healthcareЗдравоохранение. HealthcareHealthcare1027-7218Republican Scientific and Practical Center for Medical Technologies, Informatization, Management and Health Economics10.65249/1027-7218-2026-7-67-75healthcare-324Research ArticleНЕПРЕРЫВНОЕ ПРОФЕССИОНАЛЬНОЕ РАЗВИТИЕCONTINUOUS PROFESSIONAL DEVELOPMENTЦифровая трансформация интерпретации электрокардиограммы у детей: от классических подходов до алгоритмов искусственного интеллектаDigital transformation of children's electrocardiogram interpretation: from classical approaches to artificial intelligence algorithmshttps://orcid.org/0000-0002-1334-7578ТомчикН. В.TomchikN.

Томчик Наталья Валентиновна – к. м. н., доцент, зав. кафедрой поликлинической педиатрии

Ул. Горького, 80, 210009, г. Гродно

Сл. тел. +375 15 255-91-37 

https://orcid.org/0000-0003-4823-7819ПарамоноваН. С.ParamonovaN.

Парамонова Нэлла Сергеевна 

Гродно

Гродненский государственный медицинский университетBelarus202613082026176775Copyright © Томчик Н.В., Парамонова Н.С., 20262026Томчик Н.В., Парамонова Н.С.Tomchik N., Paramonova N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://healthcare.ejournal.by/jour/article/view/324

Целью обзора является систематизация современных достижений в области регистрации электрокардиограммы, включая миниатюризацию устройств, беспроводные и цифровые технологии. Инновации расширили возможности для диагностики электрической нестабильности сердца у детей. Модернизация электрокардиографического оборудования, цифровая интеграция требуют переоценки ранее установленных педиатрических нормативов электрокардиограммы. Остается актуальной проблема интерпретации данных с носимых и событийных устройств регистрации электрокардиограммы в связи с тем, что большинство автоматических алгоритмов не адаптированы к физиологическим особенностям детского сердца. В детской кардиологии перспективным является направление использования инструментов искусственного интеллекта при интерпретации электрокардиограммы с целью скрининга и стратификации риска аритмий, структурных заболеваний сердца, каналопатий.

The purpose of this review is to summarize current advances in electrocardiogram recording, including device miniaturization and wireless and digital technologies. Innovative engineering developments have expanded the capabilities for diagnosing cardiac electrical instability in children. Modernization of electrocardiographic equipment and digital integration require a reassessment of previously established pediatric electrocardiogram standards. The problem of interpreting data from wearable and eventbased electrocardiogram recording devices remains pressing, as most automatic algorithms are not adapted to the physiological characteristics of the pediatric heart. In pediatric cardiology, the use of artificial intelligence tools in electrocardiogram interpretation is promising for screening and risk stratification of arrhythmias, structural heart diseases, and channelopathies.

