electrocardiography
Enable an AI agent to recognise an electrocardiography procedure, assess whether its recording and interpretation are usable, and identify appropriate next actions within its authority.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
Researched by: Codex + Grok
Purpose and description
Enable an AI agent to recognise an electrocardiography procedure, assess whether its recording and interpretation are usable, and identify appropriate next actions within its authority.
Electrocardiography is the recording and interpretation of the heart's time-varying surface potentials, produced by myocardial depolarization and repolarization, as a diagnostic and monitoring method.
It can be Determine whether the recorded lead set, duration and conditions fit the stated clinical question.; Identify technical limitations and propose targeted checks or repeat acquisition for authorised staff.; Measure or extract ECG features while preserving the waveform segment, method and uncertainty.; Compare compatible current and prior recordings while accounting for lead and acquisition differences.; Distinguish automated observations from reviewed interpretations and route unresolved results for review.; Track communication and acknowledgement of findings under an applicable clinical workflow..
Distinguishing features
The procedure measures electrical potential differences using body-surface electrodes; a pulse waveform derived optically is photoplethysmography rather than electrocardiography.
Its primary recorded evidence is voltage over time in identified leads; anatomical images or ultrasound-derived motion belong to cardiac imaging.
Lead identity describes an electrical view and is not interchangeable with electrode identity or electrode count.
A rhythm strip, reduced-lead wearable recording and standard 12-lead acquisition must remain distinguishable because they provide different electrical views.
The procedure records cardiac electrical activity; electrical stimulation or shock delivery is a separate intervention.
Scope
+ The indication, intended question and acquisition mode of an electrocardiography procedure
+ Electrode placement, lead configuration, recording duration and acquisition settings
+ Waveform identity, technical quality, artefacts and limitations
+ Electrocardiographic measurements, observations and attributed interpretations
+ Review, comparison, repeat acquisition and communication of procedure results
- The patient's complete longitudinal health record and definitive disease diagnoses
- Echocardiography and other cardiac imaging procedures
- Intracardiac electrophysiology studies and invasive electrical mapping
- The complete exercise stress test or ambulatory monitoring programme surrounding an ECG acquisition
- ECG device manufacturing, maintenance and inventory management
- Treatment delivery, including medication administration, cardioversion and pacing
Characteristics
- Clinical question
- Rhythm assessment, symptom investigation, interval assessment, surveillance, or another stated purpose Usability depends on whether the acquisition can answer the intended question.
- Acquisition mode
- Resting acquisition, rhythm strip, ambulatory segment, exercise-associated acquisition, or another specified mode Recording context changes what can be inferred from the observed interval.
- Lead configuration
- Named lead set, electrode locations, and any modified or derived leads Electrical views determine which waveform comparisons and interpretations are supported.
- Recording duration
- Seconds, minutes or hours, with interruptions identified A short observation cannot establish that an intermittent event never occurs.
- Acquisition and display settings
- Sampling rate in Hz, displayed speed in mm/s and gain in mm/mV, where applicable Timing and amplitude measurements require known acquisition or display settings.
- Signal processing
- Applied filters, resampling, averaging, lead derivation and unknown processing Processing may change waveform appearance and the reliability of measurements.
- Technical usability
- Not assessed, usable for stated question, usable with limitations, or unusable Technical adequacy must be judged against the intended use.
- Measured ECG features
- Rate in beats/min, intervals in ms, amplitudes in mV and axes in degrees, each with method and uncertainty Measurements need their lead, segment and method to remain interpretable.
- Interpretation status
- Uninterpreted, automated preliminary, human preliminary, reviewed, amended or indeterminate An algorithmic statement and a reviewed clinical interpretation carry different authority.
- Associated clinical events
- Links to symptoms, exercise stages, interventions and prior ECG procedures with their times Temporal association supports contextual assessment without establishing causation.
Also called
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 18 findings · 30 questions.
Electrocardiographic purpose The clinical question and observation context that make this ECG procedure meaningful.
An ECG can be technically sound yet inadequate for the question that prompted it.
Indication and question
Why this recording is being obtained and what it is intended to establish.
Intended electrical assessment
The stated reason for acquisition and the electrical features or events being sought.
- What symptom, observation or monitoring need prompted this ECG? provenance
- What question is this acquisition intended to answer, and what would remain unanswered? boundary
Observation context
The patient's recorded circumstances during the acquisition.
Symptoms and recording conditions
The timing of symptoms and relevant conditions such as posture, movement or exercise.
