{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:48:21Z","timestamp":1782928101363,"version":"3.54.5"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"},{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"}],"funder":[{"name":"Medizinische Hochschule Hannover (MHH)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Herzschr Elektrophys"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The QRS axis of the electrocardiogram (ECG) is often considered in clinical practice, but its determination is frequently limited to a\u00a0rough estimation, such as \u201cnormal\u201d, with left or right deviation, and superior or inferior in the case of premature ventricular complexes (PVCs). However, a\u00a0more exact determination of the QRS axis may be warranted in certain scenarios, such as to determine the origin of PVCs more precisely, and is attainable by visual estimation using the hexaxial reference system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to determine how well such an estimation of the QRS axis would correlate with the axis calculated by formulas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A\u00a0PVC database from 2012\u20132020 was used to extract 12-lead ECGs of patients with outflow tract PVCs and analyze the QRS axes of regularly conducted beats as well as PVCs. QRS axes were determined visually by two physicians with the help of the hexaxial reference system to an accuracy of\u00a010\u00b0 on the one hand, and were calculated using three previously described formulas based on QRS voltages on the other.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A\u00a0total of 216 QRS complexes from 108 patients were analyzed (108 regularly conducted beats and 108 PVCs). Estimated QRS axes of regularly conducted beats and PVCs were 39\u202f\u00b1\u200940\u00b0 and 88\u202f\u00b1\u200915\u00b0, respectively. Calculated QRS axes of regularly conducted beats according to the three formulas were 37\u202f\u00b1\u200940\u00b0, 36\u202f\u00b1\u200940\u00b0 and 35\u202f\u00b1\u200938\u00b0, respectively. Calculated QRS axes of PVCs according to the three formulas were 87\u202f\u00b1\u200915\u00b0, 87\u202f\u00b1\u200914\u00b0 and 86\u202f\u00b1\u200916\u00b0, respectively. Correlation coefficients showed strong correlations between the estimated and the three calculated values for regularly conducted beats (0.98, 0.97 and 0.98) and PVCs (0.94, 0.94 and 0.94).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A\u00a0sophisticated visual estimation of the QRS axis correlates well with voltage-based calculations and can therefore be considered sufficient for most purposes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00399-025-01065-x","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T13:59:52Z","timestamp":1737986392000},"page":"70-74","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Determining the QRS axis: visual estimation is equal to calculation","Bestimmung der QRS-Achse\u00a0\u2013 visuelle Sch\u00e4tzung entspricht Berechnung"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3485-7657","authenticated-orcid":false,"given":"Johanna","family":"Mueller-Leisse","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Syrbius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6916-2652","authenticated-orcid":false,"given":"Henrike Aenne Katrin","family":"Hillmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg","family":"Eiringhaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1606-3423","authenticated-orcid":false,"given":"Stephan","family":"Hohmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Zormpas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizar","family":"Karfoul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2996-6338","authenticated-orcid":false,"given":"David","family":"Duncker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7587-1124","authenticated-orcid":false,"given":"Christian","family":"Veltmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,27]]},"reference":[{"key":"1065_CR1","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1093\/eurjhf\/hfq229","volume":"13","author":"C Ukena","year":"2011","unstructured":"Ukena\u00a0C, Mahfoud\u00a0F, Kindermann\u00a0I, Kandolf\u00a0R, Kindermann\u00a0M, B\u00f6hm\u00a0M (2011) Prognostic electrocardiographic parameters in patients with suspected myocarditis. European J of Heart Fail 13:398\u2013405. https:\/\/doi.org\/10.1093\/eurjhf\/hfq229","journal-title":"European J of Heart