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ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

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Errors in the computerized electrocardiogram interpretation of cardiac rhythm.

Atman P Shah¹, Stanley A Rubin

¹Division of Cardiology, VA Greater Los Angeles and the Department of Medicine, UCLA School of Medicine, Los Angeles, CA 90073, USA.

Journal of Electrocardiology

|May 29, 2007

Summary

Computer-interpreted electrocardiograms (ECG-C) show 88% accuracy, but struggle with nonsinus rhythms. Expert overreading is crucial for accurate cardiac rhythm interpretation, especially in complex cases.

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Area of Science:

Cardiology
Medical Informatics

Background:

Over 100 million computer-interpreted electrocardiograms (ECG-C) are generated annually.
Limited contemporary data exist on the accuracy of ECG-C for cardiac rhythm interpretation.

Purpose of the Study:

To evaluate the accuracy of computer-interpreted electrocardiogram (ECG-C) rhythm identification in a general patient population.

Main Methods:

A comparison was made between ECG-C rhythm interpretations and those of two expert cardiologists.
The analysis included 2112 randomly selected standard 12-lead ECGs.

Main Results:

The ECG-C achieved an overall accuracy of 88.0% (1858/2112), correctly interpreting rhythms in 1858 cases.
Accuracy for sinus rhythm was high (95.0%), but significantly lower for nonsinus rhythms (53.5%, P < .0001).
Of incorrect rhythm interpretations, 54% (137/254) had additional major errors.

Conclusions:

Computer-interpreted electrocardiograms (ECG-C) exhibit frequent errors in identifying nonsinus cardiac rhythms.
Inaccurate rhythm interpretation by ECG-C is often accompanied by other significant diagnostic inaccuracies.
Expert overreading of ECGs remains essential in clinical practice, particularly when nonsinus rhythms are prevalent.