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Zepeda-Echavarria A, Ratering Arntz NCM, Westra AH, van Schelven LJ, Euwe FE, Noordmans HJ, Vessies M, van de Leur RR, Hassink RJ, Wildbergh TX, van der Zee R, Doevendans PA, van Es R, Jaspers JEN. On the design and development of a handheld electrocardiogram device in a clinical setting. Front Digit Health 2024; 6:1403457. [PMID: 39184339 PMCID: PMC11341539 DOI: 10.3389/fdgth.2024.1403457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/17/2024] [Indexed: 08/27/2024] Open
Abstract
Cardiovascular diseases (CVDs) are a global burden that requires attention. For the detection and diagnosis of CVDs, the 12-lead ECG is a key tool. With technological advancements, ECG devices are becoming smaller and available for home use. Most of these devices contain a limited number of leads and are aimed to detect atrial fibrillation (AF). To investigate whether a four-electrode arrangement could provide enough information to diagnose other CVDs, further research is necessary. At the University Medical Center Utrecht in a multidisciplinary team, we developed the miniECG, a four-electrode ECG handheld system for scientific research in clinical environments (TRL6). This paper describes the process followed during the development of the miniECG. From assembling a multidisciplinary team, which includes engineers, cardiologists, and clinical physicians to the contribution of team members in the design input, design, and testing for safety and functionality of the device. Finally, we detail how the development process was composed by iterative design steps based on user input and intended use evolution. The miniECG is a device compliant for scientific research with patients within Dutch Medical Centers. We believe that hospital-based development led to a streamlined process, which could be applied for the design and development of other technologies used for scientific research in clinical environments.
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Affiliation(s)
- Alejandra Zepeda-Echavarria
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Niek C. M. Ratering Arntz
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Albert H. Westra
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Leonard J. van Schelven
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Froukje E. Euwe
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Herke Jan Noordmans
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Melle Vessies
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rutger R. van de Leur
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rutger J. Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | | | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
- Department of Cardiology, Central Military Hospital, Utrecht, Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Joris E. N. Jaspers
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Strik M, Ploux S, Fontagne L, Tixier R, Abu Alrub S, van der Zande J, Velraeds A, Haïssaguerre M, Bordachar P. Combining electrocardiogram smartwatches and remote monitoring to diagnose palpitations and presyncope. Heart Rhythm 2024:S1547-5271(24)02737-1. [PMID: 38897334 DOI: 10.1016/j.hrthm.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Marc Strik
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; Service de Cardiologie-électrophysiologie et stimulation cardiaque, CHU de Bordeaux, INSERM, U 1045, Bordeaux, France.
| | - Sylvain Ploux
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; Service de Cardiologie-électrophysiologie et stimulation cardiaque, CHU de Bordeaux, INSERM, U 1045, Bordeaux, France
| | - Leslie Fontagne
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; Service de Cardiologie-électrophysiologie et stimulation cardiaque, CHU de Bordeaux, INSERM, U 1045, Bordeaux, France
| | - Romain Tixier
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; Service de Cardiologie-électrophysiologie et stimulation cardiaque, CHU de Bordeaux, INSERM, U 1045, Bordeaux, France
| | - Saer Abu Alrub
- Department of Cardiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Joske van der Zande
- Service de Cardiologie-électrophysiologie et stimulation cardiaque, CHU de Bordeaux, INSERM, U 1045, Bordeaux, France; Twente University, Twente, The Netherlands
| | - Anouk Velraeds
- Service de Cardiologie-électrophysiologie et stimulation cardiaque, CHU de Bordeaux, INSERM, U 1045, Bordeaux, France; Twente University, Twente, The Netherlands
| | - Michel Haïssaguerre
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; Service de Cardiologie-électrophysiologie et stimulation cardiaque, CHU de Bordeaux, INSERM, U 1045, Bordeaux, France
| | - Pierre Bordachar
- Université de Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France; Service de Cardiologie-électrophysiologie et stimulation cardiaque, CHU de Bordeaux, INSERM, U 1045, Bordeaux, France
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Strik M, Ploux S, Ramirez FD, Fontagne L, Dos Santos P, Hocini M, Jaïs P, Haïssaguerre M, Bordachar P. A video tutorial to distinguish between sinus rhythm and atrial fibrillation using smartwatch electrocardiograms may facilitate self-diagnosis and remote monitoring. Heart Rhythm 2024:S1547-5271(24)02671-7. [PMID: 38848859 DOI: 10.1016/j.hrthm.2024.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Leslie Fontagne
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Pierre Dos Santos
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Mélèze Hocini
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Pierre Jaïs
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
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Goodings AJ, Fadahunsi KP, Tarn DM, Henn P, Shiely F, O'Donoghue J. Factors influencing smartwatch use and comfort with health data sharing: a sequential mixed-method study protocol. BMJ Open 2024; 14:e081228. [PMID: 38754889 PMCID: PMC11097863 DOI: 10.1136/bmjopen-2023-081228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/21/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Smartwatches have become ubiquitous for tracking health metrics. These data sets hold substantial potential for enhancing healthcare and public health initiatives; it may be used to track chronic health conditions, detect previously undiagnosed health conditions and better understand public health trends. By first understanding the factors influencing one's continuous use of the device, it will be advantageous to assess factors that may influence a person's willingness to share their individual data sets. This study seeks to comprehensively understand the factors influencing the continued use of these devices and people's willingness to share the health data they generate. METHODS AND ANALYSIS A two-section online survey of smartwatch users over the age of 18 will be conducted (n ≥200). The first section, based on the expectation-confirmation model, will assess factors influencing continued use of smartwatches while the second section will assess willingness to share the health data generated from these devices. Survey data will be analysed descriptively and based on structural equation modelling.Subsequently, six focus groups will be conducted to further understand the issues raised in the survey. Each focus group (n=6) will consist of three smartwatch users: a general practitioner, a public health specialist and an IT specialist. Young smartwatch users (aged 18-44) will be included in three of the focus groups and middle-aged smartwatch users (aged 45-64) will be included in the other three groups. This is to enhance comparison of opinions based on age groups. Data from the focus groups will be analysed using the microinterlocutor approach and an executive summary.After the focus group, participants will complete a brief survey to indicate any changes in their opinions resulting from the discussion. ETHICS AND DISSEMINATION The results of this study will be disseminated through publication in a peer-reviewed journal, and all associated data will be deposited in a relevant, publicly accessible data repository to ensure transparency and facilitate future research endeavours.This study was approved by the Social Research Ethic Committee (SREC), University College Cork-SREC/SOM/21062023/2.
