Inaccurate electrocardiographic interpretation of long QT:: The majority of physicians cannot recognize a long QT when they see one
Inaccurate electrocardiographic interpretation of long QT:: The majority of physicians cannot recognize a long QT when they see one
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DOI：
10.1016/j.hrthm.2005.02.011
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发表时间：
2005-06-01
期刊：
影响因子：
5.5
通讯作者：
Zeltser, D
中科院分区：
文献类型：
--
作者：
Viskin, S;Rosovski, U;Zeltser, D
所有医学领域的医生都可能遇到长QT综合征（LQTS）患者。重要的是确定能够区分长QT间期和正常QT间期的医生的百分比，因为LQTS在不治疗的情况下可能是致命的。本研究的目的是确定不同医学学科的医生在看到长QT间期时能够识别长QT间期的百分比。来自12个国家的医生（25名世界知名的QT专家、106名心律失常专家、329名心脏病专家和442名非心脏病专家）。结果对于LQTS患者，心律失常专家正确计算QTc的比例> 80%，而心脏病专家和非心脏病专家正确计算QTc的比例分别为< 50%和< 40%。LQTS患者QTc的低估和健康患者QTc的高估是常见的。QT专家之间的观察者间一致性极好，心律失常专家之间的一致性中等，心脏病专家和非心脏病专家之间的一致性较低（kappa系数分别为0.82、0.44和< 0.3）。96%的QT专家和62%的心律失常专家将所有QT间期正确分类为“长”或“正常”，但只有< 25%的心脏病专家和非心脏病专家将所有QT间期正确分类为“长”或“正常”。
BACKGROUND Physicians in all fields of medicine may encounter patients with long QT syndrome (LQTS). It is important to define the percentage of physicians capable of distinguishing QT intervals that are long from those that are normal because LQTS can be lethal when left untreated.OBJECTIVES The purpose of this study was to define the percentage of physicians in the different disciplines of medicine who can recognize a long QT when they see one.METHODS We presented the ECGs of two patients with LQTS and two healthy females to 902 physicians (25 world-renowned QT experts, 106 arrhythmia specialists, 329 cardiologists, and 442 noncardiologists) from 12 countries. They were asked to measure the QT, calculate the QTc (the QT interval corrected for the heart rate), and determine whether the QT is normal or prolonged.RESULTS For patients with LQTS, > 80% of arrhythmia experts but < 50% of cardiologists and < 40% of noncardiologists calculated the QTc correctly. Underestimation of the QTc of patients with LQTS and overestimation of the QTc of healthy patients were common. Interobserver agreement was excellent among QT experts, moderate among arrhythmia experts, and low among cardiologists and noncardiologists (kappa coefficient = 0.82, 0.44, and < 0.3, respectively). Correct classification of all QT intervals as either "long" or "normal" was achieved by 96% of QT experts and 62% of arrhythmia experts, but by only < 25% of cardiologists and noncardiologists.CONCLUSIONS Most physicians, including many cardiologists, cannot accurately calculate a QTc and cannot correctly identify a long QT.