Recommendations for the standardization and interpretation of the electrocardiogram

Kligfield, Paul; Gettes, Leonard S.; Bailey, John R.; Childers, Rory; Deal, Barbara J.; Hancock, E. William; Herpen, Gerard van; Kors, Jan A.; Macfarlane, Peter W.; Mirvis, David M.; Pahlm, Olle; Rautaharju, Pentti M.; Wagner, Galen S.

doi:10.1016/j.hrthm.2007.01.027

Cited by 114 publications

(112 citation statements)

References 138 publications

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“…Twelve-lead electrocardiograms were recorded in all participants using standardized procedures 19 and identical electrocardiographic equipment (MAC 1200; GE Medical Systems Information Technologies, Milwaukee, WI). Digitally recorded ECGs were transmitted for analysis to the CRIC ECG reading center located at Wake Forest University, Winston Salem, NC.…”

Section: Cardiac Measurementsmentioning

confidence: 99%

Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

Deo

Shou

Soliman

et al. 2016

Journal of the American Society of Nephrology

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03-5.33). Most ECG measures were stronger markers of risk for cardiovascular death than for all-cause mortality or noncardiovascular death. Adding these intervals to a comprehensive model of cardiorenal risk factors increased the C-statistic for cardiovascular death from 0.77 to 0.81 (P,0.001). Furthermore, adding ECG metrics to the model adjusted for standard risk factors resulted in a net reclassification of 12.1% (95% confidence interval 8.1%-16.0%). These data suggest common ECG metrics are independent risk factors for cardiovascular death and enhance the ability to predict death events in a population with CKD.

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Section: Cardiac Measurementsmentioning

confidence: 99%

Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

Deo

Shou

Soliman

et al. 2016

Journal of the American Society of Nephrology

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“…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.…”

Section: Estes III Computerized Interpretation Of Ecgsmentioning

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.…”

mentioning

confidence: 99%

“…[1][2][3] The transition from analogue to digital ECGs resulted in automated computer analysis of the ECG (ECG-C) assuming a larger role in the diagnostic interpretation. 3 Yet, as the ECG-C has evolved into a necessary tool of modern medical practice, many physicians remain unaware of the hazards of relying on these preliminary diagnostic interpretations. The ECG-C clinical use should always be with the understanding that they are preliminary interpretations and require reading and confirmation by qualified electrocardiographer.…”

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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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“…The ten electrodes were placed on the body parts that had been previously determined, according to the international recommendations. 10 The disposable electrodes that were used were Ambu Blue Sensor SU and 3M model 2223. The chest electrodes deserved special attention due to the possibility of committing a mistake when positioning them.…”

Section: Electrocardiogram Acquisition Proceduresmentioning

confidence: 99%

Desafios à implantação do centro de leitura de eletrocardiografia no ELSA-Brasil

et al. 2013

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Electrocardiography is an established low-cost method of cardiovascular assessment, utilized for decades large epidemiological studies. Nonetheless, its use in large epidemiological studies presents challenges, especially when seeking to develop a reading center. This article describes the process, diffi culties and challenges of implementing an electrocardiogram reading center in Brazilian Longitudinal Study for Adulth Health (ELSA-Brasil). Among the issues discussed, we have emphasized: the criteria for selection of the electrocardiography machine and the central for storage and management of the machines; the required personnel; the procedures for acquisition and transmission of electrocardiographs to the Reading Center; coding systems, with emphasis on the Minnesota code; ethical and practical issues regarding the delivery of reports to study participants; and aspects related to quality control.

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Recommendations for the standardization and interpretation of the electrocardiogram

Cited by 114 publications

References 138 publications

Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

Computerized Interpretation of ECGs

Desafios à implantação do centro de leitura de eletrocardiografia no ELSA-Brasil

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