Hip Hip Hurrah…for the 124th anniversary of the Ladder Diagram!
April 6, 2009
As many of you probably are completely unaware, this year is the 124th anniversary of the Ladder Diagram! (Yes, I know, I thought it was 125th but I can’t be bothered to wait a whole year to write this piece). Anyway, this remarkable and slightly over-looked little tool of ECG-rythm interpretation was first demonstrated in 1885 and has, since then, undergone quite a few revisions; it has developed in complexity with the increasing knowledge of cardiac electrophysiology. But even so; the original idea from the late 19th century remains virtually the same. Anyone who is trying to interpret an ECG, where the number of P-waves for some reason just doesn’t seem to equal the number of QRS-complexes, and has access to a ruler, a piece of paper and a sharp pen, might find it quite useful.
Basically you draw two lines, you mark out the P-waves on the upper line and the QRS-complexes on the lower one, and then you can start trying to decide which P-waves give rise to which complexes, and maybe even where there ought to have been P-waves but they are over-shadowed. This is what it might look like:
(For further reading: Johnson NP, Denes P. Am J Cardiol. 2008 Jun 15;101(12):1801-4. Epub 2008 Apr 16.)
You get the basic idea? Pretty neat, huh? To me, it seems like a simple and appealing way of clearifying and interpreting complex ECGs and it is well worth a happy 124th birthday!
P. S. Speaking of arrythmias, I hope you have all seen the most wonderful and endearing cardiology tutor ever: http://www.youtube.com/watch?v=zvWzm7ICzhw Don’t you just want to marry this man and have his babies?
