Heart electrical axis assessment: results of a survey of physicians in the Russian Federation. Analysis and discussion of the visual axis assessment method

Abstract

Background. Determination of the QRS axis (axQRS) plays a significant role in electrocardiograms’ (ECG) interpretation. Although multiple techniques have been introduced for estimating of axQRS, the frequency of their use by practicing physicians unknown. The study aimed to explore the frequency of usage of different axQRS assessment methods and evaluate physicians’ attitudes toward the accuracy of automatic axQRS determinations. Materials and methods. A web-based questionnaire was administered via Yandex Forms between June 24th and July 6th, 2025. Respondents included functional diagnostics physicians and cardiologists invited through specialized groups on the Telegram messenger. The obtained data underwent statistical analysis using R software. Key Findings. Analysis of 689 completed questionnaires indicated that the most common approach for axQRS estimation is the visual approximation method, which is favored by the majority of surveyed physicians (56%). Only 10% of respondents reported relying exclusively on precise table-based or calculator-assisted calculations. According to the consensus view of most participants, an acceptable level of accuracy for axQRS determination lies within approximately ±8 degrees. A substantial proportion of doctors expressed overall satisfaction with the accuracy of automated axQRS evaluations. Conclusion. The visual method has emerged as the preferred choice among physicians owing to its ease and practicality. Published evidence supports its high concordance with more exact computational approaches for determining axQRS position. Furthermore, many physicians find the outcomes provided by automated axQRS calculations satisfactory. The visual method for determining axQRS positions in Gertsch – Mueller-Leisse variant is described and recommended for practical use.