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348 Pitfalls in Computer ECG Interpretations

on the same person recorded 15 seconds apart may mendation reads: “Computer-based interpretation
have different interpretations either because of dif- of the ECG is an adjunct to the electrocardiographer,
ferent noise levels or because physiological variation and all computer-based reports require physician over
(e.g. respiratory cycle) means a diagnostic threshold reading.
has been crossed. Between the two ECGs one com-
mon error is missing small R waves resulting in a Normal ECG reported as Abnormal
wrong diagnosis of MI. Another is under and over Fig 1 and Fig 2
diagnosis of T wave Changes . (5), (6)
In interpretation of acute cardiac ischemia sensitivity
of 76% and a specificity of 88%, for acute myocardial
infarction the sensitivity was 68% and the specificity
97% and for thrombolytic therapy found a sensitivity
of 61.5% and specificity of 90%. Hence reliance on
computer interpretation would result in inappropriate
underuse of thromobolytic therapy
Benefits of computer interpretations are it is most
accurate in computing values, most accurate in cal-
culating Heart rate, Axis , intervals (PR, QRS, QT
), it is reliable in recognizing Sinus rhythm mecha-
nisms- saves time for experienced interpreter to in-
terpret large no of ECGs, it is very useful for primary
care physicians in remote areas for decision making
(7). Computer ECG is not infallible; Arrhythmias and
conduction disorders, electronic pacemakers and
Rhythm, acute myocardial infarction, high degree AV
blocks, Atrial Fibrillation, Hyperkalemia or Hypokale-
mia, Early Repolarization, WPW syndrome RBBB and
minor wave pattern change

Conclusion.
Given the profound clinical implications of the ECG-C,
all clinicians must be mindful of potential for errone-
ous interpretation resulting in unnecessary, potential-
ly harmful medical treatment, and inappropriate use
of medical resources. The publication by Lehman
serves to remind clinicians that the appropriate use
of the ECG-C is as a supplement, but not a substi-
tute, for interpretation by an electrocardiographer. Do
not rely on computer ECG interpretations in Neonatal
ECGs, Acute Myocardial infarction decision making
for thrombolysis, Rhythm abnormalities, Conduction
disturbances, Minor R wave forms and T wave chang-
es. Computer ECGs are only synthesized rhythm and Fig 3-- Abnormal ECG reported as normal ( ECG shows
not real time and hence when extra systoles are re- Lead 1 sign of emphysema,, pseudo infarct pattern
ported but sometimes we may not see it in the trac-
ings. A recent scientific statement by a consortium of
AHA/ACC and the HRS advises to be prudent when
using computer interpretations. The official recom-

GCDC 2017