электрокардиограммаинновацииносимые и событийные устройстваискусственный интеллектelectrocardiograminnovationswearable and event-based devicesartificial intelligenceReferencesArrhythmias in pediatric age : a narrative review / A. Strango, J. Ielahi, J. Sabotino [et al.] // Chidren (Basel). – 2025. – Vol. 12, № 12. – doi:10.3390/children12121580.Strango A., Ielahi J., Sabotino J. Arrhythmias in pediatric age. Chidren (Basel). 2025; 12(12): 8–19. doi: 10.3390/children12121580.Friedman, P. A. The Electrocardiogram at 100 years: history and future / P. A. Friedman // Circulation. – 2024. – Vol. 149, № 6. – P. 411–413.Friedman P.A. The Electrocardiogram at 100 years: history and future. Circulation. 2024; 149: 411–413.Deep learning and the electrocardiogram : review of the current state-of-the-art / S. Somani, A. J. Russak, F. Richter [et al.] // Europace. – 2021. – Vol. 23, № 8. – doi: 10.1093/europace/euaa377.Somani S., Russak A.J., Richter F., et al. Deep learning and the electrocardiogram. Europace. 2021; 23(8). doi: 10.1093/europace/euaa377.2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry / J. S. Steinberg, N. Varma, I. Cygankiewicz [et al.] // Heart Rhythm. – 2017. – Vol. 14, № 7. – doi:10.1016/j.hrthm.2017.03.38.Steinberg J.S., Varma N., Cygankiewicz I., et al. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Heart Rhythm. 2017; 14(7). doi: 10.1016/j.hrthm.2017.03.38.Kumthekar, R. N. Recent advancements in cardiac implantable devices for pediatric patients / R. N. Kumthekar, T. S. Howard // Current Pediatrics Reports. – 2024. – Vol. 12, № 4. – P. 147–157.Kumthekar R.N., Howard T.S. Recent advancements in cardiac implantable devices for pediatric patients. Curr Pediatr Rep. 2024; 12: 147–157.Joannou, K. Ambulatory electrocardiography: the contribution of Norman Jefferis Holter / K. Joannou, M. Jgnaszewski, J. Macdonald // British Columbia Medical Journal. – 2014. – Vol. 56, № 2. – P. 86–89.Joannou K., Jgnaszewski M., Macdonald J. Ambulatory electrocardiography: the contribution of Norman Jefferis Holter. BCMJ. 2014; 56(2): 86–89.Practical guide to ECG device performance testing according to international standards / E. Raus-Jarzabek, M. Czerw, A. Skowronek [et al.] // Electronics. – 2025. – Vol. 14, № 19. – doi: 10.3390/electronics14193878.Raus-Jarzabek E., Czerw M., Skowronek A., et al. Practical guide to ecg device performance testing according to international standards. Electronics. 2025; 14(19). doi: 10.3390/electronics14193878.A novel method for conformity assessment testing of electrocardiographs for post-market surveillance purposes / A. Badnjevi, R. Magjarevic, E. Mrdjanovic, L. G. Pokvic // Technology and Health Care. – 2023. – Vol. 31. – P. 307–315.Badnjevi A., Magjarevic R., Mrdjanovic E., Pokvic L.G. A novel method for conformity assessment testing of electrocardiographs for post-market surveillance purposes. Technol Health Care. 2023; 31: 307–315. doi: 10.3233/THC-229006.Home use : technological and clinical scoping review / A. Zepeda-Echavarria, R. R. van Leur, M. van Sleuwen [et al.] // Journal of Medical Internet Research Cardio. – 2023. – Vol. 7. – doi: 10.2196/44003.Zepeda-Echavarria A., van Leur R. R., van Sleuwen M., et al. Home use. JMIR Cardio. 2023; 7. doi: 10.2196/44003.The influence of electrocardiogram (ECG) filters on the heights of R and T waves in children / J. Hirokawa, T. Hitosugi, Y. Miki [et al.] // Scientific Reports.– 2022. – Vol. 12, № 1. – doi:10.1038/s41598-022-17680-4.Hirokawa J., Hitosugi T., Miki Y., et al. The influence of electrocardiogram (ECG) filters on the heights of R and T waves in children. Sci Rep. 2022; 2(12). doi: 10.1038/s41598-022-17680-4.Мазо, Р. Э. Особенности электрокардиограммы здоровых детей разных возрастов / Р. Э. Мазо. – Мн. : Гиз БССР, 1957. – 108 с.Mazo R.E. Electrocardiographic features of healthy children of different ages. Minsk: Giz BSSR; 1957. 