Quantification of the first-order high-pass filter's influence on the automatic measurements of the electrocardiogram

Background and objective: The first-order high-pass filter (AC coupling) has previously been shown to affect the ECG for higher cut-off frequencies. We seek to find a systematic deviation in computer measurements of the electrocardiogram when the AC coupling with a 0.05 Hz first-order high-pass filter is used.

Methods: The standard 12-lead electrocardiogram from 1248 patients and the automated measurements of their DC and AC coupled version were used. We expect a large unipolar QRS-complex to produce a deviation in the opposite direction in the ST-segment.

Results: We found a strong correlation between the QRS integral and the offset throughout the ST-segment. The coefficient for J amplitude deviation was found to be -0.277 µV/(µV⋅s).

Conclusions: Potential dangerous alterations to the diagnostically important ST-segment were found. Medical professionals and software developers for electrocardiogram interpretation programs should be aware of such high-pass filter effects since they could be misinterpreted as pathophysiology or some pathophysiology could be masked by these effects.