Intraoperative ECG Rhythm Recognition with 3- and 5-Lead Monitoring

By Conor Early, CRNA, creator of GlottaVue Anesthesia.

Learning ECG rhythm recognition for the operating room means working with the monitor available to you. GlottaVue's new Rhythm center is designed around 3- and 5-lead intraoperative monitoring, with guided observation, recorded ECG examples and practice cases that work offline.

Beta preview: Rhythm center is included in iOS TestFlight version 1.6.5 (126), uploaded September 30, 2026. It is a standalone section on Home and Specialties, with a Tools shortcut. This is not an announcement that the feature is already in the public App Store or Google Play release.

Begin with the patient and the monitor

A rhythm label is only part of the assessment. The ECG shows electrical activity; circulation also needs assessment using the patient and available pulse and blood-pressure information. The ASA standards for basic anesthetic monitoring describe ECG, heart-rate, blood-pressure and circulatory monitoring together.

Rhythm center's monitor-setup reference covers 3- and 5-wire arrangements and common sources of artifact. The tool does not assume a diagnostic 12-lead ECG is available. A limited monitor strip cannot answer every diagnostic question.

A consistent way to study a rhythm strip

The Identify tab asks for observations you make yourself, including the patient's status, rate, regularity, QRS width, atrial activity and the relationship between P waves and QRS complexes. Leave an observation unknown if the tracing does not show it clearly. Compare the resulting reference possibilities with the complete strip and clinical context.

Use Library to review recognition features and common look-alikes. Use Basics for monitor setup and measurement concepts. Rate and interval helpers depend on the strip's actual timing and calibration; a resized photograph does not preserve a physical millimeter scale.

Learn through examples and practice

The beta includes 38 rhythm references, 15 action cards, 25 practice cases and 13 recorded ECG examples. The recorded strips carry source information. Some use modified Holter leads, so their appearance should not be treated as identical to every operating-room lead arrangement.

In Practice, work through a scenario, choose an answer and review the explanation before moving on. Use the exercise to identify concepts to revisit with an instructor or colleague. Practice scores do not certify clinical competence.

Where intervention references fit

The Actions tab connects rhythm learning to adult response references, with a separate route to pediatric guidance. Management depends on pulse, stability, the cause and the clinical setting. Review the current AHA adult advanced life support guidance, local protocols and equipment instructions. During an emergency, call for help and follow the appropriate emergency response rather than delaying care to complete a learning tool.

Does it automatically identify an ECG photo?

No. You can open and zoom a local ECG image for manual comparison. Rhythm center does not diagnose a photo or video and does not upload the image for AI analysis. Use only de-identified images for study.

Does it work offline?

The bundled references, recorded strips and practice workflow work offline. Opening an external source link requires internet. This makes Rhythm center a companion to the offline anesthesia reference library and its illustrated reference galleries.

Explore GlottaVue and the current app downloads. Beta and public releases are identified separately so you can check which features your installed version includes.