108. (in Russian)Diskinson, D. F. The normal ECG in childhood and adolescence / D. F. Diskinson // Heart. – 2005. – Vol. 91, № 12. – doi: 10.1136/hrt.2004.057307.Diskinson D.F. The normal ECG in childhood and adolescence. Heart. 2005; 91(12). doi: 10.1136/hrt.2004.057307.Guidelines for the interpretation of the neonatal electrocardiogram. A task force of the European Society of Cardiology / P. J. Schwartz, A. Jr. Garson, T. Paul [et al.] // European Heart Journal. – 2002. – Vol. 23, № 17. – doi:10.1053/euhj.2002.3274.Schwartz P.J., Garson A.Jr., Paul T., et al. Guidelines for the interpretation of the neonatal electrocardiogram. Eur Heart J. 2002; 23(17). doi: 10.1053/euhj.2002.3274.New normal limits for the paediatric electrocardiogram / P. R. Rijnbeek, M. Witsenburg, E. Schrama [et al.] // European Heart Journal. – 2001. – Vol. 22, № 8. – P. 702–711.Rijnbeek P.R., Witsenburg M., Schrama E., et al. New normal limits for the paediatric electrocardiogram. Eur Heart J. 2001; 22(8): 702–711.Normal ECG standards for infants and children / A. Davignon, E. Rautaharju, E. Boisselle [et al.] // Pediatric Cardiology. – 1980. – Vol. 1, № 2 – P. 123–131. – doi:10.1007/BF02083144.Davignon A., Rautaharju P., Boisselle E., et al. Normal ECG standards for infants and children. Pediatr Cardiol. 1980; 1(2): 123–131. doi: 10.1007/BF02083144.Electrocardiograms in healthy north american children in the digital age / E. V. Saarel, S. Granger, R. J. Kaltman [et al.] // Circulation. Arrhythmia and Electrophysiology. – 2018. – Vol. 11, № 7. – doi: 10.1161/circep.117.005808.Saarel E.V., Granger S, Kaltman R. J., et al. Electrocardiograms in healthy north american children in the digital age. Circ Arrhythm Electrophysiol. 2018; 11(7). doi: 10.1161/circep.117.005808.Electrocardiogram standards for children and young adults using Z-Scores / A. Bratincsak, Ch. Kimata, B. N. Limm-Chan [et al.] // Circulation. Arrhythmia and Electrophysiology. – 2020. – Vol. 13, № 8. – doi: 10.1161/circep.119.008253.Bratincsаk A., Kimata Ch., Limm-Chan B.N., et al. Electrocardiogram standards for children and young adults using Z-Scores. Circ Arrhythm Electrophysiol. 2020; 13(8). doi: 10.1161/circep.119.008253.The electrocardiogram is a poor diagnostic tool to detect left ventricular hypertrophy in children: a comparison with echocardiographic assessment of left ventricular mass / A. Bratincsak, M. Williams, Ch. Kimata, J. C. Perry // Congenital Heart Disease. – 2015. – Vol. 10, № 4. – doi: 10.1111/chd.12249.Bratincsak A., Williams M., Kimata Ch, Perry J.C. The Electrocardiogram is a poor diagnostic tool to detect left ventricular hypertrophy in children: a comparison with echocardiographic assessment of left ventricular mass. Congenit Heart Dis. 2015; 10 (4). doi: 10.1111/chd.12249.Регистрация электрокардиограммы покоя в 12 общепринятых отведениях взрослыми детям : метод. рекомендации / Д. В. Дроздов, Л. М. Макаров, В. С. Баркан [и др.] // Российский кардиологический журнал. – 2023. – Т. 28. № 10. – С. 105–130.Drozdov D.V., Makarov L.M., Barkan V.S., et. al. Registration of a resting electrocardiogram in 12 generally accepted leads by adults and children. Rossijskij kardiologicheskij zhurnal. 2023; 28(10): 105–130. (in Russian)Новые нормы и интерпретации детской электрокардиограммы / Л. М. Макаров, И. И. Киселева, В. Н. Комолятова, Н. Н. Федина // Педиатрия. – 2015. – Т. 94, № 2. – C. 63–68.Makarov L.M., Kiseleva I.I., Komolyatova V.N., Fedina N.N. New norms and interpretations of a pediatric electrocardiogram. Pediatriya. 2015; 94(2): 63–68. (in Russian)Hitt, J. R. Patch versus traditional ambulatory ECG monitoring in children / J. R. Hitt, E. Carter, J. May // Progress in Pediatric Cardiology. – 2021. – Vol. 63, № 1. – doi: 1016/j.ppedcard.2021.101408.Hitt J.R., Carter E., May J. Patch versus traditional ambulatory ECG monitoring in children. Prog Pediatr Cardiol. 