Non-conscious detection of ST-segment elevation during physician ECG interpretation
DiGirolamo, Gregory J Kakouros, Nikolaos Sorcini, Federico Sorcini, Sofia Patrizi Dupell, Jenna Sands, Erin K Rosen, Max P
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Abstract
Objective: To investigate errors in the assessment of ST-elevation (STEs) myocardial infarctions on ECGs to determine if non-conscious processes successfully detect missed STEs, as evidenced by changes in how long and often physicians look at leads with STEs.
Materials and method: Eight experienced physicians interpreted 90 ECGs (45 STEs, 45 Normal) while eye movements were recorded. Physicians marked consciously recognized or considered STEs. No clinical context was provided.
Results: Physicians missed 18% of STEs. Eye-tracking showed longer (P = 0.02), more frequent (P = 0.02), and increased transitions (P = 0.02) to "missed" STE leads compared to Normal ECG leads.
Discussion: Non-conscious detection of STEs, including inter‑lead relationships, despite a lack of conscious recognition, suggests a sophisticated mechanism of wholistic detection, including culprit lesion sites by non-conscious processes.
Conclusion: Non-conscious detection of STEs supports non-conscious detection processing in medicine leading to more success than can be tracked by conscious report. Eye-tracking could enhance ECG interpretation and reduce diagnostic errors.
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DiGirolamo GJ, Kakouros N, Sorcini F, Sorcini SP, Dupell J, Sands EK, Rosen MP. Non-conscious detection of ST-segment elevation during physician ECG interpretation. J Electrocardiol. 2025 Oct 18;93:154148. doi: 10.1016/j.jelectrocard.2025.154148. Epub ahead of print. PMID: 41135156.