Computer
algorithms are often used for cardiac rhythm interpretation and
are subsequently corrected by an overreading physician. The
purpose of this study was to assess the incidence and clinical
consequences of misdiagnosis of atrial fibrillation based on a
12-lead electrocardiogram (ECG).
Methods
We retrieved
2298 ECGs with the computerized interpretation of atrial
fibrillation from 1085 patients. The ECGs were reinterpreted to
determine the accuracy of the interpretation. In patients in
whom the interpretation was incorrect, we reviewed the medical
records to assess the clinical consequences resulting from
misdiagnosis.
Results
We found that
442 ECGs (19%) from 382 (35%) of the 1085 patients had been
incorrectly interpreted as atrial fibrillation by the computer
algorithm. In 92 patients (24%), the physician ordering the ECG
had failed to correct the inaccurate interpretation, resulting
in change in management and initiation of inappropriate
treatment, including antiarrhythmic medications and
anticoagulation in 39 patients (10%), as well as unnecessary
additional diagnostic testing in 90 patients (24%). A final
diagnosis of paroxysmal atrial fibrillation based on the initial
incorrect interpretation