Accurate Electrocardiogram Interpretation Research Articles

Transport decisions: acute coronary syndrome and high-risk electrocardiograms

Patients experiencing a high-risk non-ST-elevation myocardial infarction are likely to benefit from prehospital medical contact, transport to a percutaneous coronary intervention (PCI) centre and early definitive treatment. They may be provisionally diagnosed through the identification of a high-risk electrocardiogram (ECG). Advances in ECG interpretation have led to the identification of a cohort of at-risk patients whose treatment may previously have been delayed. Patients with certain ECG changes are considered high risk and may be experiencing coronary occlusions. Early PCI and direct transport to a PCI-capable hospital are associated with a reduction in mortality and morbidity; this is associated with a lower financial burden on the health service. Early paramedic identification of these high-risk ECGs and appropriate transport decision-making can positively influence patient outcomes. High-risk ECGs include those that are positive for the modified Smith-Sgarbossa criteria, DeWinter T waves, Wellens syndrome, posterior acute myocardial infarction and aVR elevation. Continued education is correlated with more accurate ECG interpretation.

Effectiveness of the CRISP Method on the Primary Cardiac Arrhythmia Interpretation Accuracy of Nurses.

Accurate electrocardiogram (ECG) interpretation is key to quickly providing attention to patients, and the first health staff who evaluate ECGs are nurses. This was a prospective study with a pre-posttest design. The study test included 15 ECGs related to primary cardiac arrhythmias. After pretest nurses were instructed on arrhythmia interpretation using the Cardiac Rhythm Identification for Simple People (CRISP) method, posttests were completed. There was a significant difference between the pretest scores of nurses who had postgraduate education on ECG interpretation and who did not (p = .002). Median test score increased from 3 (interquartile range [IQR] = 2-5) to 7 (IQR = 5-9) (p < .001). Participants mostly missed questions about heart blocks and were most successful with questions about fatal arrhythmias after education. The CRISP method is an effective, simple, and easy method for accurate ECG interpretation by nurses. The posttest scores of the participants, especially accurate interpretation of fatal arrhythmias, increased significantly after training. [J Contin Educ Nurs. 2020;51(12):574-580.].

A deep neural network learning algorithm outperforms a conventional algorithm for emergency department electrocardiogram interpretation

BackgroundCardiologs® has developed the first electrocardiogram (ECG) algorithm that uses a deep neural network (DNN) for full 12‑lead ECG analysis, including rhythm, QRS and ST-T-U waves. We compared the accuracy of the first version of Cardiologs® DNN algorithm to the Mortara/Veritas® conventional algorithm in emergency department (ED) ECGs. MethodsIndividual ECG diagnoses were prospectively mapped to one of 16 pre-specified groups of ECG diagnoses, which were further classified as “major” ECG abnormality or not. Automated interpretations were compared to blinded experts'. The primary outcome was the performance of the algorithms in finding at least one “major” abnormality. The secondary outcome was the proportion of all ECGs for which all groups were identified, with no false negative or false positive groups (“accurate ECG interpretation”). Additionally, we measured sensitivity and positive predictive value (PPV) for any abnormal group. ResultsCardiologs® vs. Veritas® accuracy for finding a major abnormality was 92.2% vs. 87.2% (p < 0.0001), with comparable sensitivity (88.7% vs. 92.0%, p = 0.086), improved specificity (94.0% vs. 84.7%, p < 0.0001) and improved positive predictive value (PPV 88.2% vs. 75.4%, p < 0.0001). Cardiologs® had accurate ECG interpretation for 72.0% (95% CI: 69.6–74.2) of ECGs vs. 59.8% (57.3–62.3) for Veritas® (P < 0.0001). Sensitivity for any abnormal group for Cardiologs® and Veritas®, respectively, was 69.6% (95CI 66.7–72.3) vs. 68.3% (95CI 65.3–71.1) (NS). Positive Predictive Value was 74.0% (71.1–76.7) for Cardiologs® vs. 56.5% (53.7–59.3) for Veritas® (P < 0.0001). ConclusionCardiologs' DNN was more accurate and specific in identifying ECGs with at least one major abnormal group. It had a significantly higher rate of accurate ECG interpretation, with similar sensitivity and higher PPV.

