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Influence of Positional Changes of Arms and Legs to Electrocardiogram
Biomed Sci Letters 2018;24:43-49
Published online March 31, 2018;  https://doi.org/10.15616/BSL.2018.24.1.43
© 2018 The Korean Society For Biomedical Laboratory Sciences.

Joo-Eun Song1,§, Min-Ju Song1,§, Ye-Sul Kim1, Ha-Nuel Yang1, Ye-Jin Lee1, and Dongju Jung1,2,†

1Department of Biomedical Laboratory Science, College of Life and Health Sciences, Hoseo University, Asan, Chungnam 31499, Korea,
2The Research Institute for Basic Science, Hoseo University, Asan, Chungnam 31499, Korea
Correspondence to: Dongju Jung. Department of Biomedical Laboratory Science, College of Life and Health Sciences, Hoseo University, Asan, Chungnam 31499, Korea. Tel: +82-41-540-9969, Fax: +82-41-540-9997, e-mail: djjungg@hoseo.edu
Received January 26, 2018; Accepted March 6, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract

Electrocardiogram (ECG) is a widely used method to diagnose electrical activity of heart. Although it is a reliable and easy method, ECG could be interfered by electrical signals. One of the interfering signals is electromyogram (EMG) that is caused by muscle contraction in any parts of the body except heart. To avoid the EMG noise, an examinee is advised to be relaxed on supine position while measuring ECG. Sometimes, patients who can’t put their arms and legs down on bed due to some reasons such as cast on arms or legs necessarily have the EMG noise. But detailed information about how much of the noise could be induced by positional change of arms and legs has not been reported. Here we examined the noise by analyzing ECG data from 14 candidates, 7 males and 7 females. The ECG data was obtained using the standard 12 lead ECG. EMG noise was induced by raising arms and legs at 90°, 60° or 30°. Because arms are located close to the heart, noise by the raised arms was analyzed toward left or right arm separately. All of the examinees showed similar pattern of the EMG noise. EMG noise by positional change of left or right arm was clearly monitored in different limb leads. Change of leg positions induced the noise that was monitored in aVF of augmented leads and II and III of limb leads. There was a difference in degree of the noise between male and female examinees. In addition to the EMG noise, decrease of PR interval was monitored in particular positional changes, which was prominent in male examinees. These results will enlarge fundamental understanding about EMG noise in ECG.

Keywords : Electrocardiogram, Electromyogram, PR interval
꽌濡

떖쟾룄(electrocardiogram, ECG)뒗 궗엺쓽 泥댄몴硫댁뿉꽌 떖옣쓽 쟾湲곗쟻 솢꽦룄瑜 怨좏넻 뾾씠 痢≪젙븷 닔 엳뒗 寃궗 諛⑸쾿씠떎. 궗슜씠 媛꾨떒븯怨 떖옣怨 愿젴맂 뿬윭 吏몴瑜 痢≪젙븷 닔 엳뼱꽌 留롮 蹂묒썝뿉꽌 1李⑥쟻씤 떖옣吏덊솚쓽 吏꾨떒뿉 궗슜븯怨 엳떎. 떖쟾룄 痢≪젙湲곕뒗 떖옣洹쇱쑁뿉꽌 諛쒖깮븯뒗 깉遺꾧레怨 옱遺꾧레쓽 쟾湲곗쟻씤 怨쇱젙쓣 諛쏆븘뱾씤 뮘 씠瑜 利앺룺빐꽌 洹몃옒봽濡 굹궡뒗 옣鍮꾩씠떎. 씠 옣鍮꾨 씠슜븯뿬 떖쟾룄瑜 痢≪젙븿쑝濡쒖뜥 떖옣쓽 諛뺣룞, 由щ벉 諛 떖옣 궡 쟾湲 쓲由꾩쓣 솗씤븷 닔 엳떎. 洹몃윭誘濡 떖쟾룄瑜 痢≪젙븿쑝濡 遺젙留, 떖옣 궡遺 援ъ“쓽 蹂솕, 떖궘吏덊솚, 쟾빐吏 遺덇퇏삎, 以묐룆, 쟾룄怨꾪넻쓽 씠긽 벑쓣 媛먯븷 닔 엳떎(Simonson, 1958). 듅엳 怨좊졊솕 씤援ъ쓽 鍮좊Ⅸ 利앷濡 씤빐 떖옣吏덊솚쓽 諛쒖깮씠 넂븘吏怨 엳吏留, 蹂댄넻 궗쟾吏뺥썑瑜 蹂댁씠吏 븡뒗 寃쎌슦媛 留롪린 븣臾몄뿉 떖옣吏덊솚쓽 吏꾨떒뿉 떖쟾룄쓽 以묒슂꽦 뜑슧 겕떎怨 븷 닔 엳떎.

