Document Detail

Accurate ECG diagnosis of atrial tachyarrhythmias using quantitative analysis: a prospective diagnostic and cost-effectiveness study.
MedLine Citation:
PMID:  20522152     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-02     Completed Date:  2011-03-07     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1251-9     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
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MeSH Terms
Cost-Benefit Analysis / economics
Diagnosis, Computer-Assisted / economics*,  methods*
Electrocardiography / economics*,  methods*
Health Care Costs / statistics & numerical data*
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Single-Blind Method
Tachycardia, Ectopic Atrial / diagnosis*,  economics*,  epidemiology
United States / epidemiology
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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