Implications of Using the Cabrera Sequence for Diagnosing Acute Coronary Syndrome.

The 12-lead electrocardiogram (ECG) is the important, initial examination for diagnosing acute coronary syndrome (ACS). In the traditional 12-lead ECG display, the precordial leads are displayed in their anatomically contiguous order, which makes it easy to understand the positional relationships between the precordial leads and the heart, but the limb leads are not. The "Cabrera sequence" displays the limb leads in an anatomically contiguous manner, which facilitates understanding of the positional relations between the limb leads and the heart, resulting in more rapid, easy, and accurate ECG interpretation than the traditional limb leads display. This review explores the clinical advantages of the Cabrera sequence as compared with the traditional limb leads display for the diagnosis of ACS. (Circ J 2016; 80: 1087-1096).

Exploring the Impact of Expertise, Clinical History, and Visual Search on Electrocardiogram Interpretation

The primary aim of this study is to understand more about the perceptual-cognitive mechanisms underpinning the expert advantage in electrocardiogram (ECG) interpretation. While research has examined visual search processes in other aspects of medical decision making (e.g., radiology), this is the first study to apply the paradigm to ECG interpretation. The secondary aim is to explore the role that clinical history plays in influencing visual search behavior and diagnostic decision making. While clinical history may aid diagnostic decision making, it may also bias the visual search process. Ten final-year medical students and 10 consultant emergency medics were presented with 16 ECG traces (8 with clinical history that was not manipulated independently of case) while wearing eye tracking equipment. The ECGs represented common abnormalities encountered in emergency departments and were among those taught to final-year medical students. Participants were asked to make a diagnosis on each presented trace and report their level of diagnostic confidence. Experts made significantly faster, more accurate, and more confident diagnoses, and this advantage was underpinned by differences in visual search behavior. Specifically, experts were significantly quicker at locating the leads of critical importance. Contrary to our hypothesis, clinical history had no significant effect on the readers' ability to detect the abnormality or make an accurate diagnosis. Accurate ECG interpretation appears dependent on the perceptual skill of pattern recognition and specifically the time to fixate the critical lead(s). Therefore, there is potential clinical utility in developing perceptual training programs to train novices to detect abnormalities more effectively.

Sudden cardiac death and sport in Luxembourg: Incitement for a public health strategy

Sudden cardiac death and sport in Luxembourg: Incitement for a public health strategy

Accurate ECG Diagnosis of Atrial Tachyarrhythmias Using Quantitative Analysis: A Prospective Diagnostic and Cost‐Effectiveness Study

Quantitative ECG Analysis. Optimal atrial tachyarrhythmia management is facilitated by accurate electrocardiogram interpretation, yet typical atrial flutter (AFl) may present without sawtooth F-waves or RR regularity, and atrial fibrillation (AF) may be difficult to separate from atypical AFl or rapid focal atrial tachycardia (AT). We analyzed whether improved diagnostic accuracy using a validated analysis tool significantly impacts costs and patient care. We performed a prospective, blinded, multicenter study using a novel quantitative computerized algorithm to identify atrial tachyarrhythmia mechanism from the surface ECG in patients referred for electrophysiology study (EPS). In 122 consecutive patients (age 60 ± 12 years) referred for EPS, 91 sustained atrial tachyarrhythmias were studied. ECGs were also interpreted by 9 physicians from 3 specialties for comparison and to allow healthcare system modeling. Diagnostic accuracy was compared to the diagnosis at EPS. A Markov model was used to estimate the impact of improved arrhythmia diagnosis. We found 13% of typical AFl ECGs had neither sawtooth flutter waves nor RR regularity, and were misdiagnosed by the majority of clinicians (0/6 correctly diagnosed by consensus visual interpretation) but correctly by quantitative analysis in 83% (5/6, P = 0.03). AF diagnosis was also improved through use of the algorithm (92%) versus visual interpretation (primary care: 76%, P < 0.01). Economically, we found that these improvements in diagnostic accuracy resulted in an average cost-savings of $1,303 and 0.007 quality-adjusted-life-years per patient. Typical AFl and AF are frequently misdiagnosed using visual criteria. Quantitative analysis improves diagnostic accuracy and results in improved healthcare costs and patient outcomes.

