Statistical evaluation of reproducibility of automated ECG measurements: An example from arrhythmogenic right ventricular dysplasia/cardiomyopathy clinic

• Comprehensive statistical evaluation of reproducibility of automated ECG measurements is important for appropriate interpretation of ECG.
• Automated ECG measurements of QRS duration and terminal activation duration in right precordial leads are reproducible to within 25%.
• Precision of automated averaged QRS duration measurement was 99.96%.
• 95% limits of agreement of QRS duration in V1–V3 exceeded 10 ms.

BackgroundArrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by delay in depolarization of the right ventricle, detected by prolonged terminal activation duration (TAD) in V1–V3. However, manual ECG measurements have shown moderate-to-low intra- and inter-reader agreement. The goal of this study was to assess reproducibility of automated ECG measurements in the right precordial leads.MethodsPairs of ECGs recorded in the same day from Johns Hopkins ARVD/C Registry participants [n = 247, mean age 35.2 ± 15.6 years, 58% men, 92% whites, 11(4.5%) with definite ARVD/C] were retrospectively analyzed. QRS duration, intrinsicoid deflection, TAD, and T-wave amplitude in the right precordial leads, as well as averaged across all leads QRS duration, QRS axis, T axis, QTc interval, and heart rate was measured automatically, using 12SL TM algorithm (GE Healthcare, Wauwatosa, WI, USA). Intrinsicoid deflection was measured as the time from QRS complex onset to the alignment point of the QRS complex. TAD was calculated as the difference between QRS duration and intrinsicoid in V1–V3. Reproducibility was quantified by Bland–Altman analysis (bias with 95% limits of agreement), Lin's concordance coefficient, and Bradley–Blackwood procedure.ResultsBland–Altman analysis revealed satisfactory reproducibility of tested parameters. V1 QRS duration bias was −0.10 ms [95% limits of agreement −12.77 to 12.56 ms], V2 QRS duration bias −0.09 ms [−11.13 to 10.96 ms]; V1 TAD bias 0.14 ms [−13.23 to 13.51 ms], V2 TAD bias 0.008 ms [−12.42 to 12.44 ms].ConclusionComprehensive statistical evaluation of reproducibility of automated ECG measurements is important for appropriate interpretation of ECG. Automated ECG measurements are reproducible to within 25%.