I. Was the ECG performed?*

II. Was the Long-term ECG performed?*

III. Quality level*

1.1. Date of examination*

Date of Examination*

1.2. ECG recording quality insufficient*

1.3. Use of DAL-Square*

1.4. Comment*

1.5. Heart rate*

Heart rate*

1.6. Rhythm*

Please specify*

1.7. Pacemaker stimulation*

1.7.1. Atrial excitation following pacemaker stimulation*

1.7.2. Ventricular excitation following pacemaker stimulation*

1.7.3. Others*

1.7.4. Please specify*

1.8. PQ time*

PQ time*

1.9. QRS duration*

QRS duration*

1.10. QT time*

QT time*

1.11. AV block*

1.11.1 Degree*

1.12. Bundle branch block*

Please specify*

1.13. Hemiblock*

1.14. Discordant negative T-waves*

1.14.1 At least two of leads I, aVL, V6*

1.14.2 At least two of leads II, III, aVF*

1.14.3 At least two of leads V2, V3, V4, V5*

1.15. ST-segment pathological*

1.15.1 At least two of leads I, aVL, V6*

1.15.2 At least two of leads II, III, aVF*

1.15.3 At least two of leads V2, V3, V4, V5*

1.15.4 Others; please specify*

1.16. Q waves as an indication of expired infarction*

1.16.1 Q-wave in leads v2-v3 ? 0.02 sec or QS complex in leads v2 and v3*

1.16.2 Q-wave ? 0.03 sec and ? 0.1 mV deep or QS complex in leads I, II, aVL, aVF or v4-v6 in at least 2 neighbouring leads (I, aVL; v1-v6; II, III, aVF)*

2.1. Date of examination*

Date of Examination*

2.2. Recording duration*

Recording duration*

2.3. Average heart rate*

Mean heart rate*

2.4. Minimum heart rate*

Mean heart rate*

2.5. Maximum heart rate*

Mean heart rate*

2.6. Number of VES*

VES/SVES

2.7. Number of SVES*

VES/SVES

2.8. Duration of longest ventricular tachycardia*

VT

2.9. Frequency of longest ventricular tachycardia*

VT

2.10. Duration of fastest ventricular tachycardia*

VT

2.11. Frequency of fastest ventricular tachycardia*

VT

2.12. SDNN*

SDNN

2.13. Pauses >3 seconds*

2.13.1 Number of pauses >3 seconds*

Pausen

2.13.2 Duration of longest pause >3 seconds*

Pausen

2.13.3 Time of the longest pause >3 seconds*

Pausen