Introducing EP Calipers

Ever since the 1990s, when computer-based electrophysiology (EP) systems were introduced, HV intervals and ventricular tachycardia cycle lengths have been measured in the EP lab by electronic calipers — simple but accurate measurements accomplished on-screen using a track ball or a mouse. Despite this, physicians still often carry a physical pair of calipers, perhaps preserved from the pre-Sunshine Act days when they were provided for free by drug companies. They use these calipers to measure heart rates and QT intervals on printed electrocardiograms (ECGs). But more and more, ECGs are viewed electronically. All physicians now use smart phones and frequently send and receive photos of ECGs or rhythm strips for analysis. For example, when I was on-call there would often be a patient who went into atrial fibrillation in the middle of the night, or a patient who would be due a dose of dofetilide (a potentially dangerous QT interval prolonging drug). The nurse would have a rhythm strip or ECG that needed analyzing and the easiest way to do that in the post-fax machine era was for them to take a photo with a smart phone and text or email it to me for analysis. Measuring heart rates or corrected QT intervals requires the use of calipers, but physical calipers don’t work well with smart phones — maybe even scratching the glass screen! Electronic calipers akin to those used in the EP lab would be useful to make accurate measurements on ECG and rhythm strip images.

I did not realize that there weren’t any apps (as far as I can tell) providing electronic calipers until this was pointed out to me by one of my Twitter buddies, Dr. Michael Katz. So I wrote an app, EP Calipers, that provides these calipers.

As the screen shots show, these calipers look just like those provided by EP recording systems, such as the GE (formerly Prucka) Cardiolab system. Multiple calipers can be used at the same time. Both time and amplitude calipers are available.  Unlike real calipers, it is possible to zoom images and make much more accurate measurements. Also unlike real calipers, it is easy to measure mean heart rates and calculate QTc intervals automatically.  The app makes the necessary calculations.

I am hoping these electronic calipers will be easy to use and helpful to anyone who has to deal with ECG recordings. This is the first iteration of the app and I am open to suggestions to improve it. Right now the app is available for Apple iOS (version 8.1 or higher required), but the Android version will be available Real Soon Now. Have fun measuring intervals electronically to your heart’s content!