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Affiliation(s)
| | | | | | - Patrick Henn
- School of Medicine, University College Cork, Cork, Ireland
| | - Frances Shiely
- Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - John O'Donoghue
- Malawi eHealth Research Centre, University College Cork, Cork, Ireland
- Department of Primary Care and Public Health, University College Cork, Cork, Ireland
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Paslı S, Topçuoğlu H, Yılmaz M, Yadigaroğlu M, İmamoğlu M, Karaca Y. Diagnostic accuracy of apple watch ECG outputs in identifying dysrhythmias: A comparison with 12-Lead ECG in emergency department. Am J Emerg Med 2024; 79:25-32. [PMID: 38330880 DOI: 10.1016/j.ajem.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Wearable devices, particularly smartwatches like the Apple Watch (AW), can record important cardiac information, such as single‑lead electrocardiograms (ECGs). Although they are increasingly used to detect conditions such as atrial fibrillation (AF), research on their effectiveness in detecting a wider range of dysrhythmias and abnormal ECG findings remains limited. The primary objective of this study is to evaluate the accuracy of the AW in detecting various cardiac rhythms by comparing it with standard ECG's lead-I. METHODS This single-center prospective observational study was conducted in a tertiary care emergency department (ED) between 1.10.2023 and 31.10.2023. The study population consisted of all patients assessed in the critical care areas of the ED, all of whom underwent standard 12‑lead ECGs for various clinical reasons. Participants in the study were included consecutively. An AW was attached to patients' wrists and an ECG lead-I printout was obtained. Heart rate, rhythm and abnormal findings were evaluated and compared with the lead-I of standard ECG. Two emergency medicine specialists performed the ECG evaluations. Rhythms were categorized as normal sinus rhythm and abnormal rhythms, while ECG findings were categorized as the presence or absence of abnormal findings. AW and 12‑lead ECG outputs were compared using the McNemar test. Predictive performance analyses were also performed for subgroups. Bland-Altman analysis using absolute mean differences and concordance correlation coefficients was used to assess the level of heart rate agreement between devices. RESULTS The study was carried out on 721 patients. When analyzing ECG rhythms and abnormal findings in lead-I, the effectiveness of AW in distinguishing between normal and abnormal rhythms was similar to standard ECGs (p = 0.52). However, there was a significant difference between AW and standard ECGs in identifying abnormal findings in lead-I (p < 0.05). Using Bland-Altman analysis for heart rate assessment, the absolute mean difference for heart rate was 0.81 ± 6.12 bpm (r = 0.94). There was strong agreement in 658 out of 700 (94%) heart rate measurements. CONCLUSION Our study indicates that the AW has the potential to detect cardiac rhythms beyond AF. ECG tracings obtained from the AW may help evaluate cardiac rhythms prior to the patient's arrival in the ED. However, further research with a larger patient cohort is essential, especially for specific diagnoses.
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Affiliation(s)
- Sinan Paslı
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey.
| | - Hazal Topçuoğlu
- Siirt Education & Research Hospital, Department of Emergency Medicine, Siirt, Turkey
| | - Mutlu Yılmaz
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
| | - Metin Yadigaroğlu
- Samsun University, Faculty of Medicine, Department of Emergency Medicine, Samsun, Turkey
| | - Melih İmamoğlu
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
| | - Yunus Karaca
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
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Tyler KR, Mumma BE, Anderson DR, Goldschlager N. Spotting myocardial ischemia on a smartwatch. J Electrocardiol 2024; 84:70-74. [PMID: 38552482 DOI: 10.1016/j.jelectrocard.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Katren R Tyler
- Department of Emergency Medicine, University of California Davis, Sacramento, CA, United States of America.
| | - Bryn E Mumma
- Department of Emergency Medicine, University of California Davis, Sacramento, CA, United States of America
| | - David R Anderson
- Interventional Cardiology, The Permanente Medical Group, 1600 Eureka Road, Roseville, CA, United States of America
| | - Nora Goldschlager
- Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General, University of California San Francisco, San Francisco, CA, United States of America
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Bogár B, Pető D, Sipos D, Füredi G, Keszthelyi A, Betlehem J, Pandur AA. Detection of Arrhythmias Using Smartwatches-A Systematic Literature Review. Healthcare (Basel) 2024; 12:892. [PMID: 38727449 PMCID: PMC11083549 DOI: 10.3390/healthcare12090892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Smartwatches represent one of the most widely adopted technological innovations among wearable devices. Their evolution has equipped them with an increasing array of features, including the capability to record an electrocardiogram. This functionality allows users to detect potential arrhythmias, enabling prompt intervention or monitoring of existing arrhythmias, such as atrial fibrillation. In our research, we aimed to compile case reports, case series, and cohort studies from the Web of Science, PubMed, Scopus, and Embase databases published until 1 August 2023. The search employed keywords such as "Smart Watch", "Apple Watch", "Samsung Gear", "Samsung Galaxy Watch", "Google Pixel Watch", "Fitbit", "Huawei Watch", "Withings", "Garmin", "Atrial Fibrillation", "Supraventricular Tachycardia", "Cardiac Arrhythmia", "Ventricular Tachycardia", "Atrioventricular Nodal Reentrant Tachycardia", "Atrioventricular Reentrant Tachycardia", "Heart Block", "Atrial Flutter", "Ectopic Atrial Tachycardia", and "Bradyarrhythmia." We obtained a total of 758 results, from which we selected 57 articles, including 33 case reports and case series, as well as 24 cohort studies. Most of the scientific works focused on atrial fibrillation, which is often detected using Apple Watches. Nevertheless, we also included articles investigating arrhythmias with the potential for circulatory collapse without immediate intervention. This systematic literature review provides a comprehensive overview of the current state of research on arrhythmia detection using smartwatches. Through further research, it may be possible to develop a care protocol that integrates arrhythmias recorded by smartwatches, allowing for timely access to appropriate medical care for patients. Additionally, continuous monitoring of existing arrhythmias using smartwatches could facilitate the assessment of the effectiveness of prescribed therapies.
