Limitations of 12-Lead Electrocardiograms in Comprehensive Health Checkups—Pitfalls of Automated ECG Diagnosis—

Abstract

 The standard 12-lead electrocardiogram (ECG) test is one of the key examinations in comprehensive health checkups. In interpreting its results, automated ECG diagnosis serves as an important reference indicator. Through years of research by predecessors and advances in computer technology, automated diagnosis has achieved high accuracy and reliability. However, since some diseases do not present ECG abnormalities, it may not be diagnosed with all conditions. The Minnesota Code is an excellent classification system that is useful for ECG diagnosis and interpretation of findings. However, the question remains as to how to interpret findings with a wide range of possible meanings. Strict interpretation reduces overdiagnosis but increases the number of missed diagnoses. Broad interpretation reduces missed diagnoses but may lead to accusations of overdiagnosis. Furthermore, even with current diagnostic program technology, there are pitfalls that cannot be completely resolved when performing automatic diagnosis. Even when pacing spikes are clearly distinguishable by visual inspection, automatic diagnosis may fail to recognize them. Furthermore, while "judgment" requires comprehensive assessment based on automatic diagnosis results, the criteria for judgment are not standardized, and it is necessary to consider information other than ECG findings. It is important to recognize these limitations of automatic ECG diagnosis and to utilize it in comprehensive health checkups with this awareness.