Electrocardiography in Women

n the just over 100 years since the first ECG was performed, 1 the ECG has become the most extensively used noninvasive diagnostic and prognostic tool in cardiology. Used both at rest and during provocative exercise, the 12-lead ECG has impressive, if imperfect, utility for rhythm analysis, detection of ischemic and hypertrophic heart disease, and outcome prediction in a variety of clinical settings, with a large body of literature that illustrates and supports these applications. The first observation of gender differences in the ECG was published 85 years ago by Bazett, 2 demonstrating that women have significantly longer QT intervals than men despite having higher heart rates. However, despite a growing body of literature demonstrating significant gender differences in QRS amplitudes and duration, 3-6 QT intervals, 5,7,8 ST-segment deviation, 9,10 and novel, computer-based measurements of T-wave complexity, 8,11 few ECG criteria routinely use gender-specific diagnostic criteria, and there has been a relative paucity of data on the prognostic performance of ECG variables in women.