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(Circulation. 2004;109:562-564.)
© 2004 American Heart Association, Inc.

Focused Perspectives

The Electrocardiogram 102 Years After Einthoven

Hein J.J. Wellens, MD; Anton P. Gorgels, MD

From the Cardiovascular Research Institute Maastricht (CARIM) (H.J.J.W.), and the Department of Cardiology, Academic Hospital Maastricht (A.P.G.), Maastricht, the Netherlands.

Correspondence to Hein J.J. Wellens, MD, 21, Henric van Veldekeplein, 6211 TG Maastricht, The Netherlands. E-mail hwellens@xs4all.nl

Key Words: Focused Perspectives • electrocardiography • arrhythmia • coronary disease

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
In 2002, we celebrated in the Netherlands the 100th anniversary of Einthoven’s first publication on the electrocardiogram (ECG).^1,2 During the past century, the ECG has become indispensable for rapid diagnosis and management of patients with a wide variety of cardiac diseases. As pointed out by Fisch,³ the ECG is an easily available, patient-friendly, noninvasive, inexpensive, and reproducible technique, without peer for the diagnosis of myocardial ischemia, cardiac arrhythmias, structural changes of the myocardium, drug effects, and electrolyte and metabolic disturbances.

Twenty years ago, we reviewed the advances in electrocardiology at that time.⁴ Now, we would like to discuss new information that can be obtained from the "simple" 12-lead ECG. The limited number of words allowed in an editorial makes it impossible to discuss the ionic and cellular basis of the normal and abnormal ECG and to look at recent studies that used more sophisticated and complex noninvasive techniques to obtain information about the electrical activity of the heart. We will focus on 4 areas in which new information that is useful in our daily cardiology practice has become available.

	1. Acute Coronary Syndromes: Determining the Extent and Severity of Cardiac Ischemia

 
In recent years, rapid decision-making has become mandatory in patients presenting with symptoms of acute cardiac ischemia. In that situation, information about the size of the area at risk and the severity of ischemia is essential. The ECG can (and should) play an important role in selecting the need for and type of coronary reperfusion procedure.

Traditionally, in ST-segment–elevation myocardial infarction, the size of the area at risk can be estimated . . . [Full Text of this Article]