Normal values of the electrocardiogram for ages 16-90 years.

Introduction: To establish an up-to-date and comprehensive set of normal values for the clinically current measurements in the adult ECG, covering all ages for both sexes.

Methods: The study population included 13,354 individuals, taken from four population studies in The Netherlands, ranging in age from 16 to 90 years (55% men) and cardiologically healthy by commonly accepted criteria. Standard 12-lead ECGs were available for all participants. The ECGs were processed by a well-validated computer program. Normal limits were taken as the 2nd and 98th percentiles of the measurement distribution per age group.

Results: Our study corroborates many findings of previous studies, but also provides more differentiated results, in particular for the older age groups. Age trends were apparent for the QTc interval, QRS axis, and indices of left ventricular hypertrophy. Amplitudes in the left precordial leads showed a substantial increase in the older age groups for women, but not for men. Sex-dependent differences were apparent for most ECG parameters. All results are available on the Website www.normalecg.org, both in tabular and in graphical format.

Conclusions: We determined age- and sex-dependent normal values of the adult ECG. Our study distinguishes itself from other studies by the large size of the study population, comprising both sexes, the broad range of ages, and the exhaustive set of measurements. Our results emphasize that most diagnostic ECG criteria should be age- and sex-specific.