Skip to main content

Research Repository

Advanced Search

Accuracy of methods for diagnosing atrial fibrillation using 12-lead ECG: a systematic review and meta-analysis

Taggar, Jaspal S.; Coleman, Tim; Lewis, Sarah; Heneghan, Carl; Jones, Matthew

Authors

Dr JASPAL TAGGAR Jaspal.Taggar@nottingham.ac.uk
Clinical Associate Professor and Headof Primary Care Undergraduate Education

TIM COLEMAN tim.coleman@nottingham.ac.uk
Professor of Primary Care

Carl Heneghan

Dr MATTHEW JONES MATTHEW.JONES3@NOTTINGHAM.AC.UK
Assistant Professor in Health Economics



Abstract

Background: Screening for atrial fibrillation (AF) using 12-lead-electrocardiograms (ECGs) has been recommended; however, the best method for interpreting ECGs to diagnose AF is not known. We compared accuracy of methods for diagnosing AF from ECGs.

Methods: We searched MEDLINE, EMBASE, CINAHL and LILACS until March 24, 2014. Two reviewers identified eligible studies, extracted data and appraised quality using the QUADAS-2 instrument. Meta-analysis, using the bivariate hierarchical random effects method, determined average operating points for sensitivities, specificities, positive and negative likelihood ratios (PLR, NLR) and enabled construction of Summary Receiver Operating Characteristic (SROC) plots.

Results: 10 studies investigated 16 methods for interpreting ECGs (n = 55,376 participant ECGs). The sensitivity and specificity of automated software (8 studies; 9 methods) were 0.89 (95% C.I. 0.82–0.93) and 0.99 (95% C.I. 0.99–0.99), respectively; PLR 96.6 (95% C.I. 64.2–145.6); NLR 0.11 (95% C.I. 0.07–0.18). Indirect comparisons with software found healthcare professionals (5 studies; 7 methods) had similar sensitivity for diagnosing AF but lower specificity [sensitivity 0.92 (95% C.I. 0.81–0.97), specificity 0.93 (95% C.I. 0.76–0.98), PLR 13.9 (95% C.I. 3.5–55.3), NLR 0.09 (95% C.I. 0.03–0.22)]. Sub-group analyses of primary care professionals found greater specificity for GPs than nurses [GPs: sensitivity 0.91 (95% C.I. 0.68–1.00); specificity 0.96 (95% C.I. 0.89–1.00). Nurses: sensitivity 0.88 (95% C.I. 0.63–1.00); specificity 0.85 (95% C.I. 0.83–0.87)].

Conclusions: Automated ECG-interpreting software most accurately excluded AF, although its ability to diagnose this was similar to all healthcare professionals. Within primary care, the specificity of AF diagnosis from ECG was greater for GPs than nurses.

Journal Article Type Article
Publication Date Apr 1, 2015
Journal International Journal of Cardiology
Print ISSN 0167-5273
Electronic ISSN 1874-1754
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 184
Pages 175-183
APA6 Citation Taggar, J. S., Coleman, T., Lewis, S., & Heneghan, C. (2015). Accuracy of methods for diagnosing atrial fibrillation using 12-lead ECG: a systematic review and meta-analysis. International Journal of Cardiology, 184, 175-183. doi:10.1016/j.ijcard.2015.02.014
DOI https://doi.org/10.1016/j.ijcard.2015.02.014
Keywords Atrial fibrillation; Electrocardiogram; Diagnostic accuracy
Publisher URL http://www.sciencedirect.com/science/article/pii/S016752731500131X
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0
Additional Information

Files

J Taggar Int J Cardiol 2015.pdf (558 Kb)
PDF

Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0





You might also like



Downloadable Citations

;