쁽옱 궗슜以묒씤 떖쟾룄 옣鍮꾨뒗 꽕뜙뱶쓽 깮由ы븰옄 뿉씤듃샇踰(Willem Einthoven)씠 媛쒕컻븳 쁽꽑쟾瑜섍퀎(String galvanometer)뿉 湲곕컲븯硫 씠 諛⑸쾿쓣 넻빐 쁽옱 궗슜以묒씤 P, Q, R, S 諛 T 뙆삎씠 솗由쎈릺뿀떎. 뿉씤듃샇踰ㅼ쓽 媛쒕컻 씠썑 넗留덉뒪 猷⑥씠뒪(Thomas Lewis) 떎瑜 뿰援ъ옄뱾씠 떖옣 븵뿉꽌쓽 떒洹뱀쑀룄踰뺤쓣 媛쒕컻븯떎(Burch, 1978). 봽옲겕 쐧뒯(Frank Wilson) 벑 VR, VL, VF쓽 떒洹뱁뙏떎由 쑀룄瑜 媛쒕컻븯怨 썑뿉 뿞留덈늻뿕 怨⑤뱶踰꾧굅(Emmanuel Goldberger)媛 쐧뒯쓽 諛⑸쾿쓣 50% 뜑 利앺룺떆耳 利앺룺(augmented) 떒洹뱁뙏떎由 쑀룄瑜 媛쒕컻븯떎(Planck, 1945). 쁽옱뒗 씠 諛⑸쾿뱾쓣 醫낇빀븳 몴以12쑀룄 떖쟾룄踰뺤씠 궗슜릺怨 엳떎. 떖쟾룄뒗 媛꾪렪엳 떖옣쓽 쟾湲곗쟻 긽깭瑜 痢≪젙븷 닔 엳뒗 븞젙맂 諛⑸쾿씠吏留 뙆삎뿉 쁺뼢쓣 誘몄튌 닔 엳뒗 슂씤뱾씠 議댁옱븳떎. 뿬湲곗뿉뒗 씠굹 뵾遺 遺꾨퉬臾쇰줈 씤븳 쟾洹뱀젒珥됱씠 뒓뒯빐吏嫄곕굹, 紐 쐞쓽 꽭濡 씤븳 젒珥됰텋웾, 솚옄쓽 吏곸엫씠굹 샇씉 벑쑝濡 씤븳 諛붾떏꽑 룞슂, 쟾옄湲곗옣쓽 媛꾩꽠쑝濡 씤븳 諛붾떏꽑 룞슂, 씤怨듭떖옣蹂댁“湲 李⑹슜옄뿉꽌 諛쒖깮븯뒗 媛꾩꽠뙆삎 벑씠 엳떎. 洹몃옒꽌 씠윭븳 媛꾩꽠쓣 뾾븷湲 쐞빐 떖쟾룄 痢≪젙 떆 긽옄뒗 떖떊씠 븞젙릺뒗 寃 肉먮쭔 븘땲씪 떎궡쓽 삩룄, 뒿룄 諛 愿묐룄 벑쑝濡쒕꽣룄 쁺뼢쓣 諛쏆 븡뒗 긽깭뿉꽌 떖쟾룄 痢≪젙쓣 諛쏆븘빞 븳떎. 씠윭븳 쇅遺 議곌굔怨쇰뒗 긽愿뾾씠 슫룞 以묒뿉 떖쟾룄瑜 痢≪젙븯뒗 寃쎌슦굹, 吏덈퀝쑝濡 씤빐 뼱姨 닔 뾾씠 紐몄쓽 뼥由쇱씠 엳뒗 寃쎌슦뿉 洹쇱쟾룄(electromyogram, EMG) 샎엯씠 諛쒖깮븳떎. 뙆궓뒯蹂묒씠굹 븣肄붿삱湲덈떒利앹긽, 遺꾨끂, 떎諛쒖꽦 寃쏀솕利, 留덉빟瑜섏쓽 蹂듭슜 벑쓽 솚옄뿉꽌쓽 洹쇱쟾룄 샎엯씠 洹 삁媛 맆 닔 엳떎. 삉븳 뙏떎由 벑뿉 源곸뒪瑜 븯嫄곕굹 留덈퉬 벑쑝濡 븰쐞 옄꽭(supine position)瑜 쑀吏븯湲 옒뱺 寃쎌슦뿉룄 洹쇱쟾룄 샎엯씠 엳쓣 닔 엳떎. 븯吏留 씠윭븳 뙏떎由ъ쓽 옄꽭 蹂솕媛 뼱뒓 젙룄쓽 겕湲곕줈 뼱뼡 쑀룄뿉꽌 洹쇱쟾룄 샎엯쓣 씪쑝궎뒗吏뒗 議곗궗맂 쟻씠 뾾떎. 슦由щ뒗 씠 끉臾몄뿉꽌 뙏떎由ъ쓽 옄꽭 蹂솕媛 뼱뼡 삎깭濡 떖쟾룄뿉 쁺뼢쓣 誘몄튂뒗吏 議곗궗븯怨좎옄 븯떎. 醫, 슦 媛곴컖쓽 뙏쓽 옄꽭瑜 蹂솕떆궎怨 뿬湲곗뿉 떎由 옄꽭쓽 蹂솕瑜 뜑빐꽌 떖쟾룄瑜 痢≪젙븯떎. 몴以12쑀룄瑜 넻빐 뼸뼱吏 寃곌낵뒗 떖쟾룄 슜吏瑜 씠슜븯뿬 0.1 mV 씠긽쓽 洹쇱쟾룄 뙆삎쓽 샎엯遺꽣 떆옉븯뿬 0.1 mV뵫 利앷븷 븣留덈떎 븳 떒怨 넂 洹쇱쟾룄 샎엯쑝濡 몴떆븯떎. 떎뿕쓽 寃곌낵瑜 넻빐 醫, 슦 뙏쓽 옄꽭 蹂솕媛 뼱뒓 쑀룄뿉꽌 洹쇱쟾룄 샎엯쓣 씪쑝궎뒗吏, 뼱뒓 젙룄쓽 媛곷룄뿉꽌 媛옣 겙 洹쇱쟾룄 샎엯씠 씪뼱굹뒗吏뒗 솗씤븯떎. 븘슱윭 洹쇱쟾룄 샎엯뿉 궓 媛 李⑥씠媛 엳뒗 寃껋쓣 솗씤븯怨, 듅엳 궓꽦쓽 寃쎌슦뿉꽌 洹쇱쟾룄 샎엯 떆 PR 媛꾧꺽(PR interval)쓽 媛먯냼媛 솗씤릺뿀떎. 씠 寃곌낵瑜 넻빐 醫, 슦 뙏怨 떎由ъ쓽 옄꽭 蹂솕뿉 뵲瑜 洹쇱쟾룄 샎엯쓽 뼇긽쓣 젙웾쟻쑝濡 뙆븙븯怨 씠瑜 諛뷀깢쑝濡 뼢썑 엫긽寃궗뿉꽌 뙏떎由 吏곸엫씠 옄쑀濡吏 紐삵븳 솚옄瑜 긽쑝濡 떖쟾룄 寃궗 떆 李멸퀬옄猷뚮줈 궗슜맆 닔 엳쓣 寃껋씠씪 뙋떒맂떎. 븘슱윭 洹쇱쟾룄 샎엯씠 듅젙 떖쟾룄 媛꾧꺽뿉룄 쁺뼢쓣 誘몄튌 닔 엳떎뒗 寃껋쓣 궗떎쓣 諛쒓껄븯떎.

