Comparison of automated measurements of electrocardiographic intervals and durations by computer-based algorithms of digital electrocardiographs

Kligfield, Paul; Badilini, Fabio; Rowlandson, Ian; Xue, Joel; Clark, Elaine; Devine, Brian; Macfarlane, Peter W.; Bie, J. de; Mortara, David; Babaeizadeh, Saeed; Gregg, Richard E.; Helfenbein, Eric; Green, Cynthia L.

doi:10.1016/j.ahj.2013.10.004

Cited by 50 publications

(45 citation statements)

References 37 publications

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“…inter observer variation. In a comparison of 4 major algorithms using the same ECGs, it was shown that the mean QT interval varied by 8 ms in a group of 200 normal subjects [21]. Although the sample size was small, the inference is clear that some variation in QT measurements between studies is due to the different algorithms used to derive the results.…”

Section: Discussionmentioning

confidence: 99%

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Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients

Palhares

Marcolino

Santos

et al. 2017

BMC Cardiovasc Disord

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BackgroundKnowledge of the normal limits of the electrocardiogram (ECG) is mandatory for establishing which patients have abnormal ECGs. No studies have assessed the reference standards for a Latin American population. Our aim was to establish the normal ranges of the ECG for pediatric and adult Brazilian primary care patients.MethodsThis retrospective observational study assessed all the consecutive 12-lead digital electrocardiograms of primary care patients at least 1 year old in Minas Gerais state, Brazil, recorded between 2010 and 2015. ECGs were excluded if there were technical problems, selected abnormalities were present or patients with selected self-declared comorbidities or on drug therapy. Only the first ECG from patients with multiple ECGs was accepted. The University of Glasgow ECG analysis program was used to automatically interpret the ECGs. For each variable, the 1st, 2nd, 50th, 98th and 99th percentiles were determined and results were compared to selected studies.ResultsA total of 1,493,905 ECGs were recorded. 1,007,891 were excluded and 486.014 were analyzed. This large study provided normal values for heart rate, P, QRS and T frontal axis, P and QRS overall duration, PR and QT overall intervals and QTc corrected by Hodges, Bazett, Fridericia and Framingham formulae. Overall, the results were similar to those from other studies performed in different populations but there were differences in extreme ages and specific measurements.ConclusionsThis study has provided reference values for Latinos of both sexes older than 1 year. Our results are comparable to studies performed in different populations.

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Section: Discussionmentioning

confidence: 99%

“…This program has been extensively evaluated, meeting the requirements of IEC 60601–2-25 and is used routinely world-wide. It provides all the standard amplitude, duration and axes measurements as well as a rhythm analysis and diagnostic interpretation [21–23]. It is well suited for epidemiological studies [3–5, 15].…”

Section: Methodsmentioning

confidence: 99%

Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients

Palhares

Marcolino

Santos

et al. 2017

BMC Cardiovasc Disord

View full text Add to dashboard Cite

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“…The question whether or not similar results could be obtained with other manufacturers’ algorithms is required additional study [23]. …”

Section: Discussionmentioning

confidence: 99%

Statistical evaluation of reproducibility of automated ECG measurements: An example from arrhythmogenic right ventricular dysplasia/cardiomyopathy clinic

Huang

James

Tichnell

et al. 2014

Biomedical Signal Processing and Control

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Background Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by delay in depolarization of the right ventricle, detected by prolonged terminal activation duration (TAD) in V1–V3. However, manual ECG measurements have shown moderate-to-low intra- and inter-reader agreement. The goal of this study was to assess reproducibility of automated ECG measurements in the right precordial leads. Methods Pairs of ECGs recorded in the same day from Johns Hopkins ARVD/C Registry participants [n=247, mean age 35.2±15.6 y, 58% men, 92% whites, 11(4.5%) with definite ARVD/C] were retrospectively analyzed. QRS duration, intrinsicoid deflection, TAD, and T-wave amplitude in the right precordial leads, as well as averaged across all leads QRS duration, QRS axis, T axis, QTc interval, and heart rate was measured automatically, using 12SL TM algorithm (GE Healthcare, Wauwatosa, WI, USA). Intrinsicoid deflection was measured as the time from QRS complex onset to the alignment point of the QRS complex. TAD was calculated as the difference between QRS duration and intrinsicoid in V1, V2, V3. Reproducibility was quantified by Bland-Altman analysis (bias with 95% limits of agreement), Lin’s concordance coefficient, and Bradley-Blackwood procedure. Results Bland-Altman analysis revealed satisfactory reproducibility of tested parameters. V1 QRS duration bias was −0.10ms [95% limits of agreement −12.77 to 12.56ms], V2 QRS duration bias −0.09ms [−11.13 to 10.96ms]; V1 TAD bias 0.14ms [−13.23 to 13.51ms], V2 TAD bias 0.008ms [−12.42 to 12.44ms]. Conclusion Comprehensive statistical evaluation of reproducibility of automated ECG measurements is important for appropriate interpretation of ECG. Automated ECG measurements are reproducible to within 25%.

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“…Monitor measure ments, especially from fully automated continuous QTc monitoring, should not be considered equivalent to, or used interchangeably with, standard 12lead ECGs for serial comparison. 86 However, nurses monitoring QTc for atrisk patients every 8 hours via telemetry are able to report increasing measurements, having identi fied an increase in QTc for which the prescriber would want to be notified (eg, reaching 500 milliseconds), at which point the prescriber may decide whether a 12 lead ECG is needed to confirm the measurement and adjust treatment accordingly. Patients can be moni tored for response to Class III antiarrhythmic drugs (eg, call prescriber if QTc increases ≥25% from baseline).…”

Section: Methods Used To Measure the Qtc Intervalmentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

207

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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Comparison of automated measurements of electrocardiographic intervals and durations by computer-based algorithms of digital electrocardiographs

Cited by 50 publications

References 37 publications

Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients

Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients

Statistical evaluation of reproducibility of automated ECG measurements: An example from arrhythmogenic right ventricular dysplasia/cardiomyopathy clinic

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

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