Diagnostic performance of a computer-based ECG rhythm algorithm

Abstract

We examined the accuracy of computer-based rhythm interpretation from one electrocardiograph manufacturer (GE Healthcare Technologies MUSE software 005C) in 4297 consecutive recordings in a university hospital setting. Overreading was performed by either of 2 experienced cardiologists, and all disagreements with the initial computer rhythm statement were reviewed by the second cardiologist to achieve physician consensus used as the “gold standard” for rhythm diagnosis. Overall, 13.2% (565/4297) of computer-based rhythm statements required revision, but excluding tracings with pacemakers, the revision rate was 7.8% (307/3954), including 3.8% involving the primary rhythm diagnosis and 3.9% involving definition of ectopic complexes. The false-negative rate for sinus rhythm was only 1.3%, but a computer diagnosis of sinus rhythm was incorrect in 9.9% of other rhythms. The false-negative rate for atrial fibrillation was 9.2%, whereas a computer diagnosis of atrial fibrillation was incorrect in 1.1% of other rhythms, including sinus. Computer diagnosis of paced rhythms remains problematic, and physician overreading to correct computer-based electrocardiogram rhythm diagnoses remains mandatory.

Introduction

Computerized interpretation of the electrocardiogram (ECG) has become widely applied during the past several decades [1], [2], [3], [4], [5], [6], [7], and most digital ECG recorders are capable of providing automated diagnostic statements that can assist or at times mislead the electrocardiographer [8], [9], [10], [11], [12], [13], [14], [15]. Interpretive statements that depend on precise measurement of ECG amplitudes and durations can approach experienced readers in sensitivity, specificity, and reproducibility [16], [17], [18]. However, statements that depend on waveform configuration, such as repolarization, and relationships between waveforms, such as irregular P waves, may be less accurate [19], [20]. As a consequence, evolving algorithms for the interpretation of cardiac rhythm remain imperfect and problematic [20], [21], [22], [23], [24], [25]. Accordingly, the clinical importance of physician overreading of computer-based rhythm statements requires periodic reevaluation.