2021; 63(1). doi: 1016/j.ppedcard.2021.101408.Feasibility and diagnostic value of recording smartwatch electrocardiograms in neonates and children / J. Leroux, M. Strik, F. D. Ramiez [et al.] // The Journal of Pediatrics. – 2023. – Vol. 253. – P. 40–45.Leroux J., Strik M., Ramirez F.D., et al. Feasibility and diagnostic value of recording smartwatch electrocardiograms in neonates and children. J Pediatr. 2023; 253: 40–45.Ambulatory arrhythmia detection with ZIO XT patch in pediatric patients: a comparison of devices / S. Pradhan, J. A. Robinson, J. K. Shivapour, Ch. S. Snyder // Pediatric cardiology. – 2019. – Vol. 40, № 5. – P. 921–924.Pradhan S., Robinson J.A., Shivapour J.K., Snyder Ch.S. Ambulatory arrhythmia detection with ZIO XT patch in pediatric patients: a comparison of devices. Pediatr Cardiol. 2019; 40(5): 921–924.Cardiac arrhythmia detection outcomes among patients monitored with the Zio patch system : a systematic literature review / M. Yenikomshian, J. Jarvis, C. Patton [et al.] // Current Medical Research and Opinion. – 2019. – Vol. 35, № 10. – doi: 10.1080/03007995.2019.1610370.Yenikomshian M., Jarvis J., Patton C., et al. Cardiac arrhythmia detection outcomes among patients monitored with the Zio patch system. Curr Med Res Opin. 2019; 35(10). doi: 10.1080/03007995.2019.1610370.Effect of a home-based wearable continuous ECG monitoring patch on detection of undiagnosed atrial fibrillation : the mSToPS randomized clinical trial / S. R. Steinhubl, J. Waalen, A. M. Edwards [et al.] // Journal of the American Medical Association. – 2018. – Vol. 320, № 2. – P. 146–155.Steinhubl S.R., Waalen J., Edwards A.M., et al. Effect of a home-based wearable continuous ECG monitoring patch on detection of undiagnosed atrial fibrillation. 2018; 320(2): 146–155.A flexible, wearable, and wireless biosensor patch with internet of medical things applications / D. T. Phan, C. H. Nguyen, T. D. P. Nguyen [et al.] // Biosensors (Basel). – 2022. – Vol. 12, № 3. – doi: 10.3390/bios12030139.Phan D.T., Nguyen C.H., Nguyen T.D.P., et al. A flexible, wearable, and wireless biosensor patch with internet of medical things applications. Biosensors (Basel). 2022; 12(3). doi: 10.3390/bios12030139.Yu, Y. Biomedical implementation of liquid metal ink as drawable ECG electrode and skin circuit / Y. Yu, J. Zhang, J. Liu // Public Library of Science one. – 2013. – Vol. 8, № 3. – doi: 10.1371/journal.pone.0058771.Yu Y., Zhang J., Liu J. Biomedical implementation of liquid metal ink as drawable ECG electrode and skin circuit. PLOS one. 2013; 8(3). doi: 10.1371/journal.pone.0058771.Chen, J. X. M. Conductive bio-based hydrogel for wearable electrodes via direct ink writing on skin / J. X. M. Chen, Y. Zhang, T. Chen [et al.] // Advanced Functional Materials. – 2024. – Vol. 34, № 40. – doi: 10.1002/adfm.202403721.Chen J.X.M., Zhang Y., Chen T. Conductive bio-based hydrogel for wearable electrodes via direct ink writing on skin. Advanced Functional Materials. 2024; 34(40). doi: 10.1002/adfm.202403721.A highly conductive and stretchable wearable liquid metal electronic skin for long-term conformable health monitoring / R. Guo, X. Wang, Yu WenZhuo [et al.] // Science China Technological Sciences. – 2018. – Vol. 61, № 7. – doi: 10.1007/s11431-018-9253-9.Guo R., Wang X., Tang J. A highly conductive and stretchable wearable liquid metal electronic skin for long-term conformable health monitoring. Science China Technological Sciences. 2018; 61(7). doi: 10.1007/s11431-018-9253-9.A non-newtonian liquid metal enabled enhanced electrography / V. Timosina, T. Cole, H. Lu [et al.] // Biosensors and Bioelectronics. – 2023. – Vol. 235. – doi: 10.1016/J.bios.2023.115414.Timosina V., Cole T., Lu H., et al. A non-newtonian liquid metal enabled enhanced electrography. Biosensors and Bioelectronics. 2023; 235. doi: 10.1016/J.bios.2023.115414.Using a cardiac event recorder in children with potentially arrhythmia-related symptoms / M. Saygi, Y. Ergul, I. Ozyilmaz [et al.] // Annals of noninvasive electrocardiology. – 2016. – Vol. 21, № 5. – doi: 10.1111/anec.12339.Saygi M., Ergul Y., Ozyilmaz I., et al. Using a cardiac event recorder in children with potentially arrhythmia-related symptoms. Ann Noninvasive Electrocardiol. 