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One of the most important changes in electrocardiography is the widespread use of computerized systems for storage and analysis.Many if not most ECGs in the United States now are recorded by digital, automated machines equipped with software that measures ECG intervals and amplitudes, provides a virtually instantaneous interpretation, and often compares the tracing to those recorded earlier by the same system.Sensitivity and specificity of computer-based diagnostic statements are improving, but at the same time, it remains evident that physician overreading and confirmation of computer-based ECGs is required.A number of recommendations for the standardization of ECG recording and guidelines for ECG interpretation in the computer era have appeared during the past several decades.Derivation of representative waveforms and measurements based on global intervals are described.Special emphasis is placed on digital signal acquisition and computer-based signal processing, which provide automated measurements that lead to computer-generated diagnostic statements.Lead placement, recording methods, and waveform presentation are reviewed.

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.

The establishment of and adherence to professionally developed and endorsed evidence-based standards for all phases of the ECG procedure is an important step in ensuring the high level of precision required and expected by clinicians and their patients.

Since 1978, there have been many advances in the technology of electrocardiography; in the understanding of the anatomic, pathological, electrophysiological, and genetic information underlying ECG findings; and in the clinical correlations of ECG abnormalities.

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