Fail"},{"key":"1065_CR2","doi-asserted-by":"publisher","first-page":"370","DOI":"10.5830\/CVJA-2017-020","volume":"28","author":"I Balieva","year":"2017","unstructured":"Balieva\u00a0I, Dzudie\u00a0A, Thienemann\u00a0F, Mocumbi\u00a0AO, Karaye\u00a0K, Sani\u00a0MU et\u00a0al (2017) Prevalence and predictive value of electrocardiographic abnormalities in pulmonary hypertension: evidence from the pan-African pulmonary hypertension cohort (PAPUCO) study. Cardiovasc J Afr 28:370\u2013376. https:\/\/doi.org\/10.5830\/CVJA-2017-020","journal-title":"Cardiovasc J Afr"},{"key":"1065_CR3","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1161\/01.cir.37.3.429","volume":"37","author":"RP Lasser","year":"1968","unstructured":"Lasser\u00a0RP, Haft\u00a0JI, Friedberg\u00a0CK (1968) Relationship of right bundle-branch block and marked left axis deviation (with left parietal or peri-infarction block) to complete heart block and syncope. Circulation 37:429\u2013437. https:\/\/doi.org\/10.1161\/01.cir.37.3.429","journal-title":"Circulation"},{"key":"1065_CR4","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1161\/01.cir.12.4.604","volume":"12","author":"AJ Brink","year":"1955","unstructured":"Brink\u00a0AJ, Neill\u00a0CA (1955) The electrocardiogram in congenital heart disease; with special reference to left axis deviation. Circulation 12:604\u2013611. https:\/\/doi.org\/10.1161\/01.cir.12.4.604","journal-title":"Circulation"},{"key":"1065_CR5","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.jelectrocard.2019.04.007","volume":"63","author":"HS Stork\u00e5s","year":"2020","unstructured":"Stork\u00e5s\u00a0HS, Hansen\u00a0TF, Tahri\u00a0JB, Lauridsen\u00a0TK, Olsen\u00a0FJ, Borgquist\u00a0R et\u00a0al (2020) Left axis deviation in patients with left bundle branch block is a\u00a0marker of myocardial disease associated with poor response to cardiac resynchronization therapy. J\u00a0Electrocardiol 63:147\u2013152. https:\/\/doi.org\/10.1016\/j.jelectrocard.2019.04.007","journal-title":"J Electrocardiol"},{"key":"1065_CR6","doi-asserted-by":"publisher","first-page":"1914","DOI":"10.1111\/jce.14103","volume":"30","author":"M Kawamura","year":"2019","unstructured":"Kawamura\u00a0M, Arai\u00a0S, Gokan\u00a0T, Yoshikawa\u00a0K, Ogawa\u00a0K, Ochi\u00a0A et\u00a0al (2019) Idiopathic basal crux ventricular arrhythmias with left bundle branch block and superior axis: a\u00a0comparison with inferior-septal valvular arrhythmias. J\u00a0Cardiovasc Electrophysiol 30:1914\u20131922. https:\/\/doi.org\/10.1111\/jce.14103","journal-title":"J Cardiovasc Electrophysiol"},{"key":"1065_CR7","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euad122.297","author":"L Mazzocchetti","year":"2023","unstructured":"Mazzocchetti\u00a0L, Parollo\u00a0M, Sbragi\u00a0S, Barletta\u00a0V, Segreti\u00a0L, Di Cori\u00a0A et\u00a0al (2023) Ventricular tachycardia site of origin prediction by a\u00a0QRS axis-based algorithm confirmed by heterogenous tissue channel localization obtained from artificial-intelligence-powered CMR analysis. Europace. https:\/\/doi.org\/10.1093\/europace\/euad122.297","journal-title":"Europace"},{"key":"1065_CR8","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s00399-021-00746-7","volume":"32","author":"B Fries","year":"2021","unstructured":"Fries\u00a0B, Johnson\u00a0V, Rutsatz\u00a0W, Schmitt\u00a0J, Bogossian\u00a0H (2021) Localization of ventricular premature contractions by 12-lead ECG. Herzschrittmacherther Elektrophysiol 32:21\u201326. https:\/\/doi.org\/10.1007\/s00399-021-00746-7","journal-title":"Herzschrittmacherther Elektrophysiol"},{"key":"1065_CR9","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1002\/acr.24724","volume":"74","author":"JK Lui","year":"2022","unstructured":"Lui\u00a0JK, Sangani\u00a0RA, Chen\u00a0CA, Bujor\u00a0AM, Trojanowski\u00a0MA, Gopal\u00a0DM et\u00a0al (2022) Prognostic value of cardiac axis deviation in systemic sclerosis-related pulmonary hypertension. Arthritis Care Res 74:1219\u20131226. https:\/\/doi.org\/10.1002\/acr.24724","journal-title":"Arthritis Care Res"},{"key":"1065_CR10","doi-asserted-by":"publisher","first-page":"1587","DOI":"10.1093\/europace\/euu396","volume":"17","author":"S Kusa","year":"2015","unstructured":"Kusa\u00a0S, Hachiya\u00a0H, Iwasawa\u00a0J, Ichihara\u00a0N, Komatsu\u00a0Y, Taniguchi\u00a0H et\u00a0al (2015) Ventricular arrhythmias with superior axis originating from the left ventricular septum: electrocardiographic characteristics predicting successful ablation and