What Are the Different Types of ECG Paper?

Andrew Kirmayer

Electrocardiography is the measurement of electrical activity from the heart on a specialized piece of graph paper. Data are typically recorded onto this paper as part of an electrocardiogram (ECG), in which electrodes are taped to a person’s chest and the cardiac electrical pulses measured. A certain type of paper is generally required to provide accurate results. The kind of ECG paper used can depend on the model and brand of the machine; it sometimes comes in rolls, but folded paper is often required. There are also various sizes and widths of paper, some of which is designed to run at certain speeds.

ECG paper must be made to fit the ECG machine correctly.
ECG paper must be made to fit the ECG machine correctly.

A grid pattern is typical of ECG paper, and a series of lines cross one another to break the spaces down to squares generally 0.04 inches (one millimeter) wide. Darker lines, usually red in color, cross to block off squares that are five boxes across and five high. Most types of ECG paper also have even thicker lines to encompass blocks of four, five by five squares. The heart activity monitor usually traces a line in black ink to represent electrical signals. Boxes that the tracer ink lines touch can be analyzed with measurements common to almost any country.

A man getting an ECG.
A man getting an ECG.

The configuration of most kinds of ECG paper includes a measurement of time and the voltage of the electrical activity. Many types of it come in sheets, often designed into a z-fold pattern. The way this paper is stored can be different from how strips that come in rolls are saved before use. Roll-style paper is sold by many manufacturers. Both types of ECG paper can come in various widths and lengths, while the product can vary in terms of packaging; the amount of sheets can vary drastically as well.

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Electrocardiograms are a common form of noninvasive recording of heart activity. There are many manufacturers that can offer different brands of ECG paper. Each type is often different based on the particular machine, so it is usually important to read the instructions to know what kind of paper to order. Rolls typically vary in circumference, so usually the right size will be the only one to fit in the machine’s feeder.

If the wrong type of ECG paper is used, then the measurements of the tracer line can be inaccurate. Size and type can also be important so the mechanism of the machine won’t interfere with the results. It is often helpful to review the return policies of manufacturers and suppliers in case a mistake in an order is made, so the wrong type of paper can be exchanged for the right product.

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