Tracing Visual Expertise in ECG Interpretation: An Eye-Tracking Pilot Study

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology Pub Date : 2025-04-18 DOI:10.1111/anec.70082

Alessandro Bortolotti, Fabrizio Ricci, Carmelita Cieri, Federica Cocco, Chiara Martini, Marcello Panunzi, Davide Rossi, Anna Sorella, Silvio Saraullo, Davide Scordo, Giulia Renda, Sabina Gallina, Riccardo Palumbo

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Abstract

Background

Visual expertise is pivotal for accurate ECG interpretation. We aimed to identify and measure expertise-based differences in visual search patterns, cognitive load, and diagnostic accuracy during ECG analysis using eye-tracking technology.

Methods

First- to third-year residents and board-certified expert cardiologists interpreted ECGs of patients with suspected acute coronary syndrome, while eye-tracking glasses recorded fixation count, duration, and pupil dilation. Diagnostic accuracy and cognitive load via NASA Task Load Index were analyzed. Heatmaps illustrated relationships between cognitive load, perceived workload, and self-assessed performance across experience levels and ECG task complexities.

Results

Expert readers interpreted ECGs significantly faster than residents (107.6 ± 32.8 vs. 205.31 ± 57.43 s; p < 0.001) and demonstrated higher diagnostic accuracy across all levels of task difficulty (p < 0.001). Eye-tracking analysis revealed that experts exhibited fewer fixations (67.7 ± 25.7 vs. 143.7 ± 29.9; p < 0.001) and longer fixation durations (3.9 ± 0.7 vs. 3.2 ± 1 s; p = 0.032) than residents. Experts also showed lower pupil dilation changes (4.8% ± 2% vs. 10.5% ± 4.2%; p = 0.015). Increased task difficulty was associated with greater pupil dilation, particularly among novices (mean pupil dilation for difficult tasks 13.4% ± 4.1% vs. 7.3% ± 2.3% for easy tasks; p = 0.008), indicating higher cognitive demand. Experts maintained superior self-assessed performance (8 ± 0 vs. 7 ± 1.2; p = 0.009) and reported lower perceived negative workload (4.5 ± 1.45 vs. 6 ± 0.55; p = 0.041).

Conclusions

In this pilot study, expert readers achieved faster and more accurate diagnoses, exhibiting more efficient visual search patterns and lower cognitive load. Pending external validation, our findings suggest that ECG training programs should focus on developing targeted visual techniques, cognitive efficiency, and adaptive coping strategies to enhance accurate interpretation.

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追踪视觉专家在心电图解释：一项眼动追踪试点研究

视觉专业知识对于准确的心电解释至关重要。我们的目的是在使用眼动追踪技术进行心电图分析时，识别和测量视觉搜索模式、认知负荷和诊断准确性方面的专业差异。方法1 - 3年住院医师和委员会认证的心脏病专家解释疑似急性冠脉综合征患者的心电图，同时眼动追踪眼镜记录注视次数、持续时间和瞳孔扩张。通过NASA任务负荷指数分析诊断准确性和认知负荷。热图说明了认知负荷、感知负荷和自我评估性能之间的关系，包括经验水平和ECG任务复杂性。结果专家读者解读心电图的速度明显快于普通居民（107.6±32.8 vs. 205.31±57.43 s）；P < 0.001)，并在所有任务难度水平上表现出更高的诊断准确性（P < 0.001）。眼球追踪分析显示，专家的注视次数较少（67.7±25.7 vs. 143.7±29.9）；P < 0.001)和更长的固定时间(3.9±0.7 vs. 3.2±1 s；P = 0.032)。专家还显示瞳孔扩张变化(4.8%±2% vs. 10.5%±4.2%；p = 0.015)。任务难度的增加与瞳孔扩大有关，特别是在新手中(困难任务的平均瞳孔扩大13.4%±4.1%，而简单任务的平均瞳孔扩大7.3%±2.3%；P = 0.008)，表明认知需求较高。专家保持较好的自我评估表现（8±0比7±1.2）；P = 0.009)，报告的感知负工作负荷较低(4.5±1.45比6±0.55；p = 0.041)。在本初步研究中，专家读者的诊断速度更快、更准确，表现出更高效的视觉搜索模式和更低的认知负荷。在外部验证之前，我们的研究结果表明，ECG训练计划应侧重于开发有针对性的视觉技术，认知效率和适应性应对策略，以提高准确的解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.