In the international cooperative project entitled "Common Standards for Quantitative Electrocardiography" (CSE) systematic noise tests have been performed in order to compare measurement results of electrocardiographic computer programs under degraded operational conditions and to develop recommendations for preprocessing and measurement strategies. The influence of seven different high- and low-frequency noise types on the recognition of P, QRS, and T wave onsets and offsets was investigated. The analysis was performed on 160 electrocardiograms derived from two sets of 10 cases each, by eight electrocardiographic and six vectorcardiographic computer programs. The stability and precision of these programs were tested with respect to the results obtained (1) in the noise-free recordings and (2) by a group of five cardiologists who have analyzed the recordings previously in a Delphi reviewing process. Increasing levels of high-frequency noise shifted the onsets and offsets of most programs outward. Programs analyzing an averaged beat showed significantly less variability than programs which measure every complex or a selected beat. On the basis of the findings of the present study, a measurement strategy based on selective averaging is recommended for diagnostic ECG computer programs. However, averaging should be performed only if proper alignment and precise waveform comparison have been performed beforehand in order to exclude dissimilar complexes.
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