옱猷 諛 諛⑸쾿

떖쟾룄 痢≪젙 20 궓 媛 7紐낆뵫쓣 긽쑝濡 떎떆븯떎. 긽옄뒗 옄쑉쟻쑝濡 李몄뿬븯쑝硫 궗쟾뿉 떎뿕뿉 븳 꽕紐낆쓣 뱾뿀怨 떎뿕뿉 룞쓽븯떎. 紐⑤뱺 떎뿕 샇꽌븰援 깮紐낆쑄由ъ쐞썝쉶쓽 湲곗뿉 留욎텛뼱 떎떆븯떎. 떎뿕쓣 넻빐 뼸뼱吏 媛쒖씤젙蹂대뒗 紐⑤몢 씡紐 泥섎━븯쑝硫 떎뿕 쇅뿉 떎瑜 紐⑹쟻쑝濡 궗슜븯吏 븡븯떎.

떖쟾룄 痢≪젙쓣 쐞빐꽌 GE궗쓽 Mac 2000 떖쟾룄 湲곌린瑜 씠슜븯뿬 몴以12쑀룄瑜 痢≪젙븯떎. 쟾洹뱀쓽 遺李⑹ 넀紐 쐞履 10~15 cm, 諛쒕ぉ 쐞履 10~15 cm뿉 뙏떎由 쟾洹뱀쓣 遺李⑺븯怨, 媛뒾쟾洹뱀 떎쓬怨 媛숈씠 遺李⑺븯떎. V1 쟾洹뱀 꽬吏 媛덈퉬堉, 蹂듭옣 堉 삤瑜몄そ뿉 遺李, V2 쟾洹뱀 꽬吏 媛덈퉬堉, 蹂듭옣 堉 쇊履쎌뿉 遺李, V4 쟾洹뱀 떎꽢吏 媛덈퉬堉, 鍮쀬옣堉 以묎컙 꽑뿉 遺李⑺븯怨 V2 V4瑜 遺李⑺븳 以묎컙뿉 V3 쟾洹뱀쓣 遺李⑺븯떎. V6 쟾洹뱀쓣 V4 닔룊씠 릺룄濡 쇊 寃⑤뱶옉씠 꽑뿉 遺李⑺븯怨, V5 쟾洹뱀 V4 V6궗씠뿉 닔룊쑝濡 遺李⑺븯떎.