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Affiliation(s)
- Bence Bogár
- Department of Oxyology and Emergency Care, Pedagogy of Health and Nursing Sciences, Institute of Emergency Care, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary; (D.P.); (G.F.); (J.B.); (A.A.P.)
| | - Dániel Pető
- Department of Oxyology and Emergency Care, Pedagogy of Health and Nursing Sciences, Institute of Emergency Care, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary; (D.P.); (G.F.); (J.B.); (A.A.P.)
| | - Dávid Sipos
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, 7400 Kaposvár, Hungary;
| | - Gábor Füredi
- Department of Oxyology and Emergency Care, Pedagogy of Health and Nursing Sciences, Institute of Emergency Care, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary; (D.P.); (G.F.); (J.B.); (A.A.P.)
| | - Antónia Keszthelyi
- Human Patient Simulation Center for Health Sciences, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary;
| | - József Betlehem
- Department of Oxyology and Emergency Care, Pedagogy of Health and Nursing Sciences, Institute of Emergency Care, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary; (D.P.); (G.F.); (J.B.); (A.A.P.)
| | - Attila András Pandur
- Department of Oxyology and Emergency Care, Pedagogy of Health and Nursing Sciences, Institute of Emergency Care, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary; (D.P.); (G.F.); (J.B.); (A.A.P.)
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Song K, Hirose K, Niitsu K, Sui T, Kojima H, Fujie T, Umezu S. A combination of logical judging circuit and water-resistant ultrathin film PEDOT: PSS electrode for noninvasive ECG measurement. DISCOVER NANO 2024; 19:45. [PMID: 38483679 PMCID: PMC10940549 DOI: 10.1186/s11671-024-03988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
Heart disease-related deaths have increased in recent decades, with most patients dying of sudden cardiac arrest. In such instances, the effect of regular electrocardiogram (ECG) measurements is minimal. Therefore, long-term ECG monitoring has become increasingly important. In this paper, we report a non-adhesive high accuracy ECG monitoring system that can be used in various scenarios without interfering with daily activities. The ECG ultra-thin film electrode is made by water-resistant material based on poly(3,4-ethylenedioxythiophene) poly(4-styrenesulfonate) (PEDOT: PSS) electrode doped with ethylene glycol (EG) and xylitol, to improve the noise signal caused by sweat. The optimal ratio of the three ingredients of PEDOT: PSS/xylitol/EG was determined experimentally to accommodate the ECG monitoring. By using the proposed selectively closed multi-channel single-lead logic circuit, the noise of ECG signal received from the proposed film electrode can be successfully reduced during broad-area electrode measurements, thus to improve ECG measurement accuracy.
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Affiliation(s)
- Kewei Song
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 169-8555, Japan
| | - Kayo Hirose
- Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kioto Niitsu
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 169-8555, Japan
| | - Tsubasa Sui
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 169-8555, Japan
| | - Hiroto Kojima
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 169-8555, Japan
| | - Toshinori Fujie
- School of Life Science and Technology, Tokyo Institute of Technology, B-50, 4259 Nagatsuta-Cho, Midori-ku, Yokohama, 226-8501, Japan.
| | - Shinjiro Umezu
- Department of Modern Mechanical Engineering, Graduate School of Creative Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 169-8555, Japan.
- Department of Integrative Bioscience and Biomedical Engineering, Graduate School of Advanced Science and Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 169-8555, Japan.
- Department of Modern Mechanical Engineering, Waseda University, 3-4-1 Okubo, Shinjuku-ku, Tokyo, 169-8555, Japan.
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Zepeda-Echavarria A, van de Leur RR, Vessies M, de Vries NM, van Sleuwen M, Hassink RJ, Wildbergh TX, van Doorn JL, van der Zee R, Doevendans PA, Jaspers JEN, van Es R. Detection of acute coronary occlusion with a novel mobile electrocardiogram device: a pilot study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:183-191. [PMID: 38505481 PMCID: PMC10944676 DOI: 10.1093/ehjdh/ztae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 03/21/2024]
Abstract
Aims Many portable electrocardiogram (ECG) devices have been developed to monitor patients at home, but the majority of these devices are single lead and only intended for rhythm disorders. We developed the miniECG, a smartphone-sized portable device with four dry electrodes capable of recording a high-quality multi-lead ECG by placing the device on the chest. The aim of our study was to investigate the ability of the miniECG to detect occlusive myocardial infarction (OMI) in patients with chest pain. Methods and results Patients presenting with acute chest pain at the emergency department of the University Medical Center Utrecht or Meander Medical Center, between May 2021 and February 2022, were included in the study. The clinical 12-lead ECG and the miniECG before coronary intervention were recorded. The recordings were evaluated by cardiologists and compared the outcome of the coronary angiography, if performed. A total of 369 patients were measured with the miniECG, 46 of whom had OMI. The miniECG detected OMI with a sensitivity and specificity of 65 and 92%, compared with 83 and 90% for the 12-lead ECG. Sensitivity of the miniECG was similar for different culprit vessels. Conclusion The miniECG can record a multi-lead ECG and rule-in ST-segment deviation in patients with occluded or near-occluded coronary arteries from different culprit vessels without many false alarms. Further research is required to add automated analysis to the recordings and to show feasibility to use the miniECG by patients at home.
