Objectives: The 12-lead electrocardiogram (ECG) is the current gold standard for the diagnosis of atrial fibrillation (AF). However, undertaking a 12-lead ECG is cumbersome, expensive and time consuming compared to a rhythm strip alone. The AF detection rate using a single lead ECG compared with a12-lead ECG amongst trainees of varying degrees of experience has not yet been reviewed in depth. Methods: Five doctors of different grades and specialties and one Cardiology Specialist Nurse were each asked to review a different batch of ECGs with differing proportions of AF and Sinus Rhythm (SR). ECGs were presented to the reviewers on two separate occasions in two variations: full 12 lead and 10-second rhythm strip only. The diagnoses (AF/SR or unsure) were compared to a Consultant Cardiologist reading the 12-lead ECG. Results: Overall, compared to the Consultant Cardiologist, the AF detection rate using a 12-lead ECG was 81% and 82% with a rhythm strip. There was a significant difference (chi squared test, p< 0.01) in AF detection rate when the reviewers were divided into 2 groups according to level of cardiology experience. The AF detection rate for the 12-lead ECG amongst specialists vs. non-specialists was 93% vs. 70% (P< 0.001) and 92% vs. 73% (P= 0.003) for the rhythm strip. Conclusions: Our findings indicate that a 10-second rhythm strip alone has a comparable AF detection rate to a 12-lead ECG in the hands of doctors and nurses when measured against the consultant's diagnosis. With both the rhythm strip and a 12-lead ECG, the accuracy of AF detection improved with experience. Mass screening using a single strip could be acceptable and inexpensive particularly with mobile phone technology.
Vyas, V., Duran, J., Ansaripour, A., Niedzielko, M., Steel, A., & Bakhai, A. (2014). Does A 12-Lead Ecg More Reliably Detect Atrial Fibrilation Than A Rhythm Strip Only Ecg? Value in Health, 17(7), A485–A486. https://doi.org/10.1016/j.jval.2014.08.1421