Errors in the computerized electrocardiogram interpretation of cardiac rhythm

Shah, Atman P.; Rubin, Stanley A.

doi:10.1016/j.jelectrocard.2007.03.008

Cited by 106 publications

(86 citation statements)

References 15 publications

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“…In evaluating the ECG-C interpretation of the cardiac rhythm, the ECG-C demonstrated an overall accuracy of 88.0%. 5 Sinus rhythm was correctly interpreted in 95.0% of the ECGs with this rhythm. However, nonsinus rhythms were correctly interpreted with an accuracy of only 54%.…”

Section: Article See P 76mentioning

confidence: 91%

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Computerized Interpretation of ECGs

Estes

2013

Circ: Arrhythmia and Electrophysiology

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Estes III Computerized Interpretation of ECGs 3prolonged QT diagnostic statement. 14 The authors note that such prolonged QT under-reporting was manifest across all patient environments, and reflected algorithmic suppression of the diagnosis.14 This was because of ECG waveform-based criteria in 52.5% of ECGs with prolonged QTc.14 Of the latter ECGs with prolonged QT diagnosis suppression, the computer declared 42.1% as normal, despite QTc prolongation.14 The authors concluded that in evaluating an adult patient, whose ECG-C lacks a prolonged QT diagnostic statement, physicians should examine the actual QTc value displayed on the report before concluding that this parameter is normal.14 They also conclude that assessment of the clinical impact of prolonged QT diagnosis suppression by ECG waveform-based criteria is warranted.14 It is evident that automated evaluation of the QT interval is one of the particularly important functions of any ECG-C. Identification of a prolonged heart rate corrected QT interval (QTc) may identify an individual with an inherited LQTS atrisk for sudden cardiac death because of torsade de point. 3,[7][8][9][10][11][12][13] The QTc also serves as a marker of risk for individuals with a prolonged QT interval, acquired from electrolyte abnormalities or drugs.3,7-13 Specific technical and clinical recommendations for measurement of the QT and QTc intervals on the ECG have been made in a American Heart Association consensus document written to standardize the interpretation of ECGs.3 It is recommended that, in addition to rate, an adjustment for sex and age be incorporated into QTc measurement. As practical clinical limits for considering the QT interval as abnormal, this document recommends that the adjusted QT of 460 ms or longer in women and 450 ms or longer in men be considered a prolonged QT interval, and that QT of 390 ms and shorter be considered a short QT interval.3 It is recommended that linear regression functions rather than the Bazett formula be used for QT-rate correction, and that the method used for rate correction be identified in ECG analysis reports.3 It is further recommended that rate correction of the QT interval should not be attempted when RR interval variability is large, as often occurs with atrial fibrillation, or when identification of the end of the T-wave is unreliable. 3 In view of the clinical importance of the QT-interval prolongation, it is essential to validate QT-interval prolongation reported by a computer algorithm visually.3 In addition to administration of QT-prolonging cardioactive drugs, a number of conditions can induce QT prolongation.3 It is often possible to identify a specific cause of QT prolongation, when appropriate clinical information is available.3 Electrolyte disturbances, including hypokalemia, hypomagnesemia, and hypocalcemia, can prolong phase 2 and phase 3 of the action potential and prolong the QT interval.3 A comprehensive and current list of all possible causes of QT prolongation is readily available. 15 It is evident that presence...

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Section: Article See P 76mentioning

confidence: 91%

“…[4][5][6][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.…”

Section: Article See P 76mentioning

confidence: 99%

Computerized Interpretation of ECGs

Estes

2013

Circ: Arrhythmia and Electrophysiology

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“…In addition, ECG interpretation software is built into many modern ECG systems and contains algorithms to assess reliably the cardiac rhythm and measure the heart rate and PR, QRS, and QT intervals. 5 These metrics provide important insight into autonomic function, atrioventricular conduction, ventricular depolarization, and repolarization. In communitybased elderly participants with early CKD, ECG measures were independently associated with all-cause mortality.…”

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confidence: 99%

Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

Deo

Shou

Soliman

et al. 2016

Journal of the American Society of Nephrology

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03-5.33). Most ECG measures were stronger markers of risk for cardiovascular death than for all-cause mortality or noncardiovascular death. Adding these intervals to a comprehensive model of cardiorenal risk factors increased the C-statistic for cardiovascular death from 0.77 to 0.81 (P,0.001). Furthermore, adding ECG metrics to the model adjusted for standard risk factors resulted in a net reclassification of 12.1% (95% confidence interval 8.1%-16.0%). These data suggest common ECG metrics are independent risk factors for cardiovascular death and enhance the ability to predict death events in a population with CKD.

