Optimizing pacemaker and cardiac resynchronization therapy (CRT) device settings remains a time-intensive process, often requiring multiple manual adjustments to achieve optimal clinical outcomes. To address this, we developed a Windows-based C++ software platform that enables detailed comparison of vectorcardiograms (VCGs) acquired under different device configurations.
The platform supports VCGs obtained from two sources: (1) transformed 12-lead electrocardiograms (ECGs) using Kors and Dower matrices applied to Einthoven electrode signals, and (2) directly measured Frank VCGs from Frank lead placement. This dual capability allows for the evaluation of how transformation methods and acquisition techniques influence VCG morphology and derived parameters.
Orthogonal X, Y, and Z leads are reconstructed, and automated algorithms accurately detect and measure conventional intervals (PR, QRS duration, QT) as well as advanced spatial-temporal indices. After wave delineation, the software extracts three-dimensional parameters, including wave amplitudes, time-to-rise and time-to-descend for the P wave, QRS complex, and T wave, and the ratio of rise to fall times. All measurements are performed directly on the spatial VCG loop to minimize projection-related distortions.
An additional feature allows users to select and compare individual beats—such as ectopic or premature complexes—against the median beat from the same recording, facilitating detailed beat-to-beat variability analysis. This function is particularly valuable for evaluating conduction abnormalities and transient changes during device optimization.
The tool has been integrated into clinical practice by an experienced electrophysiologist and used to analyze VCGs from over 1,000 patients. By providing objective and spatially precise parameters, this platform offers a novel and standardized approach to applying VCG analysis in the optimization of pacemaker and CRT device settings.