| Accurate ECG diagnosis of atrial tachyarrhythmias using quantitative analysis: a prospective diagnostic and cost-effectiveness study. | |
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MedLine Citation:
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PMID: 20522152 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: Optimal atrial tachyarrhythmia management is facilitated by accurate electrocardiogram interpretation, yet typical atrial flutter (AFl) may present without sawtooth F-waves or RR regularity, and atrial fibrillation (AF) may be difficult to separate from atypical AFl or rapid focal atrial tachycardia (AT). We analyzed whether improved diagnostic accuracy using a validated analysis tool significantly impacts costs and patient care. METHODS AND RESULTS: We performed a prospective, blinded, multicenter study using a novel quantitative computerized algorithm to identify atrial tachyarrhythmia mechanism from the surface ECG in patients referred for electrophysiology study (EPS). In 122 consecutive patients (age 60 ± 12 years) referred for EPS, 91 sustained atrial tachyarrhythmias were studied. ECGs were also interpreted by 9 physicians from 3 specialties for comparison and to allow healthcare system modeling. Diagnostic accuracy was compared to the diagnosis at EPS. A Markov model was used to estimate the impact of improved arrhythmia diagnosis. We found 13% of typical AFl ECGs had neither sawtooth flutter waves nor RR regularity, and were misdiagnosed by the majority of clinicians (0/6 correctly diagnosed by consensus visual interpretation) but correctly by quantitative analysis in 83% (5/6, P = 0.03). AF diagnosis was also improved through use of the algorithm (92%) versus visual interpretation (primary care: 76%, P < 0.01). Economically, we found that these improvements in diagnostic accuracy resulted in an average cost-savings of $1,303 and 0.007 quality-adjusted-life-years per patient. CONCLUSIONS: Typical AFl and AF are frequently misdiagnosed using visual criteria. Quantitative analysis improves diagnostic accuracy and results in improved healthcare costs and patient outcomes. |
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Authors:
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David E Krummen; Mitul Patel; Hong Nguyen; Gordon Ho; Dhruv S Kazi; Paul Clopton; Marian C Holland; Scott L Greenberg; Gregory K Feld; Mitchell N Faddis; Sanjiv M Narayan |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of cardiovascular electrophysiology Volume: 21 ISSN: 1540-8167 ISO Abbreviation: J. Cardiovasc. Electrophysiol. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-02 Completed Date: 2011-03-07 Revised Date: 2011-11-01 |
Medline Journal Info:
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Nlm Unique ID: 9010756 Medline TA: J Cardiovasc Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 1251-9 Citation Subset: IM |
Copyright Information:
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© 2010 Wiley Periodicals, Inc. |
Affiliation:
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University of California San Diego, San Diego, California, USA. dkrummen@ucsd.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cost-Benefit Analysis / economics Diagnosis, Computer-Assisted / economics*, methods* Electrocardiography / economics*, methods* Female Health Care Costs / statistics & numerical data* Humans Male Middle Aged Reproducibility of Results Sensitivity and Specificity Single-Blind Method Tachycardia, Ectopic Atrial / diagnosis*, economics*, epidemiology United States / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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K23 HL070529-01/HL/NHLBI NIH HHS; R01 HL083359-04/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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