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Affiliation(s)
- Alejandra Zepeda-Echavarria
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rutger R van de Leur
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Melle Vessies
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Nynke M de Vries
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Meike van Sleuwen
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Thierry X Wildbergh
- Department of Cardiology, Meander Medical Center Amersfoort, Amersfoort, The Netherlands
| | - J L van Doorn
- Department of Cardiology, Meander Medical Center Amersfoort, Amersfoort, The Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
| | - Joris E N Jaspers
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal ref E03.511, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Knecht S, Waldmann F, Kuhn R, Mannhart D, Kühne M, Sticherling C, Badertscher P, Wildhaber RA. Technical Characterization of Single-Lead ECG Signals From 4 Different Smartwatches and its Potential Clinical Implications. JACC Clin Electrophysiol 2023; 9:1415-1417. [PMID: 37074248 DOI: 10.1016/j.jacep.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 04/20/2023]
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Zepeda-Echavarria A, van de Leur RR, van Sleuwen M, Hassink RJ, Wildbergh TX, Doevendans PA, Jaspers J, van Es R. Electrocardiogram Devices for Home Use: Technological and Clinical Scoping Review. JMIR Cardio 2023; 7:e44003. [PMID: 37418308 PMCID: PMC10362423 DOI: 10.2196/44003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Electrocardiograms (ECGs) are used by physicians to record, monitor, and diagnose the electrical activity of the heart. Recent technological advances have allowed ECG devices to move out of the clinic and into the home environment. There is a great variety of mobile ECG devices with the capabilities to be used in home environments. OBJECTIVE This scoping review aimed to provide a comprehensive overview of the current landscape of mobile ECG devices, including the technology used, intended clinical use, and available clinical evidence. METHODS We conducted a scoping review to identify studies concerning mobile ECG devices in the electronic database PubMed. Secondarily, an internet search was performed to identify other ECG devices available in the market. We summarized the devices' technical information and usability characteristics based on manufacturer data such as datasheets and user manuals. For each device, we searched for clinical evidence on the capabilities to record heart disorders by performing individual searches in PubMed and ClinicalTrials.gov, as well as the Food and Drug Administration (FDA) 510(k) Premarket Notification and De Novo databases. RESULTS From the PubMed database and internet search, we identified 58 ECG devices with available manufacturer information. Technical characteristics such as shape, number of electrodes, and signal processing influence the capabilities of the devices to record cardiac disorders. Of the 58 devices, only 26 (45%) had clinical evidence available regarding their ability to detect heart disorders such as rhythm disorders, more specifically atrial fibrillation. CONCLUSIONS ECG devices available in the market are mainly intended to be used for the detection of arrhythmias. No devices are intended to be used for the detection of other cardiac disorders. Technical and design characteristics influence the intended use of the devices and use environments. For mobile ECG devices to be intended to detect other cardiac disorders, challenges regarding signal processing and sensor characteristics should be solved to increase their detection capabilities. Devices recently released include the use of other sensors on ECG devices to increase their detection capabilities.
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Affiliation(s)
- Alejandra Zepeda-Echavarria
- Medical Technologies and Clinical Physics, Facilitation Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rutger R van de Leur
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Meike van Sleuwen
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
- HeartEye BV, Delft, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Joris Jaspers
- Medical Technologies and Clinical Physics, Facilitation Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - René van Es
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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12
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Golbus JR. Mobile Health Technology: (Smart)Watch and Wait. JACC Case Rep 2023; 17:101898. [PMID: 37496725 PMCID: PMC10366495 DOI: 10.1016/j.jaccas.2023.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Jessica R. Golbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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13
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de Vries NM, Zepeda-Echavarria A, van de Leur RR, Loen V, Vos MA, Boonstra MJ, Wildbergh TX, Jaspers JE, van der Zee R, Slump CH, Doevendans PA, van Es R. Detection of Ischemic ST-Segment Changes Using a Novel Handheld ECG Device in a Porcine Model. JACC. ADVANCES 2023; 2:100410. [PMID: 38939006 PMCID: PMC11198505 DOI: 10.1016/j.jacadv.2023.100410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/20/2023] [Accepted: 05/08/2023] [Indexed: 06/29/2024]
Abstract
Background Portable, smartphone-sized electrocardiography (ECG) has the potential to reduce time to treatment for patients suffering acute cardiac ischemia, thereby lowering the morbidity and mortality. In the UMC Utrecht, a portable, smartphone-sized, multi-lead precordial ECG recording device (miniECG 1.0, UMC Utrecht) was developed. Objectives The purpose of this study was to investigate the ability of the miniECG to capture ischemic ECG changes in a porcine coronary occlusion model. Methods In 8 animals, antero-septal myocardial infarction was induced by 75-minute occlusion of the left anterior descending artery, after the first or second diagonal. MiniECG and 12-lead ECG recordings were acquired simultaneously before, during and after coronary artery occlusion and ST-segment deviation was evaluated. Results During the complete occlusion and reperfusion period, miniECG showed large ST-segment deviation in comparison to 12-lead ECG. MiniECG ST-segment deviation was observed within 1 minute for most animals. The miniECG was positive for ischemia (ie, ST-segment deviation ≥1 mm) for 99.7% (Q1-Q3: 99.6%-99.9%) of the occlusion time, while the 12-lead was only positive for 79.8% (Q1-Q3: 81.1%-98.7%) of the time (P = 0.018). ST-segment deviation reached maxima of 10.5 mm [95% CI: 6.5-14.5 mm] vs 5.0 mm [95% CI: 2.0-8.0 mm] for the miniECG vs 12-lead ECG, respectively. Conclusions MiniECG ST-segment deviation was observed early and was of large magnitude during 75 minutes of porcine transmural antero-septal infarction. The miniECG was positive for ischemia for the complete occlusion period. These findings demonstrate the potential of the miniECG in the detection of cardiac ischemia. Although clinical research is required, data suggests that the miniECG is a promising tool for the detection of cardiac ischemia.
