The Evaluation of a smartphone application to assist in novice 12 lead ECG interpretation performance

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Introduction: The recording of 12-lead electrocardiograms (ECGs) is one of the most useful and commonly performed medical procedures. Interpretation of the 12-lead ECG involves analysing several waveforms (P, QRS, ST and T waves) which permits the detection of abnormalities that affect normal electrical conduction. The interpretation of 12-lead ECG recordings is complex and clinically challenging. Appropriate interpretation can be difficult to achieve with misinterpretation resulting in patient fatality. Despite its widespread use, several studies have highlighted deficiencies in ECG interpretation skills among health professionals. This abstract reports the design and testing of a novel interactive method to assist interpretation of 12-lead electrocardiogram (ECG). Methods: An interactive Smart Phone application learning tool labelled "systemAtic aNALYsiS of Electrocardiography" was hosted on IOS and Android platforms. This application incorporates a systematic process of analysis with the major objective to achieve precise and accurate ECG interpretation by applying various deductive approaches which included the examination of ECG tracings to evaluate heart rate, rhythm, cardiac axis, signs of chamber hypertrophy, signs of ischaemia and the measuring of electrocardiographic conduction intervals in an organised fashion. Participants (n = 15) interpreted a total of 150 12-lead electrocardiogram recordings randomly using a standard (SCST) and this novel reporting format(systemAtic aNALYsiS of Electrocardiography). Ethical approval was granted from the ethics board of the XXXX Research Centre at XXXX. Results: The overall aggregated mean mark attained using the standard format was 53 per cent (range = 38–82%, standard deviation = 12). Conversely, the overall aggregated mean mark attained using the systemAtic aNALYsiS of Electrocardiography format was 75 per cent (range = 55%–93%, standard deviation = 9). A total of 14/15 participants consistently scored higher when interpreting electrocardiograms using the systemAtic aNALYsiS of Electrocardiography format (range = 10%–45%). A significant difference between the aggregated marks scored using the systemAtic aNALYsiS of Electrocardiography format and the standard format was calculated (Wilcoxon Z Score = -3.2374 (df = 14), p < 0.01). Conclusion: This study demonstrates the clinical utility of a novel method (systemAtic aNALYsiS of Electrocardiography) to assist the learning of electrocardiogram interpretation and its association with enhanced diagnostic performance in novices.
Original languageEnglish
Title of host publicationTrinity Health and Education International Research Conference
Subtitle of host publicationTHEconf2019
Publication statusPublished - 6 Mar 2019

Bibliographical note

Cathal Breen holds a Ph.D. from Ulster University. He is a member of the Institute of Nursing and Health Research (INHR) and Centre for Health and Rehabilitative Technologies (CHaRT) at Ulster University Northern Ireland where from he leads research studies involving electrocardiography and innovative cardiology. He is Advisor, Editorial Board member of several scientific journals and also a usual Reviewer from several Specialized Journals. He has published Clinical Trials and Clinical works on his research field. He has directed programmes of Physiology at his institution.


  • Cardiac Physiology, Diagnostic decision support, Pedagogy, Electrocardiography


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