뵾寃옄뒗 癒몃━遺遺꾧낵 떎由щ遺꾩씠 媛곴컖 30° 긽듅릺룄濡 議곗젙맂 移⑤뿉 븰쐞 옄꽭濡 늻슫 긽깭濡 떖쟾룄 痢≪젙쓣 븯쑝硫, 듅엳 넀怨 諛쒖씠 移⑤ 諛뽰쑝濡 踰쀬뼱굹吏 븡룄濡 二쇱쓽븯떎. 뵾寃옄뒗 5遺 媛 늻썙 븞젙쓣 痍⑦븳 뮘 떖쟾룄 痢≪젙쓣 븯떎. 洹쇱쟾룄 샎엯쓣 쐞븳 떎뿕쓣 쐞빐꽌뒗 쟾洹뱀쓣 遺李⑺븯怨 쇊뙏, 삤瑜명뙏, 뼇履 뙏쓣 넀媛씫源뚯 렪 긽깭濡 媛곴컖 90°, 60°, 30° 뱾뼱삱由 썑 洹 옄꽭瑜 10珥 媛 쑀吏븳 긽깭뿉꽌 媛곴컖쓽 떖쟾룄瑜 痢≪젙븯떎. 떎由 媛곷룄뒗 떎由ъ 諛쒖씠 씪吏곸꽑씠 릺룄濡 90°, 60°, 30° 뱾뼱삱由 썑 옄꽭瑜 10珥 媛 쑀吏븳 긽깭뿉꽌 媛곴컖쓽 떖쟾룄瑜 痢≪젙븯떎. 뙏쓽 媛곷룄뒗 뼱源 꽑쓣 湲곗쑝濡 痢≪젙븯怨 떎由ъ쓽 媛곷룄뒗 눜怨⑥쓣 湲곗쑝濡 痢≪젙븯떎.

洹쇱쟾룄 샎엯뿉 븳 룊媛뒗 떎쓬怨 媛숈 諛⑹떇쑝濡 븯떎. 븰쐞 옄꽭뿉꽌 痢≪젙맂 떖쟾룄瑜 湲곗쑝濡 媛 쑀룄뿉꽌 洹쇱쟾룄 샎엯뿉 쓽븳 쟾쐞李⑥씠媛 뾾쓣 寃쎌슦 (-)濡 몴떆븯떎. 諛붾떏꽑쓣 以묒떖쑝濡 0.1 mV 씠븯쓽 踰붿쐞뿉꽌 洹쇱쟾룄 샎엯씠 엳쓣 寃쎌슦 (+), 0.1 mV 珥덇낵 0.2 mV 씠븯쓽 踰붿쐞뿉꽌 洹쇱쟾룄 샎엯씠 엳쓣 寃쎌슦 (++), 0.2 mV 珥덇낵 0.3 mV 씠븯쓽 踰붿쐞뿉꽌 洹쇱쟾룄 샎엯씠 엳쓣 寃쎌슦 (+++), 0.3 mV 珥덇낵 踰붿쐞뿉꽌 洹쇱쟾룄 샎엯씠 엳쓣 寃쎌슦 (++++)濡 몴떆븯떎.

떖쟾룄 뙆삎쓽 遺꾩꽍쓣 쐞빐꽌 RR 媛꾧꺽, QRS 媛꾧꺽, PR媛꾧꺽, QT 媛꾧꺽쓣 痢≪젙븯떎. 븰쐞 긽깭뿉꽌 痢≪젙맂 떖쟾룄 媛꾧꺽怨 鍮꾧탳븯뿬 뙏 삉뒗 떎由ъ쓽 옄꽭 蹂솕瑜 넻빐 媛 媛꾧꺽뿉꽌 利앷 삉뒗 媛먯냼媛 엳쓣 寃쎌슦 t 寃젙쓣 넻빐 넻怨꾩쟻씤 李⑥씠媛 엳뒗吏瑜 솗씤븯떎. 遺꾩꽍뿉 궗슜맂 媛꾧꺽뱾 紐⑤뱺 쑀룄뿉꽌 痢≪젙븯怨 룊洹좉컪쓣 援ы븯뿬 鍮꾧탳븯떎.

寃곌낵

洹쇱쟾룄 샎엯 痢≪젙쓣 쐞븳 옄꽭

洹쇱쟾룄 샎엯쓣 쑀룄븯湲 쐞빐 뙏怨 떎由щ 90°, 60°, 30°뵫 뱾뼱삱졇떎(Fig. 1). 뙏쓽 寃쎌슦 醫뚯슦瑜 븿猿 뱾뼱삱由ш굅굹 뵲濡 援щ텇븯뿬 뱾뼱삱졇怨, 떎由ъ쓽 寃쎌슦뒗 醫뚯슦瑜 븿猿 뱾뼱삱졇떎. 뙏떎由 吏곸엫뿉 쓽빐 諛붾떏꽑쓽 룞슂媛 겕寃 諛쒖깮븯湲 븣臾몄뿉 빐떦 옄꽭뿉꽌 10珥 젙룄 쑀吏븯뿬 諛붾떏꽑쓣 븞젙떆궓 긽깭뿉꽌 떖쟾룄瑜 痢≪젙븯떎. 씠윭븳 諛⑸쾿쑝濡 痢≪젙 떆 떖쟾룄 媛 쑀룄뿉꽌 洹쇱쟾룄媛 샎엯맂 寃껋쓣 솗씤븷 닔 엳뿀떎(Fig. 2).

Fig. 1.

Positional changes of arms and legs.


Fig. 2.

A Representative ECG recording have EMG (Electromyogram) noise.


