The Electrocardiology of the Twenty‐First Century

Chapter 26
The Electrocardiology of the Twenty‐First Century

After more than 100 years of its invention, the surface electrocardiogram (ECG) remains the most frequently used diagnostic method in cardiovascular medicine, and one of the most used in the emergency departments (Pérez‐Riera et al. 2014; Baranchuk et al. 2014 and Baranchuk and Pérez‐Riera 2017). A rapid question that comes to mind is, why this simple tool was not replaced by new technologies that could help in the interpretation of the heart electricity; and only few variations have been incorporated since its inception? (Nadeau‐Routhier and Baranchuk 2016; Bayes de Luna and Baranchuk 2017).

The ECG has remained the flagship technique for recording electrical activity of the heart. In the field of imaging techniques, radiology, which is even older than ECG, has been widely surpassed first by echocardiography and later by magnetic resonance imaging. However, ECG has successfully outstripped the stakes of VCG, which from our point of view is still useful to understand how ECG images originate from the sequence: dipole–vector–loop–hemifield, but it is not necessary for carrying out the diagnosis, since, with few exceptions, the VCG criteria have not surpassed the ECG ones.

The answer is not easy and it could be multifactorial (Baranchuk, 2011): (i) Single method for the diagnosis of a myriad of a huge variety of conditions; from cardiomyopathies to acute myocardial infarction, from channelopathies to pulmonary embolism, etc. (ii) High reproducibility: the same type of ECG can be rapidly obtained in any corner of the world with quite similar technique and with very reasonable quality. In addition, ECGs could be obtained in the site of contact with the patient (i.e. paramedics at the site of acute cardiac arrest) helping in rapid decision‐making and orientating the initial response which could save a life. (iii) Easy transferability: with the rapid evolution of communications, a single snapshot with a cell phone can be emailed to an operating center to determine the course of action to take. (iv) Diagnostic method not only useful to establish a differential diagnosis, but also to determine prognosis and evolution, response to therapy (either drugs or cardiac devices), and identification of populations at risk (ECG & Epidemiology) (Bayes de Luna and Baranchuk 2017).

Several efforts to establish a universal ECG curriculum for pre‐ and postgrads have been advanced (Paul and Baranchuk 2011). More recently, two societies (International Society of Electrocardiology‐ISE and the International Society of Holter and Non‐invasive Electrocardiology‐ISHNE) have identified gaps in the educational system and proposed a structured curriculum that defines what, when, by whom, and where to teach electrocardiology (Antiperovitch et al. 2018). One of the major challenges in the educational process is how to avoid erosion, and the necessary bridges between pre‐ and postgrad education. Another important aspect is the lack of universal tests and methodology for evaluation.

Despite these limitations, the interpretation of surface ECGs continue to attract thousands of students that renovate every year. The accessibility to rapid platforms of communication (Facebook, Twitter, Instagram) has created niches of science outside the formal academic frame, stimulating the interest of larger audiences. The disadvantage of spreading wrong concepts or ideas, we think, is overcompensated by the opportunity to teach and learn at a worldwide level, interacting with peers from all around the world and exchanging simple (not always!) but effective messages.

Do we need to teach electrocardiology nowadays?

The answer is YES. Every day, lives depend on rapid and accurate ECG interpretation. From the diagnosis of a classic ST‐segment elevation myocardial infarction (pattern recognition) to the less classic ST‐segment depression in precordial leads with ST‐segment elevation in lead aVR (Wellens’ pattern) (Zhan et al. 2020) indicating subocclusion of the proximal LAD. From a differential diagnosis of narrow complex tachycardia (inductive‐deductive mechanisms) to the recognition of life‐threatening ECG of channelopathies (pattern recognition) (Baranchuk and Bayés‐Genís 2016, ECG University 2017). The huge myriad of diagnoses that an ECG reader can make are difficult to enumerate in this brief report, and we simply want to call attention on why the efforts to teach ECG should continue in the twenty‐first century.

Aspects to improve about ECG teaching

Several aspects of classic ECG teaching still need to improve (Antiperovitch et al. 2018

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Oct 9, 2021 | Posted by in CARDIOLOGY | Comments Off on The Electrocardiology of the Twenty‐First Century
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