High Specificity Wearable Device With Photoplethysmography and Six-Lead Electrocardiography for Atrial Fibrillation Detection Challenged by Frequent Premature Contractions: DoubleCheck-AF

Frontiers in Cardiovascular Medicine

article

Justinas Bacevicius¹  Zygimantas Abramikas¹  Ernestas Dvinelis¹  Deimile Audzijoniene¹  Marija Petrylaite¹  Julija Marinskiene¹  Justina Staigyte¹  Albinas Karuzas¹  Vytautas Juknevicius¹  Rusne Jakaite¹  Viktorija Basyte-Bacevice¹  Neringa Bileisiene¹  Andrius Solosenko³  Daivaras Sokas³  Andrius Petrenas³  Monika Butkuviene³  Birute Paliakaite³  Saulius Daukantas³  Andrius Rapalis³  Germanas Marinskis¹  Eugenijus Jasiunas⁴  Angeliki Darma⁵  Vaidotas Marozas³  Audrius Aidietis¹ 

[1] Institute of Clinical Medicine, Faculty of Medicine, Vilnius University;Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos;Biomedical Engineering Institute, Kaunas University of Technology;Center of Informatics and Development, Vilnius University Hospital Santaros Klinikos;Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute;Department of Electronics Engineering, Kaunas University of Technology

关键词: wrist-worn device;    multiple-lead portable ECG;    telemedicine;    mhealth;    remote monitoring;    digital health;   

DOI  :  10.3389/fcvm.2022.869730

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Consumer smartwatches have gained attention as mobile health (mHealth) tools able to detect atrial fibrillation (AF) using photoplethysmography (PPG) or a short strip of electrocardiogram (ECG). PPG has limited accuracy due to the movement artifacts, whereas ECG cannot be used continuously, is usually displayed as a single-lead signal and is limited in asymptomatic cases. Objective DoubleCheck-AF is a validation study of a wrist-worn device dedicated to providing both continuous PPG-based rhythm monitoring and instant 6-lead ECG with no wires. We evaluated its ability to differentiate between AF and sinus rhythm (SR) with particular emphasis on the challenge of frequent premature beats. Methods and Results We performed a prospective, non-randomized study of 344 participants including 121 patients in AF. To challenge the specificity of the device two control groups were selected: 95 patients in stable SR and 128 patients in SR with frequent premature ventricular or atrial contractions (PVCs/PACs). All ECG tracings were labeled by two independent diagnosis-blinded cardiologists as “AF,” “SR” or “Cannot be concluded.” In case of disagreement, a third cardiologist was consulted. A simultaneously recorded ECG of Holter monitor served as a reference. It revealed a high burden of ectopy in the corresponding control group: 6.2 PVCs/PACs per minute, bigeminy/trigeminy episodes in 24.2% (31/128) and runs of ≥3 beats in 9.4% (12/128) of patients. AF detection with PPG-based algorithm, ECG of the wearable and combination of both yielded sensitivity and specificity of 94.2 and 96.9%; 99.2 and 99.1%; 94.2 and 99.6%, respectively. All seven false-positive PPG-based cases were from the frequent PVCs/PACs group compared to none from the stable SR group ( P < 0.001). In the majority of these cases (6/7) cardiologists were able to correct the diagnosis to SR with the help of the ECG of the device ( P = 0.012). Conclusions This is the first wearable combining PPG-based AF detection algorithm for screening of AF together with an instant 6-lead ECG with no wires for manual rhythm confirmation. The system maintained high specificity despite a remarkable amount of frequent single or multiple premature contractions.

【 授权许可】

CC BY