Accurate ECG diagnosis of atrial tachyarrhythmias using quantitative analysis: a prospective diagnostic and cost-effectiveness study.
Quantitative ECG Analysis.


BACKGROUND
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.


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.
Krummen
David E
DE
University of California San Diego, San Diego, California, USA. dkrummen@ucsd.edu
Patel
Mitul
M
Nguyen
Hong
H
Ho
Gordon
G
Kazi
Dhruv S
DS
Clopton
Paul
P
Holland
Marian C
MC
Greenberg
Scott L
SL
Feld
Gregory K
GK
Faddis
Mitchell N
MN
Narayan
Sanjiv M
SM
D000368:Aged; D003362:Cost-Benefit Analysis / Q000191:economics; D003936:Diagnosis, Computer-Assisted / Q000191:economics* / Q000379:methods*; D004562:Electrocardiography / Q000191:economics* / Q000379:methods*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology