Key result
Pseudo-colouring an ECG significantly increased accurate detection of QT-interval prolongation by lay people regardless of heart rate, improving the AUC from 0.895 to 0.935 on Cartesian coordinates.
Why the study?
Detecting drug-induced long QT syndrome on an ECG is difficult, particularly at high and low heart rates, limiting potential life-saving self-monitoring by lay people.
Does pseudo-colouring an ECG improve the accurate detection of QT-interval prolongation by lay people?
Does pseudo-colouring an ECG improve the accurate detection of QT-interval prolongation by lay people?
Effect estimate: AUC difference -0.039 (95% CI -0.070 to -0.007)
Absolute Event Rate: 0.935% vs 0.895%
p-value: p=0.014
Pseudo-colouring ECGs enables laypeople to accurately detect drug-induced QT-prolongation across varying heart rates, potentially facilitating self-monitoring for diLQTS.
May aid lay QT-prolongation detection; leaves open clinical adoption or self-monitoring utility.
Drug-induced long QT syndrome (diLQTS), characterized by a prolongation of the QT-interval on the electrocardiogram (ECG), is a serious adverse drug reaction that can cause the life-threatening arrhythmia Torsade de Points (TdP). Self-monitoring for diLQTS could therefore save lives, but detecting it on the ECG is difficult, particularly at high and low heart rates. In this paper, we evaluate whether using a pseudo-colouring visualisation technique and changing the coordinate system (Cartesian vs. Polar) can support lay people in identifying QT-prolongation at varying heart rates. Four visualisation techniques were evaluated using a counterbalanced repeated measures design including Cartesian no-colouring, Cartesian pseudo-colouring, Polar no-colouring and Polar pseudo-colouring. We used a multi-reader, multi-case (MRMC) receiver operating characteristic (ROC) study design within a psychophysical paradigm, along with eye-tracking technology. Forty-three lay participants read forty ECGs (TdP risk n = 20, no risk n = 20), classifying each QT-interval as normal/abnormal, and rating their confidence on a 6-point scale. The results show that introducing pseudo-colouring to the ECG significantly increased accurate detection of QT-interval prolongation regardless of heart rate, T-wave morphology and coordinate system. Pseudo-colour also helped to reduce reaction times and increased satisfaction when reading the ECGs. Eye movement analysis indicated that pseudo-colour helped to focus visual attention on the areas of the ECG crucial to detecting QT-prolongation. The study indicates that pseudo-colouring enables lay people to visually identify drug-induced QT-prolongation regardless of heart rate, with implications for the more rapid identification and management of diLQTS.
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Alahmadi et al. (2020) studied QT-interval prolongation (n=43). Pseudo-colouring visualisation technique vs. Standard ECG (no-colouring) was evaluated on Area under the ROC curve (AUC) for detecting QT-interval prolongation (Cartesian coordinates) (AUC difference -0.039, 95% CI -0.070 to -0.007, p=0.014). Pseudo-colouring an ECG significantly increased accurate detection of QT-interval prolongation by lay people regardless of heart rate, improving the AUC from 0.895 to 0.935 on Cartesian coordinates.
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