Pre-participation cardiac screening including electrocardiogram (ECG) is a subject of controversy among sports medicine practitioners. Opponents of pre-participation ECG screen site concerns regarding the cost and accuracy of the testing. Recently, a single lead ECG accessory has become available for use with smartphones. The purpose of this study was to evaluate the between and within rater validity and reliability of the Kardia device in recording the ECG parameters rate, rhythm, and PR, QRS, and QT intervals. The ECG parameter made with the smartphone were also compared to same measures made using a 12 lead electrocardiograph.
This investigation used a repeated measures cross-sectional design. The investigation was conducted in 2 separate phases using separate participant samples. Phase 1 (N=10) was used to determine the within rater reliability with the Kardia device. Phase 2 (N=12) was used to determine the reliability between the Kardia device and the 12 lead electrocardiograph.
The between rater and between device reliability for the rate, QT interval and QRS duration parameters ranged good to very good (ICC = 0.667 – 0.981). The current investigation showed that the reliability of the ECG parameters measured using the smartphone technology ranged from good to very good. This paper serves as support for a technological advancement that will help advance the debate on the utility of ECG testing as part of the athletic pre-participation physical.
Conflict(s) of Interest
No authors have any commercial relationships that would lead to a conflict of interest. This paper has not been published or is under review for publication in another journal.
References with DOI
1. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation. 2009;119(8):1085-92. https://doi.org/10.1161/circulationaha.108.804617
2. Maron BJ, Winkel BG, Tfelt-Hansen J. Perspectives on cardiovascular screening. JAMA. 2015;313(1):31-2. https://doi.org/10.1001/jama.2014.16253
3. Drezner JA, Asif IM, Owens DS, Prutkin JM, Salerno JC, Fean R, et al. Accuracy of ECG interpretation in competitive athletes: the impact of using standised ECG criteria. Br J Sports Med. 2012;46(5):335-40. https://doi.org/10.1136/bjsports-2012-090612
4. Hill AC, Miyake CY, Grady S, Dubin AM. Accuracy of interpretation of preparticipation screening electrocardiograms. J Pediatr. 2011;159(5):783-8. https://doi.org/10.1016/j.jpeds.2011.05.014
5. Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015;48(3):329-38. https://doi.org/10.1016/j.jelectrocard.2015.02.001
6. Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, et al. Cardiovascular preparticipation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26(5):516-24.
7. Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010;31(2):243-59. https://doi.org/10.1093/eurheartj/ehp473
8. Drezner JA, Ackerman MJ, Anderson J, Ashley E, Asplund CA, Baggish AL, et al. Electrocardiographic interpretation in athletes: the 'Seattle criteria'. Br J Sports Med. 2013;47(3):122-4. https://doi.org/10.1136/bjsports-2012-092067
9. Riding NR, Sheikh N, Adamuz C, Watt V, Farooq A, Whyte GP, et al. Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes. Heart. 2015;101(5):384-90. https://doi.org/10.1136/heartjnl-2014-306437
10. Drezner JA, Sharma S, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International criteria for electrocardiographic interpretation in athletes: Consensus statement. Br J Sports Med. 2017;51(9):704-31. https://doi.org/10.1136/bjsports-2016-097331
11. Nguyen HH, Van Hare GF, Rudokas M, Bowman T, Silva JN. SPEAR Trial: Smartphone Pediatric ElectrocARdiogram Trial. PLoS One. 2015;10(8):e0136256. https://doi.org/10.1371/journal.pone.0136256
12. Peritz DC, Howard A, Ciocca M, Chung EH. Smartphone ECG aids real time diagnosis of palpitations in the competitive college athlete. Journal of electrocardiology. 2015. https://doi.org/10.1016/j.jelectrocard.2015.07.010
13. Ferdman DJ, Liberman L, Silver ES. A Smartphone Application to Diagnose the Mechanism of Pediatric Supraventricular Tachycardia. Pediatric cardiology. 2015. https://doi.org/10.1007/s00246-015-1185-6
14. Haberman ZC, Jahn RT, Bose R, Tun H, Shinbane JS, Doshi RN, et al. Wireless Smartphone ECG Enables Large-Scale Screening in Diverse Populations. J Cardiovasc Electrophysiol. 2015;26(5):520-6. https://doi.org/10.1111/jce.12634
15. Muhlestein JB, Le V, Albert D, Moreno FL, Anderson JL, Yanowitz F, et al. Smartphone ECG for evaluation of STEMI: results of the ST LEUIS Pilot Study. J Electrocardiol. 2015;48(2):249-59. https://doi.org/10.1016/j.jelectrocard.2014.11.005
16. Tarakji KG, Wazni OM, Callahan T, Kanj M, Hakim AH, Wolski K, et al. Using a novel wireless system for monitoring patients after the atrial fibrillation ablation procedure: the iTransmit study. Heart Rhythm. 2015;12(3):554-9. https://doi.org/10.1016/j.hrthm.2014.11.015
17. Chung EH, Guise KD. QTC intervals can be assessed with the AliveCor heart monitor in patients on dofetilide for atrial fibrillation. J Electrocardiol. 2015;48(1):8-9. https://doi.org/10.1016/j.jelectrocard.2014.10.005
18. Baquero GA, Banchs JE, Ahmed S, Naccarelli GV, Luck JC. Surface 12 lead electrocardiogram recordings using smart phone technology. J Electrocardiol. 2015;48(1):1-7. https://doi.org/10.1016/j.jelectrocard.2014.09.006
19. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Upper Saddle River, NJ: Prentice Hall Health; 2000 2000.
20. Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001;134(8):663-94. https://doi.org/10.7326/0003-4819-134-8-200104170-00012
21. Shrout PE. Measurement reliability and agreement in psychiatry. Stat Methods Med Res. 1998;7(3):301-17. https://doi.org/10.1177/096228029800700306
22. Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19(1):231-40. https://doi.org/10.1519/15184.1
23. Rijnbeek PR, van Herpen G, Bots ML, Man S, Verweij N, Hofman A, et al. Normal values of the electrocardiogram for ages 16-90 years. J Electrocardiol. 2014;47(6):914-21. https://doi.org/10.1016/j.jelectrocard.2014.07.022
24. Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, et al. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med. 2016.
Gilliland, Andrew; Timmons, Mark; Harris, Jeffrey K.; Petrany, Stephen M.; Shepherd, Terry A.; Buchanan, Grant S.; Decker, Nicole; and Giangarra, Charles
"ECG measurement parameters of athletes are reliable when made with a smartphone based ECG device,"
Marshall Journal of Medicine:
2, Article 7.
Available at: https://mds.marshall.edu/mjm/vol4/iss2/7