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Celebrating the 100th Birthday of the Electrocardiogram: Lessons Learned From ECG Monitoring Research

Abstract

In 1902, a Dutch physiologist, Willem Einthoven, invented the first ECG machine and recorded limb leads I, II, and III in a human, for which he was awarded the Nobel Prize in Medicine. In the ensuing 100 years, an explosion of knowledge in the field of electrocardiography has sparked technological advances, including pacemakers, defibrillation, invasive cardiac electrophysiology testing, implantable cardioverter defibrillators, radio-frequency ablation, trans-telephonic transmission of ECG signals, and much more.

Drew was the first to report that VT criteria could be inadvertently changed to SVT criteria if precordial leads were positioned as little as one intercostal space away from their correct anatomic location. She also conducted a national random survey that indicated that inaccurate lead placement was a systemic problem in critical care units.

Drew also recognized the importance of monitoring ST segments to detect myocardial ischemia in patients with acute coronary syndromes (unstable angina and acute myocardial infarction [MI]). She recognized that several problems limited the efficacy of the ECG for detecting acute ischemia. First, ischemia is a localized phenomenon, and the ECG shows ST-segment abnormalities only in a restricted number of leads that directly face the myocardial zone of interest. Thus, an initial problem Drew tackled was: "How can we monitor numerous myocardial zones for ischemia without an excessive number of electrodes?" A solution to this problem that the Drew laboratory has been investigating is the use of reduced lead set technology, which involves estimating multiple ECG leads from a small number of strategically placed leads.

A second problem Drew investigated was: "How can we determine whether chest pain after percutaneous coronary interventions or thrombolytic therapy represents reocclusion at the intervention site?" A solution to this problem is to monitor for the patient’s ST "fingerprint," which is defined as the 12-lead ECG pattern during ischemia that is unique to the individual and based upon the site of coronary occlusion.

A third problem Drew studied was: "How can we identify more candidates for early reperfusion when the initial ECG is non-diagnostic in many patients who later "rule in" for acute MI?" A solution to this problem is multi-lead ST segment monitoring initiated in the emergency department, because acute MI patients often have dynamic ST elevation that may be missed with routine "snap-shot" 12-lead ECGs.

Findings were presented from 2 large prospective clinical trials testing reduced lead set 12-lead ST-segment monitoring in patients with acute coronary syndromes.

This study will be published in its entirety in the July 2002 issue of the Journal.

This Article Abstract Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Drew, B. J. Search for Related Content PubMed Articles by Drew, B. J.