뙏떎由 옄꽭 蹂솕뿉 뵲瑜 洹쇱쟾룄 샎엯 뼇긽

媛곴컖쓽 뙏떎由 옄꽭瑜 痍⑦뻽쓣 븣 샎엯릺뒗 洹쇱쟾룄쓽 쟾쐞 媛믪쓣 븰쐞 옄꽭뿉꽌쓽 쟾쐞 鍮꾧탳븯뿬 蹂솕맂 쟾쐞李(mV)瑜 젙웾쟻쑝濡 몴떆븯떎. 삤瑜몄そ 뙏쓣 媛곴컖 90°, 60°, 30° 뱾뼱삱졇쓣 븣 뙏떎由ъ쑀룄 I怨 II 쑀룄뿉꽌 洹쇱쟾룄 샎엯씠 諛쒓껄릺뿀怨 III 쑀룄뿉꽌뒗 샎엯씠 痢≪젙릺吏 븡븯떎. 떒洹뱀쑀룄뿉꽌뒗 aVL蹂대떎 aVR 쑀룄뿉꽌쓽 洹쇱쟾룄 샎엯씠 슌졆븯떎. 쇊履 뙏쓣 媛곴컖 90°, 60°, 30° 뱾뼱삱졇쓣 븣 뙏떎由ъ쑀룄 I怨 III뿉꽌 洹쇱쟾룄 샎엯씠 諛쒓껄릺뿀怨 II 쑀룄뿉꽌뒗 샎엯씠 痢≪젙릺吏 븡븯떎. 떒洹뱀쑀룄뿉꽌뒗 삤瑜몄そ 뙏쓣 뱾뼱삱졇쓣 븣 諛섎濡 쇊履 뙏쓣 뱾뼱삱졇쓣 븣뒗 aVR蹂대떎 aVL 쑀룄뿉꽌쓽 洹쇱쟾룄 샎엯씠 슌졆븯떎. 媛뒾쑀룄뿉꽌뒗 쇊履 뙏쓣 60°, 30° 뱾뼱삱졇쓣 븣 V5 V6 쑀룄뿉꽌 洹쇱쟾룄 샎엯씠 利앷릺뿀떎. 뼇履 뙏쓣 紐⑤몢 뱾뼱삱졇쓣 寃쎌슦 60°, 30°뿉꽌 V5 V6 쑀룄뿉꽌 痢≪젙맂 洹쇱쟾룄 샎엯뿉 뜑빐꽌 V3 V4 쑀룄뿉꽌룄 洹쇱쟾룄 샎엯씠 利앷븯뒗 寃껋쓣 愿李고븯떎. 뼇履 뙏쓣 90°瑜 뱾뼱삱졇쓣 寃쎌슦뿉꽌룄 븳履 뙏留 뱾뼱삱由 寃쎌슦뒗 떎瑜닿쾶 V6뿉꽌 洹쇱쟾룄 샎엯씠 利앷븯떎(Table 1-A). 뼇履 떎由щ 媛곴컖 90°, 60°, 30° 뱾뼱삱由 寃쎌슦 뙏떎由ъ쑀룄뿉꽌뒗 II III 쑀룄뿉꽌 洹쇱쟾룄 샎엯씠 슌졆븯怨, 60°, 30°瑜 뱾뼱삱由 寃쎌슦뿉꽌 뜑 슌졆븯寃 愿李곕릺뿀떎. 떒洹뱀쑀룄뿉꽌뒗 aVF뿉꽌 洹쇱쟾룄 샎엯씠 슌졆븯寃 愿李곕릺뿀怨 30°瑜 뱾뼱삱由 寃쎌슦뿉 洹쇱쟾룄 샎엯씠 紐⑤뱺 떒洹뱀쑀룄뿉꽌 利앷븯떎. 媛뒾쑀룄뿉꽌뒗 V4, V5, V6 쑀룄뿉꽌 洹쇱쟾룄 샎엯씠 슌졆븯떎(Table 1-A).

EMG noise recorded by a standard 12-lead ECG

(A)

MeanIIIIIIaVLaVRaVFV1V2V3V4V5V6

Normal------------
LA90°++-++++++++++++
LA60°+++-++++++++++++++
LA30°+++-+++++++++++++++
RA90°++++-++++++++++
RA60°++++-++++++++++
RA30°++++-+++++++++++
RLA90°++++++++++++++++++
RLA60°+++++++++++++++++++++++
RLA30°++++++++++++++++++++++++
RLL90°+++++++++++++++++
RLL60°+++++++++++++++++++++
RLL30°+++++++++++++++++++++++

(B)

FemaleIIIIIIaVLaVRaVFV1V2V3V4V5V6

Normal------------
LA90°++-++------++
LA60°++-++++----+++
LA30°+++-++++++++++++++
RA90°++--++------
RA60°+++--+++------
RA30°++++-++++--+++
RLA90°++++++++----++
RLA60°+++++++++++++++++
RLA30°++++++++++++++++++++
RLL90°-++++++++---+++
RLL60°-++++++++++++++++++++
RLL30°++++++++++++++++++++++

(C)

