Scholarlink

Introduction <p>Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias frequently misdiagnosed. The emergency department (ED), a fast-paced environment, presents challenges for accurate ECG interpretation. This study examined whether timing of ED presentation affects diagnostic accuracy.</p> Methods <p>Over five years (2019–2024), consecutive ECGs from patients discharged with AF or AFL were independently reviewed by two cardiologists. Diagnoses were classified as correct, partially correct (AF misread as AFL or vice versa), or overinterpreted (non-AF/AFL rhythms misread as AF/AFL). Arrival times were grouped into morning (07:00–15:00), afternoon (15:00–23:00), and night (23:00–07:00) shifts. Multivariable logistic regression analyzed predictors of overinterpretation.</p> Results <p>Among 2,003 patients (1,794 AF; 209 AFL), interpretations were correct in 1,780 (88.9%), partially correct in 166 (8.3%), and overinterpreted in 57 (2.8%). Overinterpretation rates were highest in the afternoon (4.3%) versus morning (2.8%) and night (0.7%) (<i>p</i> = 0.012). Independent predictors included afternoon arrival (OR 1.87; 95% CI 1.07–3.25; <i>p</i> = 0.027) and premature beats (OR 2.22; 95% CI 1.30–3.81; <i>p</i> &lt; 0.001). Overinterpretation was independent of shift workload and physician experience, and resulted in inappropriate new prescriptions of rate-control agents (38.5%), antiarrhythmics (28%), and anticoagulants (56%), with minor and major bleeding occurring in 16% and 3.5% of cases, respectively. Diagnosis was revised during outpatient follow-up in only 5% of cases.</p> Conclusion <p>Overinterpretation of AF remains a concern in the ED. Error rates did not rise during nighttime shifts, implying that factors other than clinician fatigue may underlie these mistakes.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Determinants of ECG misdiagnosis of atrial fibrillation or flutter in the emergency department and their clinical implications: results from a single-center observational study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月7日

查看全文
  • Yuval Avidan,
  • Baruch Weizman,
  • Sameha Zahra,
  • Oded Mizrahi,
  • Hani Sliman,
  • Haim Katalan,
  • Nili Stein,
  • Razi Khoury,
  • Asaf Danon,
  • Sameer Kassem

摘要

Introduction

Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias frequently misdiagnosed. The emergency department (ED), a fast-paced environment, presents challenges for accurate ECG interpretation. This study examined whether timing of ED presentation affects diagnostic accuracy.

Methods

Over five years (2019–2024), consecutive ECGs from patients discharged with AF or AFL were independently reviewed by two cardiologists. Diagnoses were classified as correct, partially correct (AF misread as AFL or vice versa), or overinterpreted (non-AF/AFL rhythms misread as AF/AFL). Arrival times were grouped into morning (07:00–15:00), afternoon (15:00–23:00), and night (23:00–07:00) shifts. Multivariable logistic regression analyzed predictors of overinterpretation.

Results

Among 2,003 patients (1,794 AF; 209 AFL), interpretations were correct in 1,780 (88.9%), partially correct in 166 (8.3%), and overinterpreted in 57 (2.8%). Overinterpretation rates were highest in the afternoon (4.3%) versus morning (2.8%) and night (0.7%) (p = 0.012). Independent predictors included afternoon arrival (OR 1.87; 95% CI 1.07–3.25; p = 0.027) and premature beats (OR 2.22; 95% CI 1.30–3.81; p < 0.001). Overinterpretation was independent of shift workload and physician experience, and resulted in inappropriate new prescriptions of rate-control agents (38.5%), antiarrhythmics (28%), and anticoagulants (56%), with minor and major bleeding occurring in 16% and 3.5% of cases, respectively. Diagnosis was revised during outpatient follow-up in only 5% of cases.

Conclusion

Overinterpretation of AF remains a concern in the ED. Error rates did not rise during nighttime shifts, implying that factors other than clinician fatigue may underlie these mistakes.