diagnosis and

Patient Age and the Age Used for Analysis

Age Age which is used for analysis

• When classifying in age range:

Age Age which is used for analysis

• When patient’s actual age is entered:

User’s Guide ECAPS 12C 1.3

User’s Guide ECAPS 12C 2.1

2.2 User’s Guide ECAPS 12C

Although various means of eliminating errors and discrepancies between

(6) ECAPS 12C does not identify wandering pacemakers.

User’s Guide ECAPS 12C 2.3

Entering Patient Data........................................................................................................................................... 3.3

User’s Guide ECAPS 12C 3.1

ECG Measurement Flowchart

Enter patient information. Refer to p. 3.3.

Record ECG. Refer to p. 3.4.

Remove AC interference and base line

Measure P, QRS and T waveforms. Refer to p. 3.6.

Analyze ECG. Refer to p. 3.7.

Print out analysis results (finding). Refer to p. 3.11.

3.2 User’s Guide ECAPS 12C

Entering Patient Data

• Patient identification number (ID)

User’s Guide ECAPS 12C 3.3

Recording ECG Data

Improving Waveform Quality

Conventional analog filter Digital filter

3.4 User’s Guide ECAPS 12C

• High frequency noise

User’s Guide ECAPS 12C 3.5

Measuring ECG Waveform

ECG waveforms are measured as shown below.

The P waves for each heartbeat are searched and classified by

The most characteristic P wave pattern among the classified

P wave, QRS wave, T wave and ST segment are measured.

Rhythm is analyzed based on QRS wave and P wave waveform

Waveforms are measured as shown on the next page.

User’s Guide ECAPS 12C C.

C. User’s Guide ECAPS 12C

User’s Guide ECAPS 12C C.

C. User’s Guide ECAPS 12C

User’s Guide ECAPS 12C C.