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Affiliation(s)
- Nynke M. de Vries
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Alejandra Zepeda-Echavarria
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rutger R. van de Leur
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vera Loen
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marc A. Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Machteld J. Boonstra
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Joris E.N. Jaspers
- Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rien van der Zee
- Stichting Cardiovasculaire Biologie, Delft, the Netherlands
- HeartEye B.V., Delft, the Netherlands
| | | | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- HeartEye B.V., Delft, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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14
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Leroux J, Strik M, Ramirez FD, Racine HP, Ploux S, Sacristan B, Chabaneix-Thomas J, Jalal Z, Thambo JB, Bordachar P. Feasibility and Diagnostic Value of Recording Smartwatch Electrocardiograms in Neonates and Children. J Pediatr 2023; 253:40-45.e1. [PMID: 36113637 DOI: 10.1016/j.jpeds.2022.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the agreement of smartwatch-derived single-lead electrocardiogram (ECG) recordings with 12-lead ECGs for diagnosing electrocardiographic abnormalities. STUDY DESIGN A 12-lead ECG and an ECG using Apple Watch were obtained in 110 children (aged 1 week to 16 years) with normal (n = 75) or abnormal (n = 35) 12-lead ECGs (atrioventricular block [7], supraventricular tachycardia [SVT] {5}, bundle branch block [12], ventricular preexcitation [6], long QT [5]). In children aged <6 years, the ECG recording was performed with the active participation of an adult who applied the neonate or child's finger to the crown of the watch. In older children, tracings were obtained after brief teaching without adult guidance. All 12-lead ECGs were independently evaluated by 2 blinded cardiologists. Apple Watch ECGs were independently evaluated by another blinded cardiologist. RESULTS In 109 children (99.1%), the smartwatch tracing was of sufficient quality for evaluation. Smartwatch tracings were 84% sensitive and 100% specific for the detection of an abnormal ECG. All 75 normal tracings were correctly identified. Of the 35 children with abnormalities on 12-lead ECGs, 5 (14%) were missed, most often because of baseline wander and artifacts. Rhythm disorders (atrioventricular block or SVT) and bundle branch blocks were correctly detected in most cases (11 of 12 and 11 of 12, respectively); preexcitation and long QT was detected in 4 of 6 and 4 of 5, respectively. CONCLUSION Smartwatch ECGs recorded with parental assistance in children aged up to 6 years and independently in older children have the potential to detect clinically relevant conditions.
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Affiliation(s)
- Justine Leroux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France.
| | - F Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Hugo Pierre Racine
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (IUCPQ-UL), Quebec, Canada
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Benjamin Sacristan
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Julie Chabaneix-Thomas
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Zakaria Jalal
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Jean-Benoit Thambo
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France
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15
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Lawin D, Kuhn S, Schulze Lammers S, Lawrenz T, Stellbrink C. Use of digital health applications for the detection of atrial fibrillation. Herzschrittmacherther Elektrophysiol 2022; 33:373-379. [PMID: 35960358 DOI: 10.1007/s00399-022-00888-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
The advances in health care technologies over the last decade have led to improved capabilities in the use of digital health applications (DiHA) for the detection of atrial fibrillation (AFib). Thus, home-based remote heart rhythm monitoring is facilitated by smartphones or smartwatches alone or combined with external sensors. The available products differ in terms of type of application (wearable vs. handheld) and the technique used for rhythm detection (electrocardiography [ECG] vs. photoplethysmography [PPG]). While ECG-based algorithms often require additional sensors, PPG utilizes techniques integrated in smartphones or smartwatches. Algorithms based on artificial intelligence allow for the automated diagnosis of AFib, enabling high diagnostic accuracy for both ECG-based and PPG-based DiHA. Advantages for clinical use result from the widespread accessibility of rhythm monitoring, thereby permitting earlier diagnosis and higher AFib detection rates. DiHA are also useful for the follow-up of patients with known AFib by monitoring the success of therapeutic interventions to restore sinus rhythm, e.g. catheter ablation. Although some studies strongly suggest a potential benefit for the use of DiHA in the setting of AFib, the overall evidence for an improvement in hard, clinical endpoints and positive effects on clinical care is scarce. To enhance the acceptance of DiHA use in daily practice, more studies evaluating their clinical benefits for the detection of AFib are required. Moreover, most of the applications are still not reimbursable, although the German Digital Health Care Act (Digitale-Versorgung-Gesetz, DVG) made reimbursement possible in principle in 2019.
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Affiliation(s)
- Dennis Lawin
- Department of Cardiology and Intensive Care Medicine, University hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany.
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany.
| | - Sebastian Kuhn
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Sophia Schulze Lammers
- Department of Cardiology and Intensive Care Medicine, University hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Thorsten Lawrenz
- Department of Cardiology and Intensive Care Medicine, University hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, University hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany
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16
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[Application of wearable 12-lead electrocardiogram devices in pre-hospital diagnosis of acute ST segment elevation myocardial infarction]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1566-1571. [PMID: 36329593 PMCID: PMC9637491 DOI: 10.12122/j.issn.1673-4254.2022.10.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the value of wearable 12-lead electrocardiogram (ECG) devices in pre-hospital diagnosis of acute ST segment elevation myocardial infarction (STEMI). METHODS This analysis was conducted among 441 patients selected from the''National ECG Network'', who used wearable 12-lead ECG device with critical situation warning of ST change between January 2019, and August, 2021.The general characteristics, response time and complaints of the patients with STEMI were analyzed.The accuracy of pre-hospital diagnosis of STEMI was compared between clinician's interpretation of ECGs and AI diagnosis by the wearable ECG device. RESULTS In 89 of the patients, a pre-hospital diagnosis of STEMI was made by physicians based on ECGs from the wearable devices, and 58 of them sought medical attention after online warning, with a referral rate of 65.17%.The average time for diagnostic assessment of the ECGs was 153.02 s, and the average time for confirmation of the diagnosis was 178.06 s.The sensitivity for pre-hospital diagnosis of STEMI by clinician's interpretation of the ECGs and by AI diagnosis was 100% and 88.37%, respectively, with a specificity of 95.40% and 79.31%, respectively.The pre-hospital diagnosis by clinicians and AI diagnosis of STEMI both showed a high consistency with the subsequent definite clinical diagnosis of STEMI. CONCLUSION Wearable 12-lead ECG devices can accurately record ECG characteristics of STEMI patients outside the hospital and allow immediate data uploading for an early diagnosis.The diagnoses of STEMI made based on AI technology are highly consistent with those by clinicians, demonstrating excellent clinical performance of the wearable ECG devices.
