Computer-Assisted Serial Comparison of ECGS: The Telemed Version

The medical community is well aware of the value of the serial comparison of ECGs in the monitoring and control of cardiac arrhythmias and evolving heart disease. It is the intent of this paper to provide an overview of the Telemed serial comparison program with particular emphasis on our approach to rhythm analysis of an ECG series. An extensive development effort to improve P-wave detection in the presence of “noise” has resulted in a notable improvement in discrimination between fundamental rhythms. These improvements combined with a battery of consistency tests in serial rhythm analysis enhance accuracy and stability in the diagnosis of serial rhythm change or persistence. The majority of serial ECG tracings show the persistence of a single fundamental rhythm. A rhythm change is consequently greeted with a precautionary set of consistency checks to ascertain whether or not the “change” in rhythm is the result of borderline cross over of decision criteria. If these tests indicate the “change” is not real, either the previous or current rhythm analysis is corrected to indicate a persisting fundamental rhythm. Statements describing the degree of change in rate and the change in degree and type of atrial and ventricular ectopic activity follow in sequential order. Examples of Telemed serial comparison reports describing changes in rhythm are presented.