As automated ECG analysis has become commonplace, mastery of ECG interpretation in medical education programs has diminished markedly. Students must still appreciate the core fundamentals of electrocardiology, but training frequently does not expose many subtleties by often favoring many of the new heart imaging methods. Even some trained cardiologists may find their range of diagnostic interpretations to be somewhat limited when using the standard 12-lead electrocardiogram.
A new method of visual training using 3-D vector analysis makes ECG diagnosis significantly more accurate and intuitive for students and experienced clinicians alike. An instructional software program has been developed to improve electrocardiology training and provide a useful means to appreciate the spatial understanding of myocardial activation. This offers an easy way to acquire a clear, visual understanding of the sequence by which electrical excitation spreads through both the normal and diseased myocardium. The student becomes keenly aware of the cardiac excitation process through a series of 3D pictures during the entire electrical excitation processes.
The software available for Purchase on this Web site enables one to readily:
These 3-D images help the user to integrate the standard 12-lead ECG lead signals with the actual electrical excitation process of the myocardium, resulting in a clearer and more accurate visualization and understanding of the biological process.
Many of the world's leading cardiologists have long known that 3-D vector analysis is the only way to truly understand the electrocardiogram.
"The actual teaching of electrocardiography during the last two or three decades has failed because the person trying to learn is expected to memorize the shapes of abstract signals, called deflections, but may not understand their origin…. Accordingly, it is my opinion that the memorization of deflection shapes without understanding them is not the best way to interpret tracings. The best way to interpret tracings is to learn basic principles of electrocardiography, including vector concepts, and apply them to each tracing that is being interpreted. Without such an approach, people who memorize are helpless when they see tracings that they have not seen previously. In addition, unless basic principles - including vector concepts - are used to interpret each tracing, most persons will soon forget the basic principles." J. Willis Hurst, "Current Status of Clinical Electrocardiology With Suggestions for Improvement of the Interpretive Process" American Journal of Cardiology, Vol. 92, Nov.1, 2003.
3D Heart is an interactive instructional software program developed by ECG-TECH that uses a spatial presentation of ventricular activation to provide understanding about the basis for the generation of electrocardiographic waveforms. Using a 35-40 frame movie sequence, 3D Heart provides the user with an animated tutorial of left ventricular activation with text descriptions and vivid illustrations of the electrical activity of the heart and how it relates to the 12-lead ECG. The main screen of 3D Heart features a three-dimensional model of the left ventricle surrounded by three orthogonal planes with the six limb leads and six precordial leads superimposed in their respective planes. The user can control the progress of the movie sequence as well as the orientation of the display using a series of user controls located at the lower right portion of the screen (Figure I).
During the activation sequence, shading is used to represent the wave of depolarization spreading across the ventricle and dipole vectors are calculated during each frame of the animation in a twelve-segment model.2,3 Although the individual dipole vectors are not displayed in this view, the resultant mean vector is shown at each frame in the animation and coordinated with changes in each of the standard twelve leads of the ECG. As the resultant vector sweeps across the ventricle, a vectorcardiogram propagates from the electrical center of the heart and is projected on to each of the three orthogonal planes. The vectorcardiogram is color-coded to reflect different intervals of time (in milliseconds) during the activation sequence. The user has the option to toggle viewing of the text descriptions with a color code illustrative so that the significance of the colors can be understood (Figure II).
The 3D Heart user controls enable a number of different manipulations of the animation sequence to be performed. For example, the user can pause the animation at any time to study the location of the resultant mean vector or advance the activation sequence on a frame-by-frame basis using the available scroll bar. Left clicking the heart model allows the user to rotate it in space to obtain the preferred orientation and right clicking the model allows the user to drag and drop it to another location. By right-clicking in the rightward panel and dragging the mouse cursor in an upward direction, the user can zoom in on the ventricle and then zoom out by dragging in a downward direction (Figure III).
When the animation sequence is complete, the 3D Heart display yields a full vectorcardiogram as well as three distinct vector loops in each of the orthogonal planes (Figure IV). At this point the user can reload the same animation file to play again or load any variety of different animation sequences, each with their own unique electrical pattern arising from normal or abnormal patterns of ventricular activation.
The 3D Heart program contains a variety of different activation simulations. Currently the program enables the user to view the activation simulation for all of the following cases:
Simulations relating to other cardiac abnormalities, such as bundle branch block and left ventricular hypertrophy, will be added in the near future.
1. Pahlm US, OBrien JE, Pettersson J, Pahlm O, White T, Maynard C, Wagner GS; Comparison of teaching the basic electrocardiographic concept of frontal plane QRS axis: A determination using classic versus orderly limb lead displays. Am Heart J 1997;134:1014-1018.
2. Selvester RH, Ideker RE, Wagner GS. Pathological validation of computer model criteria for localizing infarcts in 12 segments of the left ventricle. Proceedings of the 1982 Engineering Foundation Conference on Computerized Interpretation of the Electrocardiogram. New York, Engineering Foundation Press, 1983, pp 127-138.
3. Olson CW, Wagner GS, Warner RA, Selvester RH, ‘A Dynamic Three Dimensional Display of Ventricular Excitation and the Generation of the Vector- and Electrocardiogram’ J Electrocardiol 34: 7 2001
4. Olson CW, Warner RA, ‘The Quantitative 3-Dimensional Vectorcardiogram’ J. Electrocardiol 33: 176 2000
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