Available online 2 August 2022
Highlights•Management decisions reply on accurate wide complex tachycardia discrimination.
•A shortcoming of manual ECG approaches is complete reliance on the ECG interpreter.
•Automated differentiation methods remove the reliance on ECG interpreter competency.
•Automated differentiation methods improve physician accuracy and confidence.
AbstractBackgroundTimely and accurate discrimination of wide complex tachycardias (WCTs) into ventricular tachycardia (VT) or supraventricular WCT (SWCT) is critically important. Previously we developed and validated an automated VT Prediction Model that provides a VT probability estimate using the paired WCT and baseline 12-lead ECGs. Whether this model improves physicians' diagnostic accuracy has not been evaluated.
ObjectiveWe sought to determine whether the VT Prediction Model improves physicians' WCT differentiation accuracy.
MethodsOver four consecutive days, nine physicians independently interpreted fifty WCT ECGs (25 VTs and 25 SWCTs confirmed by electrophysiological study) as either VT or SWCT. Day 1 used the WCT ECG only, Day 2 used the WCT and baseline ECG, Day 3 used the WCT ECG and the VT Prediction Model's estimation of VT probability, and Day 4 used the WCT ECG, baseline ECG, and the VT Prediction Model's estimation of VT probability.
ResultsInclusion of the VT Prediction Model data increased diagnostic accuracy versus the WCT ECG alone (Day 3: 84.2% vs. Day 1: 68.7%, p 0.009) and WCT and baseline ECGs together (Day 3: 84.2% vs. Day 2: 76.4%, p 0.003). There was no further improvement of accuracy with addition of the baseline ECG comparison to the VT Prediction Model (Day 3: 84.2% vs. Day 4: 84.0%, p 0.928). Overall sensitivity (Day 3: 78.2% vs. Day 1: 67.6%, p 0.005) and specificity (Day 3: 90.2% vs. Day 1: 69.8%, p 0.016) for VT were superior after the addition of the VT Prediction Model.
ConclusionThe VT Prediction Model improves physician ECG diagnostic accuracy for discriminating WCTs.
KeywordsWide complex tachycardias
Ventricular tachycardia
Supraventricular wide complex tachycardia
Electrocardiogram
ECG interpretation
ECG competency
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