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The most recent comprehensive AHA recommendations for the standardization of leads and general technical requirements of ECG instruments were published in 1975.

The CSE studies were designed to reduce the wide variation in wave measurements obtained by ECG computer programs and to assess and improve the diagnostic classification of ECG interpretation programs.

Accordingly, a major purpose of this document is to provide clinicians with insight into the generally missing link between technology and its consequences for clinical ECG interpretation.

The evolution and application of ECG technology have profound clinical implications, as exemplified by the demonstration that measurements made by different automated ECG systems from reference ECG data can vary enough to alter diagnostic interpretation.

Additional articles, to be published subsequently, will discuss the ECG interpretation of intraventricular conduction disturbances, abnormalities of ventricular repolarization, hypertrophy, and ischemia/infarction.

The purposes of this statement are (1) to examine the relation of the resting ECG to its technology, (2) to increase understanding of how the modern ECG is derived and recorded, and (3) to promote standards that will improve the accuracy and usefulness of the ECG in practice.

Indications for use of the ECG were summarized in a joint American Heart Association (AHA)/American College of Cardiology report in 1992.

Because of its broad applicability, the accurate recording and precise interpretation of the ECG are critical.

Special emphasis is placed on digital signal acquisition and computer-based signal processing, which provide automated measurements that lead to computer-generated diagnostic statements.The project has been endorsed by the American College of Cardiology, the Heart Rhythm Society, and the International Society for Computerized Electrocardiology. G.) was selected by the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology of the AHA.The purposes of this project are as follows: (1) to review the status of techniques currently used to record and interpret the ECG and to identify opportunities for modification; (2) to simplify and unify the various descriptive, diagnostic, and modifying terminologies currently used in order to create a common and more easily applied lexicon; and (3) to identify the weaknesses of the descriptive, interpretative, and comparative algorithms and recommend changes that incorporate the newly recognized factors referred to above. He formed an advisory group to assist in setting goals and to recommend other writing group members.Processing of the ECG occurs in a series of steps, each of which requires adherence to methodological standards.These steps include (1) signal acquisition, including filtering; (2) data transformation, or preparation of data for further processing, including finding the complexes, classification of the complexes into “dominant” and “nondominant” (ectopic) types, and formation of an average or median complex for each lead; (3) waveform recognition, which is the process for identification of the onset and offset of the diagnostic waves; (4) feature extraction, which is the measurement of amplitudes and intervals; and (5) diagnostic classification.

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