Advanced techniques in ECG

Abstract

Over the course of nearly a century, the 12-lead ECG has proven to be a valuable investigation in the diagnosis and assessment of a wide range of conditions. Like all tests, it has limitations. However, in certain circumstances, and in relation to particular conditions, modification of the standard ECG recording procedure can greatly increase the diagnostic value of the test. The authors look at how modified chest electrode positions and an ajmaline provocation test can unmask Brugada syndrome that is not evident from the standard ECG; how high-resolution signal-averaged ECGs may reveal late ventricular potentials that suggest an increased risk of malignant arrhythmias or the presence of arrhythmogenic right ventricular cardiomyopathy; and how multi-site body surface mapping may prove to be of value, particularly when combined with cardiac imaging, in elucidating the origin, and guiding the curative treatment, of certain arrhythmias.