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“…Those annotations were then used as a "golden standard" upon which the computer algorithms were validated for each pair of ECG sequences [10]. A similar approach was used by Shah and Rubin in their study of errors in the computerized ECG interpretation, where two cardiology experts interpreted the tracings recorded [11].…”

Section: Comparing Ecg Recordings From a Variety Of Equipmentmentioning

confidence: 99%

“…Therefore a similar evaluation should be performed as a randomized control study involving more hospitals and cardiologists. Furthermore, several different Holter recorders should be considered, as there might be limited accuracy in the automatic ECG interpretations as described by Shah and Rubin [11]. It would be preferable if ECG recordings from the two different systems could be exported to a standardized format in which a third party arrhythmia detection software could be able to compare actual findings from the two recording systems, as this would be an independent evaluation to be manually confirmed by the cardiologists.…”

Section: 4mentioning

confidence: 99%

Clinical evaluation of a wireless ECG sensor system for arrhythmia diagnostic purposes

Fensli

Gundersen

Snaprud

et al. 2013

Medical Engineering & Physics

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Abstract. In a clinical study, a novel wireless electrocardiogram (ECG) recorder has been evaluated with regard to its ability to perform arrhythmia diagnostics. As the ECG recorder will detect a "non-standard" ECG signal, it has been necessary to compare those signals to "standard" ECG recording signals in order to evaluate the arrhythmia detection ability of the new system. Simultaneous recording of ECG signals from both the new wireless ECG recorder and a conventional Holter recorder were compared by two independent cardiology specialists with regard to signal quality for performing arrhythmia diagnosis. In addition, calculated R-R intervals from the two systems were correlated. A total number of 16 patients participated in the study. It can be considered that recorded ECG signals obtained from the wireless ECG system had an acceptable quality for arrhythmia diagnosis. Some of the patients used the wireless sensor while doing physical sport activities, and the quality of the recorded ECG signals made it possible to perform arrhythmia diagnostics even under such conditions. Consequently, this makes possible improvements in correlating arrhythmias to physical activities. IntroductionDisease management programs with ECG recording equipment (to be used by patients at home) and integrated telemedicine solutions are expected to become important in ensuring safety and cost-effectiveness in future health-care services [1,2]. In recent years, several interesting projects have focused on developing new wireless ECG solutions. However, little information has been published on clinical results from this wireless technology. The Amon wrist watch system had a promising design, but a study with healthy volunteers showed unsatisfactory ECG signal quality [3]. The SmartVest system showed results from a variety of sensors including ECG, but has only been tested on healthy subjects for a 30-minute test during standing and walking [4].Even though a wireless system can give valuable benefits for the patient with regard to mobility, a reliable and precise monitoring quality will be needed in order to use such equipment as a clinical diagnostic tool. Clinical experience also confirms the need for improvements in ECG recording equipment when the patient is performing physical activities, where artefact signals today represent a major obstacle.A new wireless ECG system consisting of a wireless ECG sensor communicating by means of a hand-held receiver, intended for long-term arrhythmia detection, has been developed [5]. The new design of this "electronic electrode" uses only one ECG lead, which is in a different position compared to standard lead systems, which will thus record a "non-standard" ECG signal. A totally wireless solution eliminating the "cable spaghetti" can give continuous monitoring, while the patient's behaviour may be closer to his normal routines than when using existing technology [6]. Because there are no wires between the electrodes and the recording device, the patient will also be able to carry out physical act...

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Errors in the computerized electrocardiogram interpretation of cardiac rhythm

Cited by 106 publications

References 15 publications

Computerized Interpretation of ECGs

Computerized Interpretation of ECGs

Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

Clinical evaluation of a wireless ECG sensor system for arrhythmia diagnostic purposes

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