Interpretation of the electrocardiogram: clinical correlation suggested

Vijayaraghavan et al. have investigated the interpretation of the initial 12-lead electrocardiogram (ECG) in acute coronary syndrome (ACS) patients, focusing on the patient with potential ST segment elevation myocardial infarction (STEMI).1 The authors emphasize the importance of accurate ECG interpretation by the acute care physician (i.e. emergency physician, internist, and cardiologist).1 The authors compared the initial interpretation of the initial admission ECG by the treating physician with the interpretation of the same tracing by a physician at the core electrocardiographic laboratory. The ECG interpreters at the site were acute care physicians (emergency physician, internist, and cardiologist); at the core lab, the ECG was interpreted by non-cardiologist physicians using specific definitions of abnormality—in this case, ST segment elevation was defined as >0.1 mV in two contiguous leads. The subgroup of patients used in the study were taken from the Canadian ACS Registry and comprised 1310 patients, of which 1202 had complete data and were used for analysis. The definition of STEMI included ST segment elevation and a positive biomarker. What is unclear is whether a positive biomarker was a single spot test or the more appropriate ‘typical rise and fall’ pattern. Overall concordance between core-lab and site interpretation of the admission ECG was 62%. The calculated kappa value was 0.49, indicating modest agreement. When compared with the agreement group of the study, patients in the discordant subgroup were older with higher rates of diabetes mellitus, angina, myocardial infarction, congestive heart failure, coronary artery bypass grafting, and percutaneous coronary intervention. Patients with core-lab-defined ST segment elevation that was not noted by the treating site, who also had a positive biomarker, were significantly less likely to receive aspirin, heparin, and reperfusion therapy when compared with patients with core lab-site ECG interpretation agreement. After adjusting for other validated prognostic factors, site-unrecognized ST … *Corresponding author: Tel: +1 4344651816, Fax: +1 4349242877. Email: wb4z{at}hscmail.mcc.virginia.edu

Electrocardiogram artifacts caused by deep brain stimulation.

Deep brain stimulation (DBS) is increasingly used to treat a variety of neurological conditions (e.g. movement disorders and chronic pain). This prospective study was designed to detect electrocardiogram (ECG) artifacts induced by deep brain stimulation and to investigate which factors (patient disease, electrode position within the brain or type of stimulation) produced these artifacts. Twelve patients (four women, eight men) with deep brain stimulators were enrolled in the study. Patients were selected to represent the common indications for DBS (Parkinson's disease, tremor, dystonia), the common electrode locations (pallidum, thalamus, subthalamic nucleus) and the two types of stimulation (monopolar, bipolar). Patients had one ECG with the DBS turned 'on' and another with the DBS turned 'off'. The ECGs were then randomized and read by a cardiologist blinded to the status of the patient and DBS and artifacts were noted to be either present or absent. The six patients using monopolar stimulation all had artifacts on their electrocardiograms. These artifacts were severe enough to interfere with ECG interpretation. There were no artifacts detected in the six patients using bipolar stimulation. Electrode location and patient disease appeared to have no effect on ECG artifact. Deep brain stimulation can cause ECG artifacts when monopolar settings are used. These artifacts are not present with bipolar settings or when the DBS is turned 'off'. Knowledge of these potential ECG artifacts and how to avoid them is essential to facilitate accurate ECG interpretation.