MaleIIIIIIaVLaVRaVFV1V2V3V4V5V6

Normal------------
LA90°++-+++++++++++++
LA60°+++-++++++++++++++++
LA30°+++-++++++++++++++++
RA90°++++-++++++++++
RA60°++++++-+++++++++++++
RA30°++++++-++++++++++++++
RLA90°++++++++++++++++++++
RLA60°+++++++++++++++++++++++++++++
RLA30°++++++++++++++++++++++++++++++
RLL90°++++++++++++++++++++++
RLL60°+++++++++++++++++++++++
RLL30°++++++++++++++++++++++++

Normal indicates remaining in supine position. RA and LA indicate right arm and left arm respectively. RLA indicates both of right and left arms. RLL indicates both of right and left legs. The numbers next to the RA, LA, RLA, and RLL indicate angles of arms and legs raised. (-) indicates no EMG noise, (+) indicates EMG noise of 0.1 mV.


洹쇱쟾룄 샎엯쓽 궓 李

궓꽦怨 뿬꽦뿉꽌쓽 뙏떎由 옄꽭 蹂솕뿉 뵲瑜 洹쇱쟾룄 샎엯쓣 鍮꾧탳븯湲 쐞빐 궓쓽 寃곌낵瑜 뵲濡 뼹뼱궡뼱 鍮꾧탳븯떎. 쟾諛섏쟻쑝濡 궓꽦뿉꽌쓽 洹쇱쟾룄 샎엯씠 뿬꽦蹂대떎 겙 寃껋쓣 솗씤븷 닔 엳뿀떎. 몴以뙏떎由 쑀룄뿉꽌 쇊履 뙏쓣 뱾뿀쓣 븣쓽 II 쑀룄 삤瑜명뙏쓣 뱾뿀쓣 븣쓽 III 쑀룄뿉꽌뒗 궓꽦뿉꽌룄 洹쇱쟾룄 샎엯씠 愿李곕릺吏 븡븯떎. 뿬꽦뿉꽌 洹쇱쟾룄 샎엯씠 굹굹吏 븡븯뜕 떒洹뱀쑀룄 媛뒾쑀룄쓽 寃쎌슦뿉꽌뒗 0.1 mV 씠븯 젙룄쓽 洹쇱쟾룄 샎엯씠 利앷맂 寃껋씠 궓꽦뿉寃뚯꽌 愿李곕릺뿀떎(Table 1-B, C).

洹쇱쟾룄 샎엯뿉 뵲瑜 떖쟾룄 媛꾧꺽쓽 蹂솕

洹쇱쟾룄 샎엯씠 씠猷⑥뼱議뚯쓣 寃쎌슦, 떖쟾룄 뙆삎쓽 媛꾧꺽뿉 쁺뼢쓣 誘몄튂뒗吏 솗씤븯떎. 씠瑜 쐞빐 RR 媛꾧꺽, QRS 媛꾧꺽, PR 媛꾧꺽, QT 媛꾧꺽쓣 痢≪젙븯뿬 븰쐞 긽깭뿉꽌 痢≪젙맂 떖쟾룄 媛꾧꺽怨 鍮꾧탳븯떎. 鍮꾧탳瑜 넻빐 떆媛 蹂솕媛 넻怨꾩쟻 쑀쓽꽦쓣 媛뽯뒗吏瑜 t 寃젙쑝濡 遺꾩꽍븯뿬 P 媛믪쑝濡 굹궡뿀떎. P 媛믪씠 0.05 씠븯씤 寃쎌슦뒗 쑀쓽쟻 李⑥씠媛 엳뒗 寃껋쑝濡 뙋紐낇븯怨, 0.01 씠븯씤 寃쎌슦뒗 留ㅼ슦 쑀쓽쟻 李⑥씠媛 엳뒗 寃껋쑝濡 뙋紐낇븯떎. 삤瑜명뙏씠굹 뼇떎由щ 30° 뱾뿀쓣 寃쎌슦 궓꽦뿉꽌 PR 媛꾧꺽씠 以꾩뼱뱶뒗 寃껋씠 솗씤릺뿀떎(Fig. 3A). 뿬꽦뿉꽌룄 삤瑜명뙏씠굹 뼇떎由щ 30° 뱾뿀쓣 寃쎌슦 PR 媛꾧꺽씠 以꾩뼱뱶뒗 寃껋씠 蹂댁씠굹 넻怨꾩쟻쑝濡 쑀쓽븯吏뒗 븡븯떎(Fig. 3B). 궓 寃곌낵瑜 빀븯뿬 遺꾩꽍븷 寃쎌슦, 뼇떎由щ 30° 뱾뿀쓣 寃쎌슦 PR 媛꾧꺽씠 以꾩뼱뱶뒗 寃껋쓽 넻怨꾩쟻 쑀쓽꽦씠 넂븘議뚮떎(Fig. 3C). 鍮꾨줉 PR 媛꾧꺽씠 以꾩뼱뱾뿀吏留 뼇떎由щ 30° 뱾뼱삱젮룄 RR 媛꾧꺽쓽 蹂솕뿉뒗 쁺뼢쓣 誘몄튂吏 紐삵븯떎(Data not shown).

Fig. 3.

