title: Variation in the identification of Q wave initiation and its contribution to QT measurement.
abstract: Cardiac repolarization abnormalities can be assessed from measurements of the QT duration taken from paper electrocardiogram recordings. Errors associated with determining the end of the T wave are known, but those associated with the start of the Q wave have so far been neglected. This paper quantifies the variation in manual identification of the start of the Q wave, and assesses its contribution to errors in the manual measurement of QT. A randomized study of errors in the timing of Q wave initiation from electrocardiograms plotted on paper was conducted. Four electrocardiogram leads were recorded in eight subjects relaxing in a semi-recumbent position. Manual measurements were made of the time of Q wave initiation in 512 electrocardiograms, presented with different superimposed noise, recording speed and recording gain. The greatest mean difference between four cardiologists amounted to 6.7 ms. A recording gain of 5 mm mV-1, in comparison with 10 mm mV-1, resulted in a difference in Q wave timing of 3.2 ms (P < 0.05). A further increase in gain, or the addition of noise up to 20 microV made no significant difference to Q wave measurements. Provided ECGs of at least 10 mm mV-1 are used, the effect of variation in Q determination on QT measurement is likely to be small.
authors.affiliation: Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: A
authors.initials: A
authors.lastname: Murray
authors.forename: N B
authors.initials: NB
authors.lastname: McLaughlin
mesh_terms: D004562:Electrocardiography; D006321:Heart / Q000502:physiology*; D006801:Humans