Enhanced rhythm analysis for resting ECG using spectral and time-domain techniques

Interpretation of cardiac rhythms is highly dependent on accurate detection of atrial activity. Several new enhancements were made to the previously described MAC-RHYTHM atrial analysis program, including spectral analysis for the detection of atrial flutter; optimal lead selection for P wave detection; and T wave alignment to reduce subtraction artifact in the residual signals used to create a P wave detection function. Performance was assessed using a test set of 69957 confirmed ECGs from four hospitals. The rhythm interpretation in the confirmed ECG was compared to the rhythm interpretations from the previous and new versions of the program. The rate of disagreements between the confirmed rhythm and the computerized interpretation decreased from 6.9% to 4.1%. Sensitivity improved for sinus, atrial fibrillation, atrial flutter, and junctional rhythms, while specificity and positive predictive value improved for all arrhythmias.