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17
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Svennberg E, Tjong F, Goette A, Akoum N, Di Biase L, Bordachar P, Boriani G, Burri H, Conte G, Deharo JC, Deneke T, Drossart I, Duncker D, Han JK, Heidbuchel H, Jais P, de Oliviera Figueiredo MJ, Linz D, Lip GYH, Malaczynska-Rajpold K, Márquez M, Ploem C, Soejima K, Stiles MK, Wierda E, Vernooy K, Leclercq C, Meyer C, Pisani C, Pak HN, Gupta D, Pürerfellner H, Crijns HJGM, Chavez EA, Willems S, Waldmann V, Dekker L, Wan E, Kavoor P, Turagam MK, Sinner M. How to use digital devices to detect and manage arrhythmias: an EHRA practical guide. Europace 2022; 24:979-1005. [PMID: 35368065 DOI: 10.1093/europace/euac038] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Emma Svennberg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Fleur Tjong
- Heart Center, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Andreas Goette
- St. Vincenz Hospital Paderborn, Paderborn, Germany
- MAESTRIA Consortium/AFNET, Münster, Germany
| | - Nazem Akoum
- Heart Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Haran Burri
- Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Giulio Conte
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Jean Claude Deharo
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France
- Aix Marseille Université, C2VN, Marseille, France
| | - Thomas Deneke
- Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Inga Drossart
- European Society of Cardiology, Sophia Antipolis, France
- ESC Patient Forum, Sophia Antipolis, France
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Janet K Han
- Cardiac Arrhythmia Centers, Veterans Affairs Greater Los Angeles Healthcare System and University of California, Los Angeles, CA, USA
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Cardiovascular Research Group, Antwerp University, Antwerp, Belgium
| | - Pierre Jais
- Bordeaux University Hospital, Bordeaux, France
| | | | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Manlio Márquez
- Department of Electrocardiology, Instituto Nacional de Cardiología, Mexico City, Mexico
| | - Corrette Ploem
- Department of Ethics, Law and Medical Humanities, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Kyoko Soejima
- Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Eric Wierda
- Department of Cardiology, Dijklander Hospital, Hoorn, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Cristiano Pisani
- Arrhythmia Unit, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Hui Nam Pak
- Yonsei University, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Dhiraj Gupta
- Faculty of Health and Life Sciences, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK
| | | | - H J G M Crijns
- Em. Professor of Cardiology, University of Maastricht, Maastricht, Netherlands
| | - Edgar Antezana Chavez
- Division of Cardiology, Hospital General de Agudos Dr. Cosme Argerich, Pi y Margall 750, C1155AHB Buenos Aires, Argentina
- Division of Cardiology, Hospital Belga, Antezana 455, C0000 Cochabamba, Bolivia
| | | | - Victor Waldmann
- Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France
- Adult Congenital Heart Disease Unit, European Georges Pompidou Hospital, Paris, France
| | - Lukas Dekker
- Catharina Ziekenhuis Eindhoven, Eindhoven, Netherlands
| | - Elaine Wan
- Cardiology and Cardiac Electrophysiology, Columbia University, New York, NY, USA
| | - Pramesh Kavoor
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Moritz Sinner
- Univ. Hospital Munich, Campus Grosshadern, Munich, Germany
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18
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Chakraborty P, Brahmbhatt DH, Nair K. Smart-watching the heart: Ready now or a way to go? Indian Pacing Electrophysiol J 2022; 22:137-138. [PMID: 35504687 PMCID: PMC9091717 DOI: 10.1016/j.ipej.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Praloy Chakraborty
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Darshan H Brahmbhatt
- Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Krishnakumar Nair
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada.
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19
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Xintarakou A, Sousonis V, Asvestas D, Vardas PE, Tzeis S. Remote Cardiac Rhythm Monitoring in the Era of Smart Wearables: Present Assets and Future Perspectives. Front Cardiovasc Med 2022; 9:853614. [PMID: 35299975 PMCID: PMC8921479 DOI: 10.3389/fcvm.2022.853614] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
Remote monitoring and control of heart function are of primary importance for patient evaluation and management, especially in the modern era of precision medicine and personalized approach. Breaking technological developments have brought to the frontline a variety of smart wearable devices, such as smartwatches, chest patches/straps, or sensors integrated into clothing and footwear, which allow continuous and real-time recording of heart rate, facilitating the detection of cardiac arrhythmias. However, there is great diversity and significant differences in the type and quality of the information they provide, thus impairing their integration into daily clinical practice and the relevant familiarization of practicing physicians. This review will summarize the different types and dominant functions of cardiac smart wearables available in the market. Furthermore, we report the devices certified by official American and/or European authorities and the respective sources of evidence. Finally, we comment pertinent limitations and caveats as well as the potential answers that flow from the latest technological achievements and future perspectives.
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Affiliation(s)
| | | | | | - Panos E Vardas
- Heart Sector, Hygeia Hospitals Group, HHG, Athens, Greece.,European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | - Stylianos Tzeis
- Department of Cardiology, Hygeia Group, Mitera Hospital, Athens, Greece
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20
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Lawin D, Albrecht UV, Oftring ZS, Lawrenz T, Stellbrink C, Kuhn S. [Mobile health for detection of atrial fibrillation-Status quo and perspectives]. Internist (Berl) 2022; 63:274-280. [PMID: 35147711 PMCID: PMC8832086 DOI: 10.1007/s00108-022-01267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/24/2022]
Abstract
Mobile health (mHealth) for the detection of atrial fibrillation is an innovative domestic monitoring of the heart rhythm. The use of mHealth in the context of atrial fibrillation increases the availability of diagnostic technologies and facilitates the integration into telemedical treatment concepts as well as the active participation of patients in the treatment process. The detection of atrial fibrillation with mHealth applications is usually based on electrocardiography (ECG) or by detection of the pulse wave using photoplethysmography (PPG). Some applications require additional sensors, others make use of sensors integrated into smartphones or smartwatches. A high diagnostic accuracy for the detection of atrial fibrillation has been shown for most mHealth applications regardless of the underlying technology (analytical validation); however, the evidence on positive care effects and improvement of medical endpoints (clinical validation) is so far scarce. Screening of symptomatic or asymptomatic patients and the follow-up care after antiarrhythmic measures are possibilities for the integration into the reality of care. The preventive detection of atrial fibrillation is an attractive field of application for mHealth with great potential for the future. Nevertheless, at present mHealth is only integrated to a limited extent into the reality of patient care. Adequate reimbursement and medical remuneration as well as opportunities to derive information and qualification are prerequisites in order to be able to guarantee a comprehensive implementation in the future. The Digital Health Care Act passed in 2019, regulates the reimbursement of digital healthcare applications but issues of primary preventive applications have not yet been included.
