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Aim. To study the electrocardiographic characteristics of secondary atrial septal defect (ASD) depending on its size. Subjects and methods. A total of 80 patients (32 men and 48 women; mean age 23.5±2.7 years) with this defect were examined and divided into three groups according to its size relative to body surface area. Results. The degree of electrocardiographic changes in secondary ASD depended on its size: a significant positive correlation was established between defect size and P wave amplitude (r=0.8; p