PR interval decrease by EMG noise. normal indicates remaining in supine position, RA30 indicates raise of right arm at 30 degree, and RLL30 indicates raise of right and left legs at 30 degree.


怨좎같

떖쟾룄 痢≪젙 떆 샎엯릺뒗 洹쇱쟾룄뒗 젙긽쟻씤 痢≪젙쓣 諛⑺빐븯뒗 떊샇씠떎. 諛섎濡 洹쇱쟾룄 痢≪젙 떆뿉룄 떖쟾룄쓽 샎엯씠 臾몄젣媛 릺뼱 씠瑜 젣嫄고븯뒗 諛⑸쾿룄 蹂닿퀬릺뿀떎(Lu et al., 2009). 떖쟾룄 痢≪젙 떆 洹쇱쟾룄쓽 샎엯쓣 留됯린 쐞븳 諛⑸쾿쑝濡쒕뒗 솚옄쓽 긽깭瑜 븞젙쟻쑝濡 븯뒗 寃껋씠 媛옣 씪諛섏쟻씠떎. 븯吏留 洹쇱쑁쓽 吏곸엫씠 諛쒖깮븯뒗 吏덊솚쓣 媛吏怨 엳뒗 솚옄굹 뿞釉붾윴뒪뿉꽌 떖쟾룄瑜 痢≪젙븷 寃쎌슦뿉꽌뒗 뼱姨 닔 뾾씠 洹쇱쟾룄 샎엯씠 諛쒖깮븯誘濡 湲곌린쟻쑝濡 洹쇱쟾룄 샎엯쓣 嫄몃윭궡뒗 뿬윭 媛吏 諛⑸쾿뱾씠 媛쒕컻릺뿀떎(Cherkassky and Kilts, 2001; Blanco-Velasco et al., 2008; Mithun et al., 2011). 씪諛섏쟻쑝濡 엫긽뿉꽌 吏꾨떒슜쑝濡 궗슜븯뒗 몴以12쑀룄 떖쟾룄 湲곌린뒗 洹쇱쟾룄 샎엯씠 諛쒖깮븷 닔 엳쑝誘濡 뙏 삉뒗 떎由ъ쓽 쐞移 蹂솕媛 뼹留덈쭔겮쓽 洹쇱쟾룄瑜 쑀諛쒗븯怨, 샎엯맂 洹쇱쟾룄쓽 듅씠꽦쓣 씠빐븳떎硫 젙솗븳 떖쟾룄 寃곌낵 뙋룆뿉 留롮 룄쓣 以 닔 엳쓣 寃껋씠떎. 씠踰 떎뿕쓽 寃곌낵 뙏쓽 쐞移 蹂솕媛 엳뒗 寃쎌슦뿉꽌뒗 醫뚯륫 뙏씤吏 븘땲硫 슦痢 뙏씤吏뿉 뵲씪 洹쇱쟾룄 샎엯씠 꽌濡 떎瑜 떖쟾룄 쑀룄뿉꽌 痢≪젙릺뒗 寃껋쓣 솗씤븯떎. 씠뒗 뙏떎由 쑀룄 痢≪젙踰뺤쓽 痢≪젙썝由ъ뿉 젙솗엳 遺빀븯뒗 寃곌낵씠떎. 떎由ъ쓽 쐞移 蹂솕瑜 쑀룄븷 寃쎌슦뿉뒗 떖쟾룄 痢≪젙쟾洹뱀 쇊履쎌뿉, 젒吏쟾洹뱀 삤瑜몄そ 떎由ъ뿉 遺李⑺븯誘濡 뙏쓽 쐞移 蹂솕뒗 떎瑜닿쾶 醫뚯슦 李⑤ 솗씤븯湲 뼱젮썙 몢 떎由щ 紐⑤몢 븿猿 뱶뒗 諛⑹떇쑝濡 떎뿕쓣 吏꾪뻾븯떎. 씠 寃쎌슦 떒洹뱀쑀룄쓽 aVF, 뙏떎由ъ쑀룄쓽 II III 쑀룄 벑 떎由 履 諛⑺뼢쓽 異뺤쓣 媛吏怨 엳뒗 쑀룄뿉꽌 洹쇱쟾룄 샎엯씠 옒 痢≪젙릺뒗 寃껋쓣 솗씤븷 닔 엳뿀떎. 洹몃━怨 媛뒾쑀룄쓽 寃쎌슦뿉꽌뒗 뜑 醫뚯륫뿉 쐞移섑븳 V4, V5 洹몃━怨 V6 쑀룄뿉꽌 뜑 겙 洹쇱쟾룄 샎엯씠 굹궃 寃껋씠 듅吏뺤씠뿀떎. 洹몃윭誘濡 뼱뒓 쑀룄뿉꽌 洹쇱쟾룄媛 샎엯릺뒗吏瑜 솗씤븳떎硫 뙏떎由 뼱뒓 遺쐞쓽 洹쇱쑁뿉꽌 洹쇱쟾룄媛 諛쒖깮븯뒗吏瑜 삁痢 媛뒫븯寃 맂떎.