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Affiliation(s)
- Dennis Lawin
- Arbeitsgruppe für Digitale Medizin, Medizinische Fakultät OWL der Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland.
- Klinik für Kardiologie und internistische Intensivmedizin, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Teutoburger Straße 50, 33604, Bielefeld, Deutschland.
| | - Urs-Vito Albrecht
- Arbeitsgruppe für Digitale Medizin, Medizinische Fakultät OWL der Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland
| | - Zoe Sophie Oftring
- Arbeitsgruppe für Digitale Medizin, Medizinische Fakultät OWL der Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland
| | - Thorsten Lawrenz
- Klinik für Kardiologie und internistische Intensivmedizin, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Teutoburger Straße 50, 33604, Bielefeld, Deutschland
| | - Christoph Stellbrink
- Klinik für Kardiologie und internistische Intensivmedizin, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Teutoburger Straße 50, 33604, Bielefeld, Deutschland
| | - Sebastian Kuhn
- Arbeitsgruppe für Digitale Medizin, Medizinische Fakultät OWL der Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland
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21
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Abu-Alrub S, Strik M, Ramirez FD, Moussaoui N, Racine HP, Marchand H, Buliard S, Haïssaguerre M, Ploux S, Bordachar P. Smartwatch Electrocardiograms for Automated and Manual Diagnosis of Atrial Fibrillation: A Comparative Analysis of Three Models. Front Cardiovasc Med 2022; 9:836375. [PMID: 35187135 PMCID: PMC8854369 DOI: 10.3389/fcvm.2022.836375] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/07/2022] [Indexed: 01/05/2023] Open
Abstract
AimsThe diagnostic accuracy of proprietary smartwatch algorithms and the interpretability of smartwatch ECG tracings may differ between available models. We compared the diagnostic potential for detecting atrial fibrillation (AF) of three commercially available smartwatches.MethodsWe performed a prospective, non-randomized, and adjudicator-blinded clinical study of 100 patients in AF and 100 patients in sinus rhythm, patients with atrial flutter were excluded. All patients underwent 4 ECG recordings: a conventional 12-lead ECG, Apple Watch Series 5®, Samsung Galaxy Watch Active 3®, and Withings Move ECG® in random order. All smartwatch ECGs were analyzed using their respective automated proprietary software and by clinical experts who also graded the quality of the tracings.ResultsThe accuracy of automated AF diagnoses by Apple and Samsung outperformed that of Withings, which was attributable to a higher proportion of inconclusive ECGs with the latter (sensitivity/specificity: 87%/86% and 88%/81% vs. 78%/80%, respectively, p < 0.05). Expert interpretation was more accurate for Withings and Apple than for Samsung (sensitivity/specificity: 96%/86% and 94%/84% vs. 86%/76%, p < 0.05), driven by the high proportion of uninterpretable tracings with the latter (2 and 4% vs. 15%, p < 0.05).ConclusionDiagnosing AF is possible using various smartwatch models. However, the diagnostic accuracy of their automated interpretations varies between models as does the quality of ECG tracings recorded for manual interpretation.
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Affiliation(s)
- Saer Abu-Alrub
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc Strik
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
- *Correspondence: Marc Strik
| | - F. Daniel Ramirez
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Nadir Moussaoui
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Hugo Pierre Racine
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Hugo Marchand
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Samuel Buliard
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Michel Haïssaguerre
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Sylvain Ploux
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Pierre Bordachar
- Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
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22
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Leroux J, Strik M, Ramirez FD, Ploux S, Sacristan B, Chabaneix-Thomas J, Jalal Z, Thambo JB, Bordachar P. Using a smartwatch to record an electrocardiogram in the pediatric population. J Electrocardiol 2022; 71:25-27. [PMID: 35016137 DOI: 10.1016/j.jelectrocard.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 10/19/2022]
Abstract
The accuracy of smartwatch ECG recordings in adults has been demonstrated primarily in the automated diagnosis of atrial fibrillation. While the detection of atrial fibrillation is a priority among adults given the arrhythmia's prevalence and actionable ramifications, the potential value of smartwatch ECG recordings in children differs considerably. In this case series, we will describe some examples of smartwatch ECGs recorded in children, highlighting the feasibility and potential indications of this technology in the pediatric population.
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Affiliation(s)
- Justine Leroux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.
| | - F Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Benjamin Sacristan
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Julie Chabaneix-Thomas
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Zakaria Jalal
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Jean-Benoit Thambo
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France
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23
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Briosa E Gala A, Pope MT, Leo M, Lobban T, Betts TR. NICE atrial fibrillation guideline snubs wearable technology: a missed opportunity? Clin Med (Lond) 2022; 22:77-82. [PMID: 38589105 DOI: 10.7861/clinmed.2021-0436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a growing public health epidemic. In the UK, over 1.3 million people have a diagnosis of AF and an estimated 400,000 remain undiagnosed. AF-related strokes account for a quarter of all strokes and, as AF episodes are often asymptomatic, are still often the first manifestation of AF. Early diagnosis and initiation of oral anticoagulation, where appropriate, may prevent some of these thromboembolic strokes. Public Health England is committed to decrease the incidence of AF-related strokes and has sponsored initiatives aimed at improving AF detection by promoting the uptake of wearable technologies. However, the National Institute for Health and Care Excellence (NICE) has not recommended wearable technology in their recent AF diagnosis and management guidelines (NG196). Diagnostic accuracy of single-lead electrocardiography (ECG) generated by the latest iteration of wearable devices is excellent and, in many cases, superior to general practitioner interpretation of the 12-lead ECG. High-quality ECG from wearable devices that unequivocally shows AF can expedite AF detection. Otherwise, there is a real risk of delaying AF diagnosis with the potential of devastating consequences for patients and their families.
