Computerized interpretation of ECGs: supplement not a substitute.

Since the introduction of the string galvanometer by Willem Einthoven more than a century ago, the ECG has become the most commonly performed cardiovascular test and an essential diagnostic tool in clinical cardiology.1–3 The transition from analogue to digital ECGs resulted in automated computer analysis of the ECG (ECG-C) assuming a larger role in the diagnostic interpretation.3 Yet, as the ECG-C has evolved into a necessary tool of modern medical practice, many physicians remain unaware of the hazards of relying on these preliminary diagnostic interpretations. The ECG-C clinical use should always be with the understanding that they are preliminary interpretations and require reading and confirmation by qualified electrocardiographer.3 With an increased reliance on these readings for point-of-care decision making, clinicians must remain mindful of many limitations of the ECG-C.2,3 Article see p 76 Multiple prior investigations on the ECG-C interpretation have demonstrated erroneous interpretation, resulting in unnecessary, potentially harmful medical treatment, and inappropriate use of medical resources.4–7 A large international study compared the performance of 9 ECG-C programs with that of cardiologists in interpreting ECGs in clinically validated cases of various cardiac disorders.4 The percentage of ECGs correctly classified by the ECG-C was lower than that for the cardiologists.4 The median sensitivity of the computer programs was also significantly lower than that of the cardiologists in diagnosing left ventricular hypertrophy, right ventricular hypertrophy, anterior myocardial infarction, and inferior myocardial infarction.4 The median total accuracy level (the percentage of correct classifications) was 6.6% lower for the computer programs (69.7%) than for the cardiologists (76.3%; P <0.001).4 More contemporary analysis of the accuracy of ECG-C similarly concluded that there are frequent errors in the interpretation of the cardiac rhythm. In evaluating the ECG-C interpretation of the cardiac …

[1]  M Demeester,et al.  Assessment of the performance of electrocardiographic computer programs with the use of a reference data base. , 1985, Circulation.

[2]  J. L. Willems,et al.  The diagnostic performance of computer programs for the interpretation of electrocardiograms. , 1992, The New England journal of medicine.

[3]  P. Kowey,et al.  Safety and risk/benefit analysis of ibutilide for acute conversion of atrial fibrillation/flutter. , 1996, The American journal of cardiology.

[4]  M. Ackerman,et al.  Diagnostic accuracy of screening electrocardiograms in long QT syndrome I. , 2001, Pediatrics.

[5]  Paul Kligfield,et al.  The centennial of the Einthoven electrocardiogram. , 2002, Journal of electrocardiology.

[6]  R. Califf,et al.  Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young , 2004, Circulation.

[7]  Frank Bogun,et al.  Misdiagnosis of atrial fibrillation and its clinical consequences. , 2004, The American journal of medicine.

[8]  Sophia H Zhou,et al.  Relation of QT interval measurements to evolving automated algorithms from different manufacturers of electrocardiographs. , 2006, The American journal of cardiology.

[9]  M. Malik,et al.  Precision of QT Interval Measurement by Advanced Electrocardiographic Equipment , 2006, Pacing and clinical electrophysiology : PACE.

[10]  Marjorie Funk,et al.  Practice standards for ECG monitoring in hospital settings: executive summary and guide for implementation. , 2006, Critical care nursing clinics of North America.

[11]  E. W. Hancock,et al.  Recommendations for the standardization and interpretation of the electrocardiogram: part II: Electrocardiography diagnostic statement list: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College , 2007, Circulation.

[12]  A. Shah,et al.  Errors in the computerized electrocardiogram interpretation of cardiac rhythm. , 2007, Journal of electrocardiology.

[13]  E. W. Hancock,et al.  Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Card , 2007, Journal of the American College of Cardiology.

[14]  E. W. Hancock,et al.  AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American , 2009, Journal of the American College of Cardiology.

[15]  Snehal Kothari,et al.  Comparison of 5 methods of QT interval measurements on electrocardiograms from a thorough QT/QTc study: effect on assay sensitivity and categorical outliers. , 2011, Journal of electrocardiology.

[16]  M. Lehmann,et al.  Prolonged QT Interval Diagnosis Suppression by a Widely Used Computerized ECG Analysis System , 2013, Circulation. Arrhythmia and electrophysiology.