3D ECG: a new simplified view.

BACKGROUND: The standard 12‑lead electrocardiogram (ECG) represents cardiac electrical activity through two-dimensional projections, requiring clinicians to mentally reconstruct the three-dimensional behavior of the cardiac vector. This process is highly dependent on experience and may limit interpretation accuracy. OBJECTIVE: To introduce and demonstrate a novel qualitative method for three-dimensional (3D) ECG visualization based on orthogonal leads, designed to enhance spatial and temporal interpretation of cardiac electrical activity. METHODS: Orthogonal X, Y, and Z leads from the Frank system were analyzed using a circular polar representation that enables simultaneous visualization of vector magnitude and direction over time. Representative recordings from normal subjects and patients with conduction disturbances, myocardial infarction, and pre-excitation were evaluated. RESULTS: The proposed 3D ECG representation provided intuitive visualization of cardiac electrical activity across frontal, transverse, and sagittal planes. The method enabled clear identification of wave onset and offset, spatial orientation of depolarization and repolarization vectors, and characteristic patterns associated with ischemia, bundle branch block, and accessory pathway conduction. These findings are presented as qualitative, demonstrative results supported by reproducible clinical examples. CONCLUSION: Three-dimensional ECG visualization using orthogonal leads offers a practical and informative complement to the standard ECG, facilitating improved qualitative interpretation and supporting future integration with automated and artificial intelligence-based analysis systems.