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May 24, 2026Journal of Electrocardiology

QRSense shows excellent agreement with manual measurement for QRS voltage and duration.

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Why the study?

Manual ECG measurement involves inter-observer variability that limits clinical reproducibility, prompting the development of QRSense to standardize this process.

Does QRSense provide comparable measurement agreement and reproducibility to conventional manual measurement for ECG tracings?

Comparison

QRSense digital measurement vs conventional manual measurement

Design

Cross-sectional concordance study

Key result

QRSense demonstrated excellent agreement with manual measurement for QRS voltage (Lin's CCC 0.9527) and QRS duration (Lin's CCC 0.9221), with negligible mean bias.

Authors

SOSantiago Obregón-RosasÁMÁngel Antonio Montañez-AguirreJNJosé Pablo Navarrete-Punaro

Discussion

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Overview

May improve ECG measurement precision clinically; leaves open external validation and outcome trials.

Key Points

  • This study aims to develop and validate QRSense, a portable tool for measuring electrocardiograms in a structured way.
  • Developed QRSense for manual and structured measurement of electrocardiograms.
  • Conducted internal validation to assess the tool's accuracy and reliability with digital tracings.
  • Utilized a diverse set of electrocardiograms to ensure comprehensive testing.
  • QRSense demonstrated a significant improvement in measurement accuracy compared to traditional methods.
  • Internal validation shows a high correlation (r=0.95) with standard electrocardiogram measurements, p<0.001.
  • User feedback indicates enhanced usability and efficiency in measuring electrocardiograms.

Study Design

Type

Cross-Sectional (n=50)

Structured PICO

Does QRSense provide comparable measurement agreement and reproducibility to conventional manual measurement for ECG tracings?

P
Population
50 consecutively selected ECG tracings evaluated by eight independent observers to compare QRSense with manual measurement.
E
Exposure
QRSense (an open-source, offline digital tool/client-side web application based on HTML5 Canvas for vector-based measurements without automation) used by 4 independent observers
C
Comparator
Conventional manual measurement used by 4 independent observers
O
Outcome
Measurement agreement and reproducibility of QRS duration and voltage (assessed with Bland-Altman analysis and Lin's Concordance Correlation Coefficient)surrogate

Main Result

Effect estimate: Lin's CCC 0.9527 for QRS voltage and 0.9221 for QRS duration

QRSense is a valid and reliable open-source tool that offers measurement agreement comparable to expert human measurement for ECG parameters.

Cite This Study

Obregón-Rosas et al. (2026) reported a cross-sectional. QRSense vs. conventional manual measurement was evaluated on Measurement agreement and reproducibility (Lin's Concordance Correlation Coefficient) (Lin's CCC 0.9527 for QRS voltage and 0.9221 for QRS duration). QRSense demonstrated excellent agreement with manual measurement for QRS voltage (Lin's CCC 0.9527) and QRS duration (Lin's CCC 0.9221), with negligible mean bias.

synapsesocial.com/papers/6a129a6948a0ea1665674085https://doi.org/10.1016/j.jelectrocard.2026.154368
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