A Lesson for Electrocardiography ? Update

Update placed by new imaging methods in many applications. And in some applications, ECG is even considered obsolete, eg, in the diagnostics of left ventricular hypertrophy (LVH). The rational way to increase the interest of cardiolo-gists, to attract young scientists, and to increase the value of ECG, is to analyze and consequently to reduce its limitations. This means, first, to reevaluate the " old truths " and " myths, " second, to focus attention on the unique information provided by electrocardiography, and third, to recognize the added value of ECG in the context of other diagnostic methods, such as echocardiography, scintigraphy, NMR, and many others. I do not consider the frequently presented statement that ECG is easily available and inexpensive to be a sound argument. The need to constantly reevaluate accumulated knowledge and evidence is not limited to electrocardiography. It is a necessity for most fields of medical and professional practice. In the last 2 decades, this need has been formulated as evidence-based medicine (EBM) demanding the critical appraisal of evidence. Sackett et al 2 defined evidence-based medicine as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. The evidence based approach includes 4 stages: the formulation of answerable questions; the search for the best evidence; critical appraisal of the evidence; the decision to apply the conclusions to patients' health care. EBM provides general principles and a standardized way to reevaluate knowledge. The aim of this article is to apply the principles of evidence-based medicine to electro-cardiography and to begin discussions about evidence-based electrocardiography. An evidence-based medicine approach is applied to the ECG diagnostics of left ventricular hypertrophy based on voltage criteria not currently considered a " hot topic " and one in which a decline in interest is evident. We will assess whether an EBM approach is helpful in our efforts to reevaluate the " old truths, " to define the unique information provided by electrocardiography and Electrocardiography is an old diagnostic method, introduced at the end of the 19th century. Now, at the beginning of the 21st century, one of the main concerns of elec-trocardiologists is a decreased interest in electrocardiogra-phy in general, particularly among young scientists 1. Naturally, electrocardiography has strengths and weaknesses related to its age. On …