- Was the recording obtained during the reported event, before it or after it, and how certain is that timing? measurement
- What posture, activity, symptoms and relevant interventions were documented during acquisition? provenance
Lead and acquisition design The electrical views, observation window and settings used to produce the recording.
Lead geometry and acquisition settings determine which electrical evidence the procedure actually captures.
Electrodes and leads
The relationship between physical electrode placement and recorded electrical views.
Actual lead configuration
The acquired lead set, placement deviations and distinction between measured and derived signals.
- Which leads were recorded, and which were reconstructed or derived rather than directly acquired? definition
- Were electrode locations standard for the declared configuration, modified or uncertain? provenance
Time and signal settings
Temporal coverage and transformations affecting waveform representation.
Recording window and calibration
Recording duration, simultaneity, calibration and processing needed to interpret the trace.
- What time window is represented, where are the gaps, and were displayed leads acquired simultaneously? measurement
- What sampling rate, gain, display speed and filters are known, and which settings are unavailable? provenance
Waveform integrity Whether the electrical recording can support the intended observations and measurements.
Artefacts, placement errors and incomplete traces can imitate or obscure clinically relevant patterns.
Artefacts and placement checks
Technical disturbances and suspected acquisition errors in specific leads or intervals.
Localised signal limitations
The extent and location of baseline drift, movement artefact, interference, clipping or possible lead misconnection.
- Which leads and time segments show artefact, dropout, clipping or unstable baseline? measurement
- What evidence supports a suspected electrode-placement or lead-connection error, and has it been checked? provenance
Fitness for interpretation
A question-specific judgement of which parts of the ECG remain usable.
Usable evidence and repeat need
Supported uses, unsupported conclusions and acquisition changes needed to resolve limitations.
- Which intended rhythm, interval or morphology assessments remain supported by the available signal? boundary
- What specific electrode check, setting correction or repeat acquisition would address the unresolved limitation? action
Electrical observations and interpretation Measured features and interpretive statements grounded in identifiable waveform evidence.
The model must distinguish a waveform observation, a calculated quantity and a clinical interpretation.
Rhythm and waveform measurements
Rate, timing and morphology observations with their methods and evidence locations.
Trace-grounded features
Reported rhythm features, intervals, amplitudes and morphology tied to leads and representative beats.
- What rate, regularity, atrial-to-ventricular relationships and waveform features are observed, and in which leads and segments? measurement
- How were reported intervals and corrected values calculated, including beat selection and any QT correction formula? provenance
Interpretive claims and limits
Attributed interpretations, competing explanations and the limits of this recording.
Supported interpretation
The meaning assigned to observations without equating an ECG pattern with a settled diagnosis.
- Which statements are direct observations, automated classifications or human interpretations, and who or what produced each? provenance
- What alternative explanations and acquisition limitations constrain the interpretation? boundary
- What cannot be excluded because the recording covers only these leads and this observation window? boundary
Comparison, review and disposition How this ECG is linked to prior evidence, reviewed and acted upon within an authorised workflow.
ECG meaning may depend on change over time, and a recorded result requires traceable review and communication.
Recording lineage and comparison
The connection between the procedure, its waveform versions and comparable earlier recordings.
Comparable ECG evidence
Verified recording identity and the conditions under which serial differences can be assessed.
- What links this waveform and report version to the correct patient, acquisition time and recording device? provenance
- Which prior ECG is being compared, and could lead placement, gain, filtering or acquisition context explain apparent changes? boundary
Review and result routing
Interpretation authority, unresolved discrepancies and completion of result communication.
Reviewed result and next action
The current report status and traceable next steps under the applicable clinical process.
