INTRODUCTION/BACKGROUND: Eighty-lead (80 L) body surface map (BSM) technology provides electrocardiogram data for the clinician to interpret. A BSM device also offers an automated interpretation. Little information is available about the performance of automated algorithm interpretation in comparison to human interpretation of the 80 L BSM. METHODS: Interpretations of BSMs by automated algorithm and a core laboratory of physician readers from The Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction trial were compared. The κ statistic and its 95% confidence interval for concordance were calculated. The effect of BSM quality on concordance was also analyzed. RESULTS: 3405 maps for 1601 subjects were reviewed by the core laboratory and automated algorithm. There was a combined concordance rate of 87.3% (κ = 0.46; 95% confidence interval, 0.40-0.52). A decrease in signal quality was associated with a decrease in concordance between human and automated algorithm interpretation (κ = 0.52 for good quality vs κ = 0.30 for poor quality). CONCLUSION: A moderate degree of concordance was noted between physician and automated algorithm interpretation of 80 L BSMs. Signal quality of 80 L electrocardiographic BSM directly affected concordance.