insights into their mechanism-observations from a\u00a0small series of patients. Europace 17:1587\u20131595. https:\/\/doi.org\/10.1093\/europace\/euu396","journal-title":"Europace"},{"key":"1065_CR11","doi-asserted-by":"publisher","first-page":"1970","DOI":"10.1093\/europace\/euab189","volume":"23","author":"TR Larsen","year":"2021","unstructured":"Larsen\u00a0TR, Shepard\u00a0RK, Koneru\u00a0JN, Cabrera\u00a0J\u2011A, Ellenbogen\u00a0KA, Padala\u00a0SK (2021) Electrocardiographic characteristics and ablation of ventricular arrhythmias originating from the basal inferoseptal area. Europace 23:1970\u20131979. https:\/\/doi.org\/10.1093\/europace\/euab189","journal-title":"Europace"},{"key":"1065_CR12","doi-asserted-by":"publisher","first-page":"7369","DOI":"10.3390\/jcm11247369","volume":"11","author":"O Dzikowska-Diduch","year":"2022","unstructured":"Dzikowska-Diduch\u00a0O, Kurnicka\u00a0K, Lichodziejewska\u00a0B, Dudzik-Niewiadomska\u00a0I, Machowski\u00a0M, Roik\u00a0M et\u00a0al (2022) Electrocardiogram, echocardiogram and NT-proBNP in screening for thromboembolism pulmonary hypertension in patients after pulmonary embolism. J\u00a0Clin Med 11:7369. https:\/\/doi.org\/10.3390\/jcm11247369","journal-title":"J Clin Med"},{"key":"1065_CR13","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1536\/ihj.27.17","volume":"27","author":"Y Takayama","year":"1986","unstructured":"Takayama\u00a0Y, Seki\u00a0A, Imataka\u00a0K, Fujii\u00a0J (1986) Exercise-induced QRS axis shift and its clinical significance. Jpn Heart\u00a0J 27:17\u201323. https:\/\/doi.org\/10.1536\/ihj.27.17","journal-title":"Jpn Heart J"},{"key":"1065_CR14","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1111\/anec.12206","volume":"19","author":"A Oehler","year":"2014","unstructured":"Oehler\u00a0A, Feldman\u00a0T, Henrikson\u00a0CA, Tereshchenko\u00a0LG (2014) QRS\u2011T angle: a\u00a0review. Ann Noninvasive Electrocardiol 19:534\u2013542. https:\/\/doi.org\/10.1111\/anec.12206","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"1065_CR15","first-page":"180","volume":"87","author":"SR Gupta","year":"1989","unstructured":"Gupta\u00a0SR, Gupta\u00a0SK, Sudhir\u00a0K, Reddy\u00a0KN, Murthy\u00a0JS, Abraham\u00a0KA (1989) Mean frontal QRS axis and pulmonary artery pressures in rheumatic mitral stenosis. J\u00a0Indian Med Assoc 87:180\u2013182","journal-title":"J Indian Med Assoc"},{"key":"1065_CR16","first-page":"1389","volume":"75","author":"R Soria","year":"1982","unstructured":"Soria\u00a0R, Guize\u00a0L, Fernandez\u00a0F, Chaouat\u00a0JC, Chr\u00e9tien\u00a0JM (1982) Prevalence and electrocardiographic forms of the wolff-parkinson-white syndrome. Arch Mal Coeur Vaiss 75:1389\u20131399","journal-title":"Arch Mal Coeur Vaiss"},{"key":"1065_CR17","doi-asserted-by":"publisher","first-page":"13","DOI":"10.5152\/eajm.2012.03","volume":"44","author":"MF Karakas","year":"2012","unstructured":"Karakas\u00a0MF, Bilen\u00a0E, Kurt\u00a0M, Arslantas\u00a0U, Ipek\u00a0G, Karakas\u00a0E et\u00a0al (2012) The correlation between infarct size and the QRS axis change after thrombolytic therapy in ST elevation acute myocardial infarction. Eurasian J Med 44:13\u201317. https:\/\/doi.org\/10.5152\/eajm.2012.03","journal-title":"Eurasian J Med"},{"key":"1065_CR18","doi-asserted-by":"publisher","first-page":"43","DOI":"10.4103\/2352-4197.191481","volume":"1","author":"Zhang","year":"2016","unstructured":"Zhang (2016) A\u00a0vector-based algorithm to differentiate septal and free wall sites of origin of ventricular arrhythmias in the right ventricular outflow tract. Int J Heart Rhythm 1:43\u201349. https:\/\/doi.org\/10.4103\/2352-4197.191481","journal-title":"Int J Heart Rhythm"},{"key":"1065_CR19","doi-asserted-by":"publisher","DOI":"10.1111\/anec.13066","author":"X Cao","year":"2023","unstructured":"Cao\u00a0X, Wang\u00a0Z, Fang\u00a0Z, Yu\u00a0C, Shi\u00a0L (2023) Value of frontal QRS axis for risk stratification of individuals with prolonged PR interval. Ann Noninvasive Electrocardiol. https:\/\/doi.org\/10.1111\/anec.13066","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"1065_CR20","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euad108","author":"S Weng","year":"2023","unstructured":"Weng\u00a0S, Xie\u00a0H, Guo\u00a0X, Sun\u00a0Q, Wang\u00a0F, Tang\u00a0M (2023) A\u00a0subtype electrocardiogram pattern on idiopathic ventricular arrhythmias originating around the pulmonary right sinus: discordance between electrocardiographic classification and