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Peering yet a little more behind the veil: Further insights from the ECG

Published:October 28, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.10.022
      Since the discovery that the electrical activity of the heart could be detected by electrodes on the skin and recorded as the electrocardiogram (ECG), scientists have been seeking the meaning of the varied deflections on the ECG and trying to correlate these with clinical findings. Discoveries came quickly—high QRS voltage meant hypertrophy, Q waves meant infarction had occurred, wide QRS complexes of different patterns implied delayed activation of one or the other ventricles, and wide QRS complex tachycardias had different physiological causes. By the 1990s, nearly a century after the first ECG recording and 50 years after the full 12-lead configuration had been established, it probably seemed to most that the era of finding something new in the ECG had passed. Yet, just since that time, the Brugada sign, malignant early repolarization patterns, fragmented QRS, upstroke on S waves in arrhythmogenic right ventricular dysplasia, ST elevation in aVR, short QT syndrome, refinements of subtypes of the long QT syndrome, Wellens T-wave sign, DeWinter ST-T sign, as well as other findings, have all been described. In all of these cases, observed abnormalities of the ECG led to a search for the physiological explanation.
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      Reference

      1. Arceluz MR, Liuba I, Tschabrunn CM, et al. Sinus rhythm QRS amplitude and fractionation in patients with non-ischemic cardiomyopathy to identify ventricular tachycardia substrate and location. Heart Rhythm 202X;XX:XXX–XXX.

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