2016; 21(5). doi: 10.1111/anec.12339.Use of AliveCor Kardia Mobile in the detection of supraventricular tachycardia in a pediatric population / A. Shahrier, G. L. Hackett, J. Cowen [et al.] // Pediatrics. – 2021. – Vol. 147, № 3. – doi: 10.1542/peds.147.3MA1.24.Shahrier A., Hackett G.L., Cowen J.G., et al. Use of AliveCor Kardia Mobile in the detection of supraventricular tachycardia in a pediatric population. Pediatrics. 2021; 147(3). doi: 10.1542/peds.147.3MA1.24.An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm : a retrospective analysis of outcome prediction / Z. I. Attia, P. Noseworthy, F. Lopez-Jimenez [et al.] // Lancet. – 2019. – Vol. 394. – P. 861–867.Attia Z.I., Noseworthy P., Lopez-Jimenez F., et al. An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm. Lancet. 2019; 394: 861–867.Leone, D. M. Artificial intelligence in pediatric electrocardiography : a comprehensive review / D. M. Leone, D. O´Sullivan, K. Bravo-Jaimes // Children (Basel). – 2024. – Vol. 12, № 1. – doi: 10.3390/children12010025.Leone D.M., O´Sullivan D., Bravo-Jaimes K. Artificial intelligence in pediatric electrocardiography. Children (Basel). 2024; 12(1). doi: 10.3390/children12010025.Edenbrandt, L. Recognition of lead reversals in pediatric electrocardiograms / L. Edenbrandt, R. Rittner // The American Journal of Cardiology. – 1998. – Vol. 82, № 10. – doi: 10.1016/S0002-9149(98)00621-3.Edenbrandt L., Rittner R. Recognition of lead reversals in pediatric electrocardiograms. Am J Cardiol. 1998; 82(10). doi: 10.1016/S0002-9149(98)00621-3.Fetal electrocardiography and artificial intelligence for prenatal detection of congenital heart disease / I. R. de Vries, J. O. E. H. van Laar, M. B. van der Hout-van der Jagt [et al.] // Acta Obstetricia et Gynecologica Scandinavica. – 2023. – Vol. 102, № 11. – doi: 10.1111/aogs.14623.de Vries I.R., van Laar J.O.E.H., van der Hout-van der Jagt M.B., et al. Fetal electrocardiography and artificial intelligence for prenatal detection of congenital heart disease. Acta Obstet Gynecol Scand. 2023; 102(11). doi: 10.1111/aogs.14623.Accessory pathway analysis using a multimodal deep learning model / M. Nishimori, K. Kiuchi, K. Nishimori [et al.] // Scientific Reports. – 2021. – Vol. 11, № 1. – doi: 10.1038/s41598-021-87631-y.Nishimori M., Kiuchi K., Nishimori K., et al. Accessory pathway analysis using a multimodal deep learning model. Sci Rep. 2021; 11(1). doi: 10.1038/s41598-021-87631-y.Use of artificial intelligence and deep neural networks in evaluation of patients with electrocardiographically concealed long QT syndrome from the surface 12-lead electrocardiogram / J. M. Bos, I. Zach, D. E. Albert [et al.] // JAMA Cardiology. – 2021. – Vol. 6, № 5. – P. 532–538.Bos J.M., Zach I., Albert D.E., et al. Use of artificial intelligence and deep neural networks in evaluation of patients with electrocardiographically concealed long QT syndrome from the surface 12-lead electrocardiogram. JAMA Cardiol. 2021; 6(5): 532–538.Prediction of adverse cardiovascular events in children using artificial intelligence-based electrocardiogram / Y. Nogimori, K. Sato, K. Takamizawa [et al.] // International Journal of Cardiology.– 2024. – Vol. 406. – doi: 10.1016/j.ijcard.2024.132019.Nogimori Y., Sato K., Takamizawa K., et al. Prediction of adverse cardiovascular events in children using artificial intelligence-based electrocardiogram. Int J Cardiol. 2024; 406. doi: 10.1016/j.ijcard.2024.132019.Detection of hypertrophic cardiomyopathy by an artificial intelligence electrocardiogram in children and adolescents / K. C. Siontis, K. Liu, J. M. Bos [et al.] // International Journal of Cardiology. – 2021. – Vol. 340. – P. 42–47.Siontis K.C., Liu K., Bos J.M., et al. Detection of hypertrophic cardiomyopathy by an artificial intelligence electrocardiogram in children and adolescents. Int J Cardiol. 2021; 340: 42–47.

The authors declare that there are no conflicts of interest present.