Accuracy of the EASI 12-lead electrocardiogram compared to the standard 12-lead electrocardiogram for diagnosing multiple cardiac abnormalities

Drew, Barbara J.; Pelter, Michele M.; Wung, Shu Fen; Adams, Mary G.; Taylor, Carrie A.; Evans, Griffith; Foster, Elyse

doi:10.1016/s0022-0736(99)90033-x

Cited by 75 publications

(40 citation statements)

References 20 publications

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“…The 12-lead ECG derived by Dower has been investigated in a series of studies that conclude it is comparable to the standard 12-lead ECG for the diagnosis of wide QRS complex tachycardias 124 and acute myocardial ischemia. [125][126][127] These investigators also conducted a clinical trial that compared the reduced lead system with routine monitoring for detecting acute myocardial ischemia in 422 patients admitted to the CCU with acute coronary syndromes. They reported that of 463 ischemic events detected with ST-segment monitoring using the reduced lead ECG, 67% showed no evidence of ischemia in routine CCU monitoring leads (V 1 and II), and 80% of the episodes were asymptomatic.…”

Section: -Electrode 12-lead Ecg Systemmentioning

confidence: 99%

Practice Standards for Electrocardiographic Monitoring in Hospital Settings

Drew¹,

Califf²,

et al. 2004

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Abstract-The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided. Key Words: AHA Scientific Statements Ⅲ pediatrics Ⅲ electrocardiography Ⅲ torsade de pointes Ⅲ myocardial infarction Ⅲ tachyarrhythmias Ⅲ ischemia Ⅲ antiarrhythmic agents Ⅲ long-QT syndrome S ince the introduction of electrocardiographic (ECG) monitoring in hospital units Ͼ40 years ago, 1 the goals of monitoring have expanded from simple tracking of heart rate and basic rhythm to the diagnosis of complex arrhythmias, the detection of myocardial ischemia, and the identification of a prolonged QT interval. During the same 4 decades, major improvements have occurred in cardiac monitoring systems, including computerized arrhythmia detection algorithms, STsegment/ischemia monitoring software, improved noisereduction strategies, multilead monitoring, and reduced lead sets for monitoring-derived 12-lead ECGs with a minimal number of electrodes. 2,3 Despite these advances in technology, the need for human oversight in the interpretation of ECG monitoring data is as important today as it was 40 years ago for the following reasons. First, cardiac monitor algorithms are intentionally set for high sensitivity at the expense of specificity. As a result, numerous false alarms occur that must be evaluated by healthcare professionals so that overtreatment of patients will not occur. Examples of overtreatment are reported in the The American Heart Association makes every effort to avoid any actual or potential ...

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Section: -Electrode 12-lead Ecg Systemmentioning

confidence: 99%

Practice Standards for Electrocardiographic Monitoring in Hospital Settings

Drew¹,

Califf²,

et al. 2004

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“…An advantage of EASI leads is the relative anatomic simplicity of electrode placement. Tracings synthesized from the EASI leads have been shown to have useful correlative value with the standard 12-lead ECG 115,116 ; however, it is recognized that these synthesized tracings can differ in interval duration and amplitude from the corresponding standard ECGs. Whether synthesized 12-lead tracings provide practical advantage and adequate reproduction of ST-segment shifts to be a substitute for standard tracings during acute ischemic syndromes is a matter of intense current investigation.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for the Standardization and Interpretation of the Electrocardiogram

Kligfield¹,

Gettes²,

Bailey³

et al. 2007

Circulation

518

152

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Abstract-This statement examines the relation of the resting ECG to its technology. Its purpose is to foster understanding of how the modern ECG is derived and displayed and to establish standards that will improve the accuracy and usefulness of the ECG in practice. Derivation of representative waveforms and measurements based on global intervals are described. Special emphasis is placed on digital signal acquisition and computer-based signal processing, which provide automated measurements that lead to computer-generated diagnostic statements. Lead placement, recording methods, and waveform presentation are reviewed. Key Words: AHA Scientific Statements Ⅲ electrocardiography Ⅲ computers Ⅲ diagnosis Ⅲ electrophysiology Ⅲ intervals Ⅲ potentials Ⅲ tests I n the century since the introduction of the string galvanometer by Willem Einthoven, 1 the electrocardiogram (ECG) has become the most commonly conducted cardiovascular diagnostic procedure and a fundamental tool of clinical practice. 2,3 It is indispensable for the diagnosis and prompt initiation of therapy in patients with acute coronary syndromes and is the most accurate means of diagnosing intraventricular conduction disturbances and arrhythmias. Its interpretation may lead to the recognition of electrolyte abnormalities, particularly of serum potassium and calcium, and permit the detection of some forms of genetically mediated electrical or structural cardiac abnormalities. The ECG is routinely used to monitor patients treated with antiarrhythmic and other drugs, in the preoperative assessment of patients undergoing noncardiac surgery, and in screening individuals in high-risk occupations and, in some The American Heart Association, the American College of Cardiology, and the Heart Rhythm Society make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Copies: This document is available on the World Wide Web sites of the American Heart Association (www.americanheart.org) and the American College of Cardiology (www.acc.org). A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0389. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml? Identifierϭ4431. A link to the "Permission Request Form" appears on the right side of the page.© 2007 American...

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“…For simplification purposes, 4-lead EASI electrodes (leads E, A, and I of the Frank lead system plus an additional S lead positioned over the superior end of the sternum) [258][259][260] (Figure 16.2) are placed and the acquired data are stored and downlinked for retrospective analysis. A study by Drew et al [261] in which 540 patients were tested with this 4-lead system showed that the agreement with standard 12-lead electrocardiography was 100% for arrhythmias, 100% for acute infarction, 95% for angioplasty-induced ischemia, and 89% for transient ischemia. Although the 4-lead EASI electrode system has been used in terrestrial settings [261][262][263][264][265][266][267][268], correlation of the EASI 4-to 10-electrode electrical conversion for full 12-lead ECG monitoring under the conditions of microgravity-induced fluid and anatomic shifts has not been validated either at rest or during exercise.…”

Section: Periodic Cardiovascular Evaluationsmentioning

confidence: 95%

Cardiovascular Disorders

Hamilton¹

2008

Principles of Clinical Medicine for Space Flight

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Accuracy of the EASI 12-lead electrocardiogram compared to the standard 12-lead electrocardiogram for diagnosing multiple cardiac abnormalities

Cited by 75 publications

References 20 publications

Practice Standards for Electrocardiographic Monitoring in Hospital Settings

Practice Standards for Electrocardiographic Monitoring in Hospital Settings

Recommendations for the Standardization and Interpretation of the Electrocardiogram

Cardiovascular Disorders

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