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

Autor: Justinas Bacevicius, Zygimantas Abramikas, Ernestas Dvinelis, Deimile Audzijoniene, Marija Petrylaite, Julija Marinskiene, Justina Staigyte, Albinas Karuzas, Vytautas Juknevicius, Rusne Jakaite, Viktorija Basyte-Bacevice, Neringa Bileisiene, Andrius Solosenko, Daivaras Sokas, Andrius Petrenas, Monika Butkuviene, Birute Paliakaite, Saulius Daukantas, Andrius Rapalis, Germanas Marinskis, Eugenijus Jasiunas, Angeliki Darma, Vaidotas Marozas, Audrius Aidietis
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Frontiers in Cardiovascular Medicine, Vol 9 (2022)
Druh dokumentu: article
ISSN: 2297-055X
DOI: 10.3389/fcvm.2022.869730
Popis: BackgroundConsumer 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.ObjectiveDoubleCheck-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 ResultsWe 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).ConclusionsThis 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.
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