- Has an authorised reviewer assessed the trace, and how were disagreements with automated or earlier interpretations resolved? provenance
- Under the applicable workflow, does this result require routine reporting, prompt review or urgent escalation, and who determines that? action
- Who must receive the result, has receipt been acknowledged, and what review or acquisition task remains open? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Kinds and varieties
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- resting 12-lead ECG
- ambulatory/Holter ECG
- exercise/stress ECG
- continuous bedside/telemetry ECG
- event/loop recorder ECG
- high-resolution/signal-averaged ECG
- fetal ECG
- vectorcardiography
- Which of these kinds and varieties hold for the sense of electrocardiography this model covers, and on what evidence? provenance
Identifiers and schemes
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Wikidata - Q79785 - electrocardiography
- Which of these identifiers and schemes hold for the sense of electrocardiography this model covers, and on what evidence? provenance
Standards and regulation
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- AHA/ACC/HRS recommendations for standardization and interpretation of the electrocardiogram (AHA/ACC/HRS)
- IEC 60601-2-25: Particular requirements for the basic safety and essential performance of electrocardiographs (IEC)
- IEC 60601-2-27: Particular requirements for electrocardiographic monitoring equipment (IEC)
- ISO 11073-91064 / SCP-ECG: Standard communications protocol for computer-assisted electrocardiography (ISO/CEN)
- FDA 21 CFR 870.2340: Electrocardiograph (FDA)
- Which of these standards and regulation hold for the sense of electrocardiography this model covers, and on what evidence? provenance
Real-world use
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- 12-lead ECG in emergency departments and clinics to detect acute coronary syndrome, arrhythmia, and conduction block
- Continuous bedside or telemetry monitoring in ICU and ward settings
- Ambulatory Holter and event recorders for intermittent palpitations and syncope workup
- Exercise ECG for inducible ischemia and chronotropic assessment
- Pre-participation, preoperative, and occupational screening
- Device clinics and wearable consumer ECG (single-lead) with clinician overread
- Which of these real-world use hold for the sense of electrocardiography this model covers, and on what evidence? provenance
Typical measurements
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- heart rate - 60-100 (resting adult) - beats/min
- PR interval - 120-200 - ms
- QRS duration - 80-120 - ms
- QT interval (rate-corrected QTc) - 350-450 (sex-dependent) - ms
- ST-segment deviation - 0 to ±1 (diagnostic thresholds higher by lead and sex) - mm
- paper/display speed - 25 (standard); 50 also used - mm/s
- amplitude calibration - 10 - mm/mV
- Which of these typical measurements hold for the sense of electrocardiography this model covers, and on what evidence? provenance
Failure modes and hazards
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Lead misplacement or limb-lead reversal producing false infarct or dextrocardia patterns
- Motion, tremor, and 50/60 Hz interference mimicking arrhythmia or ST change
- Filter and gain settings distorting ST segments or hiding pacing spikes
- Misdiagnosis of artifact as ventricular tachycardia leading to unnecessary shocks or drugs
- Electrical safety hazards (leakage current, defibrillator recovery) on connected equipment
- QTc-prolonging drugs and electrolyte disturbance causing torsades
- Over-reliance on automated interpretation without clinician review
- Which of these failure modes and hazards hold for the sense of electrocardiography this model covers, and on what evidence? provenance
Regional variation
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Cabrera (physically contiguous) vs standard limb-lead display order used in parts of Europe
- Right-sided (V3R-V6R) and posterior (V7-V9) leads more routinely added in some ACS protocols
- 50 Hz vs 60 Hz notch filtering by mains frequency
- Mason-Likar torso limb electrodes common in stress/monitoring vs wrists/ankles at rest
- Pediatric and neonatal lead sets and voltage criteria differ from adult cutoffs
- Which of these regional variation hold for the sense of electrocardiography this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- echocardiography - Ultrasound of cardiac structure and motion, not surface electrical potentials; no P-QRS-T waveform.
- electrophysiology study (intracardiac ECG) - Catheter electrodes inside the heart for mapping/ablation; not a surface 12-lead recording.
- vectorcardiography - Orthogonal XYZ loops of the same electrical field rather than scalar 12-lead traces.
- photoplethysmography / pulse oximetry waveform - Optical pulse volume, not myocardial voltage; cannot show P waves or QRS morphology.
- magnetocardiography - Magnetic field of cardiac currents, typically in a shielded room, not skin electrodes.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of electrocardiography this model covers, and on what evidence? provenance
Sources
- Recommendations for the Standardization and Interpretation of the Electrocardiogram - Clinical definition of ECG as surface recording of cardiac electrical activity; lead systems and measurement conventions used in practice.
What the second pass must settle
- Does an existing Vercy world model already own electrocardiography or a materially equivalent concept, requiring this registry entry to link to it?
- Should this entry own complete ambulatory ECG sessions as well as individual acquisitions, or should monitoring programmes own session-level coverage and event aggregation?
- Which authoritative acquisition and interpretation standards should ground requirements for conventional, modified and wearable lead configurations?
- Which population-specific contexts require additional questions or interpretation constraints, including paediatric recordings and paced rhythms?
- Which local policies define review authority, escalation criteria and permitted agent actions for preliminary ECG results?