泥댄몴硫댁뿉꽌 湲곕줉릺뒗 洹쇱쟾룄쓽 샎엯 떖쟾룄 슜吏쓽 꼻 遺쐞뿉 嫄몄퀜 옉怨 뿰냽쟻씤 뙆삎쓣 留뚮뱺떎. 씠 삎깭뒗 QRS援곗뿉 吏묒쨷릺뼱 겙 븳 媛쒖쓽 뙆삎쓣 깮꽦븯뒗 떖쟾룄 뙆삎怨 겕寃 援щ텇맂떎(Gabriel et al., 2007). 洹몃옒꽌 洹쇱쟾룄 샎엯 뙆삎쓽 삎깭瑜 蹂닿퀬 돺寃 援щ텇빐궪 닔 엳쑝硫 洹 샎엯쓽 겕湲곕뒗 뙆삎쓽 겕湲곕줈 遺꾩꽍씠 媛뒫븯떎. 洹 삁濡 洹쇱쑁씠 긽쟻쑝濡 뜑 留롮 궓꽦뿉寃뚯꽌 媛숈 媛곷룄쓽 뙏떎由 쐞移 蹂솕뿉룄 洹쇱쟾룄 샎엯씠 뿬꽦蹂대떎 넂寃 굹궃 寃껋쓣 뱾 닔 엳떎. 궓꽦뿉寃뚯꽌 洹쇱쟾룄 샎엯 떆 떖쟾룄 PR 媛꾧꺽씠 以꾩뼱뱶뒗 寃껋 湲곗〈뿉 븣젮吏吏 븡븯뜕 듅吏뺤씠떎. 씠윭븳 궓 媛꾩쓽 李⑥씠뒗 洹쇱쟾룄 샎엯肉먮쭔 븘땲씪 쑀쟾옄쓽 떒씪뿼湲곕떎삎꽦(single nucleotide polymorphism, SNP)怨 듅젙 삎吏덉쓽 뿰愿꽦뿉꽌룄 굹굹뒗 寃껋쓣 솗씤븷 닔 엳떎(Jin and Jung, 2015). 븯吏留 以꾩뼱뱺 媛꾧꺽씠 젙긽 媛꾧꺽뿉꽌 踰쀬뼱궇 젙룄濡 媛먯냼븯吏뒗 븡 寃껋쑝濡 굹궗떎. PR 媛꾧꺽(interval) 떖諛⑹쓽 깉遺꾧레쓣 굹궡뒗 P뙆쓽 떆옉遺꽣 떖떎쓽 깉遺꾧레쓣 굹궡뒗 Q뙆쓽 떆옉 쟾源뚯쓽 떆媛꾩쓣 굹궡硫 젙긽쟻쑝濡 120 ms (millisecond)쓽 湲곌컙쓣 媛뽯뒗떎. PR 媛꾧꺽씠 留ㅼ슦 吏㏃븘吏뒗 寃쎌슦뒗 룞留μ쓽 긽泥섎굹 떖留됱뿼쓽 寃쎌슦뿉 諛쒖깮븯뒗 寃껋쑝濡 蹂닿퀬릺뿀떎(Pedley et al., 2002). 씠踰 떎뿕뿉꽌 洹쇱쟾룄 샎엯뿉 쓽븳 PR 媛꾧꺽쓽 媛먯냼뒗 痢≪젙릺뿀쑝굹 RR 媛꾧꺽 씪젙븳 寃껋쑝濡 蹂댁븘 떖옣諛뺣룞씠 利앷빐꽌 吏㏃븘吏 寃껋 븘땶 寃껋쑝濡 뙋떒맂떎. 듅엳 PR 媛꾧꺽쓽 媛먯냼뒗 삤瑜명뙏씠굹 뼇떎由щ 30° 뱾뿀쓣 寃쎌슦뿉꽌留 痢≪젙릺뿀怨, 쇊뙏쓣 30° 뱾뿀쓣 寃쎌슦뿉꽌뒗 媛먯냼媛 諛쒖깮븯吏 븡 寃껋씠 듅吏뺤쟻씤 寃곌낵씠떎.

씠踰 떎뿕 寃곌낵뒗 떖쟾룄 痢≪젙 떆 諛쒖깮븷 닔 엳뒗 洹쇱쟾룄 샎엯쓽 뼇긽쓣 뙏떎由ъ쓽 吏곸엫쓣 넻빐 젙웾쟻쑝濡 굹궡뿀떎. 옄뱾 씠 寃곌낵瑜 넻빐 엫긽뿉꽌 떖쟾룄 痢≪젙 떆 洹쇱쟾룄 샎엯뿉 븳 뙋떒 湲곗쓣 꽭슱 닔 엳쑝硫, 궓 媛꾩쓽 洹쇱쟾룄 샎엯쓽 李⑥씠媛 엳쓬쓣 젙웾쟻쑝濡 諛앺삍怨, 洹쇱쟾룄 샎엯쑝濡 씤빐 떖쟾룄쓽 듅젙 媛꾧꺽쓽 媛먯냼媛 諛쒖깮븷 닔 엳쓬쓣 諛앺삍떎.

ACKNOWLEDGEMENTS

None.

CONFLICT OF INTEREST

The authors declare that they have no competing interests.

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