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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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The Human Factor: Physicians' Unbiased Interpretation of Atrial Fibrillation in the Emergency Department

Yuval Avidan1, Razi Khoury1, Hani Sliman2

  • 1Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel.

Pacing and Clinical Electrophysiology : PACE
|February 20, 2026
PubMed

Insights

Atrial fibrillation (AF) misdiagnosis in emergency departments is common, affecting 2.7% of cases and leading to inappropriate treatments. This rate is similar whether or not computerized ECG interpretations are used.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Medical Diagnostics

Background:

  • Misinterpreting atrial fibrillation (AF) carries significant clinical risks.
  • Limited real-world data exists on emergency department (ED) clinicians' diagnostic accuracy for AF without computerized ECG interpretation (CIE).
  • This study assesses AF misdiagnosis frequency and impact in an ED environment lacking CIE.

Purpose of the Study:

  • To determine the prevalence of atrial fibrillation misdiagnosis in an ED setting.
  • To evaluate the clinical consequences of misdiagnosed atrial fibrillation.
  • To compare diagnostic accuracy with and without computerized ECG interpretation.

Main Methods:

  • Retrospective review of 1797 ECGs initially diagnosed with AF over five years.
  • Two cardiologists reevaluated ECGs, with an electrophysiologist as arbitrator.
  • Clinical follow-up was conducted for misdiagnosed cases.

Main Results:

  • A misdiagnosis rate of 2.7% (49 cases) was identified among the reviewed ECGs.
  • Common misclassifications included supraventricular tachycardia and sinus rhythm variants.
  • Patients with incorrect AF diagnoses were older and received inappropriate therapies like anticoagulants and rate-control agents.

Conclusions:

  • Atrial fibrillation misdiagnosis is prevalent in EDs, leading to unnecessary pharmacotherapy.
  • The rate of AF misdiagnosis appears comparable between CIE-assisted and physician-only interpretations.
  • Improved diagnostic strategies are needed to reduce misclassification and inappropriate treatment.
Abstract

Keywords:
ECG misinterpretationatrial fibrillationelectrocardiogram

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