Sources of common computer-cardiologist discord in e.c.g. interpretations in ambulatory population

Based on clinical experience in performing mass computerised interpretations of e.c.g.s, some common sources of computer-cardiologist disagreements are presented. Examples are given along with a discussion of the technological or logical bases for discord. It is concluded that computer interpretations are generally reliable and accurate; however, disagreements sometimes occur in borderline cases, in tracings with much electrical 'noise' or in those where the transitions between different segments of the QRS complex are not well demarcated. A computerised e.c.g. interpretation system can help the cardiologist by providing all required measurements and most of the diagnostic statements. Thus, only review and validation of the processed tracings are needed. By continuously refining the program criteria based on the accumulated experience of many cardiologists, the reliability and acceptability of computer e.c.g. interpretations could be enhanced and expanded to screen large populations.