Finding ECG Readers in Clinical Practice: Is It Time to Change the Paradigm?

Abstract

The standard 12-lead electrocardiogram (ECG) is the most commonly performed cardiac diagnostic test because it provides vital information about cardiac rhythm, acute myocardial injury, and a host of other abnormalities while also being simple to perform, risk free, and inexpensive. Historically, ECG readers have been trained in cardiology and clinical electrocardiography. However, mentoring of cardiology trainees in clinical electrocardiography has been superseded by a host of emerging diagnostic and treatment modalities such as invasive procedures, imaging techniques, cardiac device therapies, and cardiogenomics. As a result, there is an ever-shrinking pool of cardiologists who have the expertise or desire to read ECGs. In the United States, most ECGs are read by noncardiologists (emergency, internal-medicine, and family-practice physicians) who have had minimal training in clinical electrocardiography (1). Inadequate training of ECG readers has also led to an overreliance on computerized measurements/interpretations that are frequently inaccurate.