Establishment of a reference library for evaluating computer ECG measurement programs

As a result of an international cooperative project entitled "Common Standards for Quantitative Electrocardiography" (CSE), an ECG reference data base has been established with the aim of standardizing computer-derived ECG measurements. The objective of the project is to reduce the wide variation in wave measurements currently obtained by ECG analysis programs. A library of 250 ECGs with selective ECG abnormalities was established and a comprehensive reviewing scheme was devised for the visual determination of the onsets and offsets of P, QRS, and T. This task was performed by a board of cardiologists on highly amplified, selected complexes from the library. A subset was examined in order to study beat-to-beat and intraobserver variability. By using a modified Delphi approach, individual outlying point estimates were eliminated in four successive rounds. In this way final referee estimates were obtained which proved to be highly reproducible and precise. A reference library has thereby been developed which allows testing of the performance of ECG measurement programs and is a useful instrument in establishing recommendations for more precise measurement rules and definitions.