The present Standard relates to the conventional recording of the electrocardiogram, i.e. the so-called standard 12-lead electrocardiogram and the vectorcardiogram (VCG). Initially, the electric connections used for recording the ECG were made to the limbs only. These connections to the right arm (RA), left arm (LA), left leg (LL) and right leg (RL) were introduced by Einthoven. The electrical variations detected by these leads are algebraically combined to form the bipolar leads I, n, and IH. Lead I, for example records the difference between the voltages of the electrodes placed on the left arm and the right arm. The unipolar electrocardiographic leads (aVR, aVL, aVF and the precordial leads V1 to V6) were introduced much later, starting in 1933.. In these leads, potentials are recorded at one location with respect to a level which does not vary significantly in electrical activity during cardiac contraction. The "augmented" limb lead potentials are recorded with reference to the average potential of (L+F), (R+F) and (L+R) respectively. The unipolar chest leads are recorded with reference to the average potential of (RA+RL+LL)/3 which is cailed the Wilson "central terminal" (CT).. In vectorcardiography recordings are made of three mutually perpendicular leads, running parallel to one of the rectilinear coordinate axes of the body. The axes are the X-axis going right to left, the Y-axis with a top to bottom orientation, and the Z or front to back axis.
In some research centers, so-called body surface maps are obtained by placing many (from 24 to 124 or even more) closely spaced electrodes around the torso. The current Standard has not been designed to handle transmission of such recordings, although future extensions could be made to this end. The Standard has also not been designed to transmit specialised recordings of intracardiac potentials or of the so-called Holter or other long-term ECG recordings made for monitoring cardiac rhythm . The current Standard also does not address exercise ECG recordings. The clinical need for transmission of these specialized recordings is indeed very low and has therefore not been considered in this Standard.
DS/ENV 1064:1993 history
1993DS/ENV 1064:1993 Medical informatics. Standard communication protocol. Computer-assisted electrocardiography