three-dimensional mapping. Europace. https:\/\/doi.org\/10.1093\/europace\/euad108","journal-title":"Europace"},{"key":"1065_CR21","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1016\/j.amjcard.2007.07.069","volume":"101","author":"DH Spodick","year":"2008","unstructured":"Spodick\u00a0DH, Frisella\u00a0M, Apiyassawat\u00a0S (2008) QRS axis validation in clinical electrocardiography. Am J Cardiol 101:268\u2013269. https:\/\/doi.org\/10.1016\/j.amjcard.2007.07.069","journal-title":"Am J Cardiol"},{"key":"1065_CR22","first-page":"77","volume":"40","author":"D Novosel","year":"1999","unstructured":"Novosel\u00a0D, Noll\u00a0G, Luscher\u00a0TF (1999) Corrected formula for the calculation of the electrical heart axis. Croat Med\u00a0J 40:77\u201379","journal-title":"Croat Med J"},{"key":"1065_CR23","volume-title":"The ECG manual","author":"M Gertsch","year":"2008","unstructured":"Gertsch\u00a0M (2008) The ECG manual. Springer Science & Business Media"},{"key":"1065_CR24","first-page":"212","volume":"47","author":"PN Singh","year":"2003","unstructured":"Singh\u00a0PN, Athar\u00a0MS (2003) Simplified [correction of simlified] calculation of mean QRS vector (mean electrical axis of heart) of electrocardiogram. Indian J Physiol Pharmacol 47:212\u2013216","journal-title":"Indian J Physiol Pharmacol"},{"key":"1065_CR25","doi-asserted-by":"publisher","first-page":"2411","DOI":"10.3390\/ijerph20032411","volume":"20","author":"C Ciucurel","year":"2023","unstructured":"Ciucurel\u00a0C, Iconaru\u00a0EI (2023) The relationship between the frontal QRS\u2011T angle on ECG and physical activity level in young adults. Int J Environ Res Public Health 20:2411. https:\/\/doi.org\/10.3390\/ijerph20032411","journal-title":"Int J Environ Res Public Health"},{"key":"1065_CR26","first-page":"12","volume":"14","author":"S Hoseini","year":"2011","unstructured":"Hoseini\u00a0S, Moeeny\u00a0A, Shoar\u00a0S, Shoar\u00a0N, Naderan\u00a0M, Gharibzadeh\u00a0S et\u00a0al (2011) Designing nomogram for determining the heart\u2019s QRS axis. J\u00a0Clin Basic Cardiol 14:12\u201315","journal-title":"J Clin Basic Cardiol"},{"issue":"1","key":"1065_CR27","first-page":"35","volume":"27","author":"G Lanza-Tarricone","year":"2016","unstructured":"Lanza-Tarricone\u00a0G (2016) Methods for determining the electrical axis in the electrocardiogram. Revista Mexicana De Cardiol 27(1):35\u201340","journal-title":"Revista Mexicana De Cardiol"}],"container-title":["Herzschrittmachertherapie + Elektrophysiologie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00399-025-01065-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00399-025-01065-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00399-025-01065-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:07:54Z","timestamp":1782925674000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00399-025-01065-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,27]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["1065"],"URL":"https:\/\/doi.org\/10.1007\/s00399-025-01065-x","relation":{},"ISSN":["0938-7412","1435-1544"],"issn-type":[{"value":"0938-7412","type":"print"},{"value":"1435-1544","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,27]]},"assertion":[{"value":"9 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"J.\u00a0Mueller-Leisse received lecture honoraria, travel grants and\/or a\u00a0fellowship grant from Abbott, Biotronik, Boehringer-Ingelheim, Boston Scientific, Medtronic and Zoll. H.A.K.\u00a0Hillmann received lecture honoraria and\/or a\u00a0fellowship grant from AstraZeneca, Boston Scientific, Medtronic and Zoll. J.\u00a0Eiringhaus received a\u00a0fellowship grant from Biotronik. S.\u00a0Hohmann received a\u00a0fellowship grant from Boston Scientific. C.\u00a0Zormpas received travel grants and a\u00a0fellowship grant from Biotronik, Biosense Webster and Medtronic. D.\u00a0Duncker received lecture honoraria, travel grants and\/or a\u00a0fellowship grant from Abbott, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Medtronic, Microport, Pfizer, Zoll. C.\u00a0Veltmann received lecture honoraria\/advisory board fees from Biotronik, Medtronic, Abbott, Zoll. N.\u00a0Karfoul received lecture honoraria from Abbott. G.\u00a0Syrbius declares that she has no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study complied with the Declaration of Helsinki and was approved by the local ethics committee. All participants provided written informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}