Comparison of automated interval measurements by widely used algorithms in digital electrocardiographs

Abstract

Among current-generation computer-based electrocardiographs, clinically small but statistically significant differences exist between ECG interval measurements by individual algorithms. Measurement differences between algorithms for QRS duration and for QT interval are larger in long QT interval subjects than in normal subjects. Comparisons of population study norms should be aware of small systematic differences in interval measurements due to different algorithm methodologies, within-individual interval measurement comparisons should use comparable methods, and further attempts to harmonize interval measurement methodologies are warranted.

A Population‐wide study of electrocardiographic (ECG) norms and the effect of demographic and anthropometric factors on selected ECG characteristics in young, Southeast Asian males—results from the Singapore Armed Forces ECG (SAFE) study

“…In Table 2, we compared the QTcB in our population against that derived from the Swiss study by Kobza et al Kobza's study used the SCHILLER AG ECG software technology system compared to the Phillips ECG software used in our study. There are reported differences in ECG intervals obtained from different automated ECG systems (Kligfield et al, 2018). However, there was still a statistically significant difference observed between the racial groups in our study based on the Phillips ECG software.…”

Importance of the heart vector origin point definition for an ECG analysis: The Atherosclerosis Risk in Communities (ARIC) study

“…Moreover, detection of QRS onset is challenging, resulting in disagreement between different algorithms. [25] A physiologically accurate definition of the heart vector origin point is crucial for accurate VCG and ECG measurements. Our algorithm searches for the flattest line within the cardiac cycle to provide a robust and reproducible solution, which is important for accurate detection of QRS, T, and SVG peak vectors.…”

“…A recent comparison of leading ECG algorithms revealed significant differences in ECG measurements by ECG manufacturers. [25] Different approaches to beat alignment may be one of the reasons of discrepant results of ECG measurements. Results of our study showed that time-coherent beat construction is the best approach, which preserves the physiological sequence of cardiac activation and recovery.…”

Sources of QTc variability: Implications for effective ECG monitoring in clinical practice

“…It is thus questionable whether manual measurements should be used on their own or whether it is more reliable to visually check the automatic measurements provided by most of the advanced models of ECG equipment (Hnatkova, Gang, Batchvarov, & Malik, ). Similar to the necessity of having serial ECGs interpreted by the same observer, ECG measurements by different equipment may lead to substantial variability (Kligfield et al, , ). However, since the algorithms used in the commercial equipment are steadily advancing (Green et al, ) their clinical reliability is now probably at least equivalent to fully manual measurements especially if combined with visual verifications to eliminate occasional outliers (Hnatkova et al, ).…”

“…It is thus questionable whether manual measurements should be used on their own or whether it is more reliable to visually check the automatic measurements provided by most of the advanced models of ECG equipment (Hnatkova, Gang, Batchvarov, & Malik, 2006). Similar to the necessity of having serial ECGs interpreted by the same observer, ECG measurements by different equipment may lead to substantial variability (Kligfield et al, 2018(Kligfield et al, , 2014. (Hnatkova et al, 2006).…”