Diagnostic Accuracy of Screening Electrocardiograms in  Long QT Syndrome I

Miller, Misha D.; Porter, Co Burn J.; Ackerman, Michael J.

doi:10.1542/peds.108.1.8

Cited by 51 publications

(33 citation statements)

References 24 publications

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Section: Estes III Computerized Interpretation Of Ecgsmentioning

confidence: 99%

“…[4][5][6][7] A large international study compared the performance of 9 ECG-C programs with that of cardiologists in interpreting ECGs in clinically validated cases of various cardiac disorders. 4 The percentage of ECGs correctly classified by the ECG-C was lower than that for the cardiologists.…”

Section: Article See P 76mentioning

confidence: 99%

“…Identification of a prolonged heart rate corrected QT interval (QTc) may identify an individual with an inherited LQTS atrisk for sudden cardiac death because of torsade de point. 3,[7][8][9][10][11][12][13] The QTc also serves as a marker of risk for individuals with a prolonged QT interval, acquired from electrolyte abnormalities or drugs.3,7-13 Specific technical and clinical recommendations for measurement of the QT and QTc intervals on the ECG have been made in a American Heart Association consensus document written to standardize the interpretation of ECGs.3 It is recommended that, in addition to rate, an adjustment for sex and age be incorporated into QTc measurement. As practical clinical limits for considering the QT interval as abnormal, this document recommends that the adjusted QT of 460 ms or longer in women and 450 ms or longer in men be considered a prolonged QT interval, and that QT of 390 ms and shorter be considered a short QT interval.…”

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confidence: 99%

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Computerized Interpretation of ECGs

Estes

2013

Circ: Arrhythmia and Electrophysiology

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Estes III Computerized Interpretation of ECGs 3prolonged QT diagnostic statement. 14 The authors note that such prolonged QT under-reporting was manifest across all patient environments, and reflected algorithmic suppression of the diagnosis.14 This was because of ECG waveform-based criteria in 52.5% of ECGs with prolonged QTc.14 Of the latter ECGs with prolonged QT diagnosis suppression, the computer declared 42.1% as normal, despite QTc prolongation.14 The authors concluded that in evaluating an adult patient, whose ECG-C lacks a prolonged QT diagnostic statement, physicians should examine the actual QTc value displayed on the report before concluding that this parameter is normal.14 They also conclude that assessment of the clinical impact of prolonged QT diagnosis suppression by ECG waveform-based criteria is warranted.14 It is evident that automated evaluation of the QT interval is one of the particularly important functions of any ECG-C. Identification of a prolonged heart rate corrected QT interval (QTc) may identify an individual with an inherited LQTS atrisk for sudden cardiac death because of torsade de point. 3,[7][8][9][10][11][12][13] The QTc also serves as a marker of risk for individuals with a prolonged QT interval, acquired from electrolyte abnormalities or drugs.3,7-13 Specific technical and clinical recommendations for measurement of the QT and QTc intervals on the ECG have been made in a American Heart Association consensus document written to standardize the interpretation of ECGs.3 It is recommended that, in addition to rate, an adjustment for sex and age be incorporated into QTc measurement. As practical clinical limits for considering the QT interval as abnormal, this document recommends that the adjusted QT of 460 ms or longer in women and 450 ms or longer in men be considered a prolonged QT interval, and that QT of 390 ms and shorter be considered a short QT interval.3 It is recommended that linear regression functions rather than the Bazett formula be used for QT-rate correction, and that the method used for rate correction be identified in ECG analysis reports.3 It is further recommended that rate correction of the QT interval should not be attempted when RR interval variability is large, as often occurs with atrial fibrillation, or when identification of the end of the T-wave is unreliable. 3 In view of the clinical importance of the QT-interval prolongation, it is essential to validate QT-interval prolongation reported by a computer algorithm visually.3 In addition to administration of QT-prolonging cardioactive drugs, a number of conditions can induce QT prolongation.3 It is often possible to identify a specific cause of QT prolongation, when appropriate clinical information is available.3 Electrolyte disturbances, including hypokalemia, hypomagnesemia, and hypocalcemia, can prolong phase 2 and phase 3 of the action potential and prolong the QT interval.3 A comprehensive and current list of all possible causes of QT prolongation is readily available. 15 It is evident that presence...

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Section: Estes III Computerized Interpretation Of Ecgsmentioning

confidence: 99%

Section: Article See P 76mentioning

confidence: 99%

mentioning

confidence: 99%

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Computerized Interpretation of ECGs

Estes

2013

Circ: Arrhythmia and Electrophysiology

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“…Twenty primary studies 28,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] reported sensitivity and specificity estimates by using ECG to detect LQTS and/or HCM,…”

Section: Characteristics Of Reviewed Studiesmentioning

confidence: 99%

“…13 When incorporating Kobza, the summary prevalence increased fivefold to 38 per 100 000 (95% CI: 19-58) and heterogeneity increased (I 2 = 99%, P , .001). [42][43][44][45][46][47][48][49][50] The Bayesian sensitivity analysis giving the Schwartz 13 prior a low weight (1/2500) resulted in similar 48 Genotyped probands and relatives Not specified To provide clinical context, we used the summary phenotypic prevalence estimate for LQTS and 2 illustrative points (the maximal accuracy point and the maximal specificity point) on the HSROC curve for detection of LQTS by using ECG (Table 3). For both points, the NPV was near 100%.…”

Section: Long Qt Syndromementioning

confidence: 99%

Electrocardiogram Screening for Disorders That Cause Sudden Cardiac Death in Asymptomatic Children: A Meta-analysis

et al. 2012

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BACKGROUND AND OBJECTIVES: Pediatric sudden cardiac death (SCD) occurs in an estimated 0.8 to 6.2 per 100 000 children annually. Screening for cardiac disorders causing SCD in asymptomatic children has public appeal because of its apparent potential to avert tragedy; however, performance of the electrocardiogram (ECG) as a screening tool is unknown. We estimated (1) phenotypic (ECG-or echocardiogram [ECHO]-based) prevalence of selected pediatric disorders associated with SCD, and (2) sensitivity, specificity, and predictive value of ECG, alone or with ECHO. METHODS:We systematically reviewed literature on hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), and Wolff-ParkinsonWhite syndrome, the 3 most common disorders associated with SCD and detectable by ECG. RESULTS:We identified and screened 6954 abstracts, yielding 396 articles, and extracted data from 30. Summary phenotypic prevalences per 100 000 asymptomatic children were 45 (95% confidence interval [CI]: 10-79) for HCM, 7 (95% CI: 0-14) for LQTS, and 136 (95% CI: 55-218) for Wolff-Parkinson-White. The areas under the receiver operating characteristic curves for ECG were 0.91 for detecting HCM and 0.92 for LQTS. The negative predictive value of detecting either HCM or LQTS by using ECG was high; however, the positive predictive value varied by different sensitivity and specificity cut-points and the true prevalence of the conditions. CONCLUSIONS:Results provide an evidence base for evaluating pediatric screening for these disorders. ECG, alone or with ECHO, was a sensitive test for mass screening and negative predictive value was high, but positive predictive value and false-positive rates varied.

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