Bogun F et al. (2004) Misdiagnosis of atrial fibrillation and its clinical consequences. Am J Med 117: 636–642

The diagnosis of atrial fibrillation frequently relies on a computer-generated interpretation of the electrocardiogram and subsequent verification by the cardiologist. A recent study by Bogun and colleagues has revealed that this approach is prone to error and can result in inappropriate treatment.

The authors retrieved 2,298 electrocardiograms (in 1,085 patients) that had resulted in a computer-based interpretation of atrial fibrillation. Reinterpretation showed that the computer had generated an incorrect interpretation in 382 (35%) patients. Furthermore, the ordering physician had failed to correct the original diagnosis in 92 (24%) of these cases. Almost all of these patients had been subjected to further diagnostic testing, and needless medical treatment was initiated in 39 cases. This treatment resulted in adverse events in two patients. Compared with physicians from other subspecialties, cardiologists were significantly more likely to correct the computer interpretation of the electrocardiogram. Sinus rhythm with atrial premature complexes and sinus rhythm with artifacts were particularly susceptible to misinterpretation by the computer algorithm; Bogun et al. recommend that the over-reading physicians should be aware of this.

The study highlights the danger of becoming overly reliant on computerized algorithms in this setting, and emphasizes the need for more extensive education about the appearance of atrial dysrhythmias and artifacts on the electrocardiogram.