The triangular wave test for electrocardiographic devices: A historical perspective

Baseline wander makes interpretation ECG recordings difficult, especially the assessment of ST deviation. Eliminating baseline wander without distorting the ST segment is a problem. The traditional high pass filter with a 0.5 Hz low frequency cutoff effectively suppresses baseline but introduces considerable distortion in the level of the ST segment. This distortion results from phase nonlinearities that occur when frequency content and wave amplitude change abruptly, as occurs where the end of the QRS complex meets the ST segment. Since the 1980s nonlinear, digital filters have been designed that can increase the low frequency Cutoff without the introduction of phase distortion. The triangular wave test, first described in the 1990 AHA Recommendations, is an objective method for measuring the ability to suppress baseline wander without affecting the ST segment. This methodology was adopted in 3 American National Standards (Diagnostic ECG in1991; Ambulatory ECGs in 1998; and Cardiac Monitors in 2002).