Pseudo-colouring an ECG enables lay people to detect QT-interval prolongation regardless of heart rate

PLoS One. 2020 Aug 27;15(8):e0237854. doi: 10.1371/journal.pone.0237854. eCollection 2020.

Abstract

Drug-induced long QT syndrome (diLQTS), characterized by a prolongation of the QT-interval on the electrocardiogram (ECG), is a serious adverse drug reaction that can cause the life-threatening arrhythmia Torsade de Points (TdP). Self-monitoring for diLQTS could therefore save lives, but detecting it on the ECG is difficult, particularly at high and low heart rates. In this paper, we evaluate whether using a pseudo-colouring visualisation technique and changing the coordinate system (Cartesian vs. Polar) can support lay people in identifying QT-prolongation at varying heart rates. Four visualisation techniques were evaluated using a counterbalanced repeated measures design including Cartesian no-colouring, Cartesian pseudo-colouring, Polar no-colouring and Polar pseudo-colouring. We used a multi-reader, multi-case (MRMC) receiver operating characteristic (ROC) study design within a psychophysical paradigm, along with eye-tracking technology. Forty-three lay participants read forty ECGs (TdP risk n = 20, no risk n = 20), classifying each QT-interval as normal/abnormal, and rating their confidence on a 6-point scale. The results show that introducing pseudo-colouring to the ECG significantly increased accurate detection of QT-interval prolongation regardless of heart rate, T-wave morphology and coordinate system. Pseudo-colour also helped to reduce reaction times and increased satisfaction when reading the ECGs. Eye movement analysis indicated that pseudo-colour helped to focus visual attention on the areas of the ECG crucial to detecting QT-prolongation. The study indicates that pseudo-colouring enables lay people to visually identify drug-induced QT-prolongation regardless of heart rate, with implications for the more rapid identification and management of diLQTS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Color
  • Electrocardiography*
  • Eye Movements / physiology
  • Female
  • Fixation, Ocular / physiology
  • Heart Rate*
  • Humans
  • Long QT Syndrome / diagnostic imaging*
  • Long QT Syndrome / physiopathology*
  • Male
  • Middle Aged
  • Personal Satisfaction
  • Photic Stimulation
  • Psychophysics
  • ROC Curve
  • Reaction Time
  • Risk Factors
  • Sensitivity and Specificity
  • Young Adult

Grants and funding

This work was supported by the first author’s (Alaa Alahmadi) sponsor (Taibah University, Kingdom of Saudi Arabia, College of Computer Science and Engineering, Yanbu) and was funded for her PhD research by Saudi Arabian Cultural Bureau (grant number TAU388), https://uksacb.org/language/en/.