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Computer Analysis of Electrocardiograms with Six and Twelve Leads

P. J. Schneider, J. K. Cooper, A. A. Birch, Jr. and E. M. Dwyer
Public Health Reports (1896-1970)
Vol. 85, No. 10 (Oct., 1970), pp. 853-858
DOI: 10.2307/4593983
Stable URL: http://www.jstor.org/stable/4593983
Page Count: 6
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Computer Analysis of Electrocardiograms with Six and Twelve Leads
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Abstract

An investigation of the value of several methods of screening with electrocardiograms (ECG's) was undertaken by the Bureau of Medicine and Surgery, U.S. Navy, and the Heart Disease and Stroke Control Program, Public Health Service. Since rapid computer analysis of electrocardiograms had become available, it seemed feasible to compare the accuracy of interpretation with limited numbers of ECG leads. A system of rapid application of the six frontal plane electrodes was used. The patient was seated; both his feet were placed on electrodes moistened with saline or alcohol, and his index fingers were inserted into tension clips. Application of the electrodes took approximately 1 minute. The six leads were then recorded. Conventional 12-lead ECG's were obtained with ordinary ECG electrodes and paste while the subject was recumbent. This procedure usually took 4 to 5 minutes. Both six-lead and 12-lead ECG's were fed into a data acquisition console. As a standard for comparison, 309 full 12-lead ECG's were obtained and interpreted by two cardiologists independently. Differences of interpretation were then discussed, and an assumed correct interpretation was obtained. This reading was compared with the readings by digital computer of the 12-lead ECG and of a special six-lead (no chest leads) ECG, as well as with a physician's analysis of the six-lead tracing. The interpretations of the 12-lead ECG's by computer were found to be 91 percent sensitive and 72 percent specific; the interpretations of the six-lead ECG's by computer were found to be 77 percent sensitive and 85 percent specific. The interpretations by the physician of the six-lead ECG's were found to be 88 percent sensitive and 65 percent specific. The ability to detect abnormality was less with the six-lead screening method (23 percent) than with the 12-lead. Overdiagnosis occurred more frequently in the interpretation of the 12-lead ECG by computer (28 percent). For large computer studies, the rapid frontal plane electrode application system is feasible in detecting normality, but it conceivably could miss a considerable number of abnormal electrocardiograms. Further investigation of this rapid application system in conjunction with selected precordial-lead ECG's seems indicated.

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