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Affiliation(s)
- Andre Briosa E Gala
- John Radcliffe Hospital, Oxford, UK and University of Southampton, Southampton, UK.
| | - Michael Tb Pope
- John Radcliffe Hospital, Oxford, UK and University of Southampton, Southampton, UK
| | | | - Trudie Lobban
- Arrhythmia Alliance and AF Association, Stratford upon Avon, UK
| | - Timothy R Betts
- John Radcliffe Hospital, Oxford, UK, University of Oxford, Oxford, UK and NIHR Oxford Biomedical Research Centre, Oxford, UK
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24
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Magnocavallo M, Vetta G, Della Rocca DG, Gianni C, Mohanty S, Bassiouny M, Di Lullo L, Del Prete A, Cirone D, Lavalle C, Chimenti C, Al-Ahmad A, Burkhardt JD, Gallinghouse GJ, Sanchez JE, Horton RP, Di Biase L, Natale A. Prevalence, Management, and Outcome of Atrial Fibrillation and Other Supraventricular Arrhythmias in COVID-19 Patients. Card Electrophysiol Clin 2022; 14:1-9. [PMID: 35221076 PMCID: PMC8783208 DOI: 10.1016/j.ccep.2021.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Michele Magnocavallo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giampaolo Vetta
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Roma, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Cristina Chimenti
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - G Joseph Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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25
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Ploux S, Strik M, Caillol T, Ramirez FD, Abu-Alrub S, Marchand H, Buliard S, Haïssaguerre M, Bordachar P. Beyond the wrist: Using a smartwatch electrocardiogram to detect electrocardiographic abnormalities. Arch Cardiovasc Dis 2021; 115:29-36. [PMID: 34953753 DOI: 10.1016/j.acvd.2021.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND When worn on the wrist, smartwatch electrocardiograms may provide important but incomplete information. AIMS We sought to evaluate the added benefit of placing the smartwatch on the ankle and on the chest to diagnose various electrocardiographic abnormalities compared with 12-lead electrocardiograms. METHODS Two hundred and sixty patients with (n=189) or without (n=71) known cardiac disorders underwent 12-lead electrocardiogram and smartwatch electrocardiogram recordings of lead I (AW-I) and of leads I and II and pseudo chest leads V1 and V6 (AW-4). AW-I and AW-4 diagnoses (three-cardiologist consensus) were compared with 12-lead electrocardiogram diagnoses (three-cardiologist consensus) to calculate sensitivity and specificity. RESULTS AW-I showed high accuracy for the diagnoses of atrial fibrillation (96% sensitivity, 91% specificity) and complete bundle branch block (85% sensitivity, 98% specificity). Compared with AW-I, AW-4 improved detection of an abnormal 12-lead electrocardiogram (91% vs. 80% sensitivity; P<0.01), atrial flutter/tachycardia (69% vs. 25% sensitivity; P=0.04), T-wave abnormalities (77% vs. 34% sensitivity; P<0.01), pathological Q-waves (41% vs. 7% sensitivity; P<0.01) and left anterior hemiblock (70% vs. 0% sensitivity; P=0.02). AW-4 also enabled better differentiation between atrioventricular block and sinus bradycardia (from 81% to 95% correct; P=0.03) and between atrial fibrillation and atrial flutter/tachycardia (from 71% to 89% correct; P=0.02), but not between bundle branch blocks (from 82% to 87% correct; P=0.57). CONCLUSIONS A smartwatch electrocardiogram on the wrist accurately diagnoses atrial fibrillation and bundle branch block. Recording additional leads significantly improves the accuracy of detecting an abnormal electrocardiogram and repolarization changes, and also allows for better differentiation of brady- and tachyarrhythmias.
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Affiliation(s)
- Sylvain Ploux
- Cardiothoracic unit, Bordeaux university hospital, CHU, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux université, 33600 Pessac, France
| | - Marc Strik
- Cardiothoracic unit, Bordeaux university hospital, CHU, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux université, 33600 Pessac, France.
| | - Théo Caillol
- Cardiothoracic unit, Bordeaux university hospital, CHU, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux université, 33600 Pessac, France
| | - F Daniel Ramirez
- Cardiothoracic unit, Bordeaux university hospital, CHU, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux université, 33600 Pessac, France
| | - Saer Abu-Alrub
- Cardiothoracic unit, Bordeaux university hospital, CHU, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux université, 33600 Pessac, France
| | - Hugo Marchand
- Cardiothoracic unit, Bordeaux university hospital, CHU, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux université, 33600 Pessac, France
| | - Samuel Buliard
- Cardiothoracic unit, Bordeaux university hospital, CHU, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux université, 33600 Pessac, France
| | - Michel Haïssaguerre
- Cardiothoracic unit, Bordeaux university hospital, CHU, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux université, 33600 Pessac, France
| | - Pierre Bordachar
- Cardiothoracic unit, Bordeaux university hospital, CHU, 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux université, 33600 Pessac, France
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26
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Nasarre M, Strik M, Daniel Ramirez F, Buliard S, Marchand H, Abu-Alrub S, Ploux S, Haïssaguerre M, Bordachar P. Using a smartwatch electrocardiogram to detect abnormalities associated with sudden cardiac arrest in young adults. Europace 2021; 24:406-412. [PMID: 34468759 DOI: 10.1093/europace/euab192] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Smartwatch electrocardiograms (ECGs) could facilitate the detection of sudden cardiac arrest (SCA)-associated abnormalities. We evaluated the feasibility of using smartwatch-derived ECGs for detecting SCA-associated abnormalities in young adults and its agreement with 12-lead ECGs. METHODS AND RESULTS Twelve-lead and Apple Watch ECGs were registered in 155 healthy volunteers and 67 patients aged 18-45 years with diagnosis and ECG signs of long-QT syndrome (n = 10), Brugada syndrome (n = 12), ventricular pre-excitation (n = 19), hypertrophic cardiomyopathy (HCM, n = 13), and arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC/D, n = 13). Cardiologists separately analysed 12-lead ECGs and the smartwatch ECGs taken from the left wrist (AW-I) and then from chest positions V1, V3, and V6 (AW-4). Compared with AW-I, AW-4 improved the classification of ECGs as 'abnormal', increasing the sensitivity from 64% to 89% (P < 0.01). Pre-excitation was detected in most cases using AW-I (sensitivity 89%) and in all cases using AW-4 (sensitivity 100%, P = 0.48 compared with AW-I, specificity 100% for both). Brugada was missed using AW-I but was detected in 11/12 patients using AW-4 (sensitivity 92%, specificity 100%, P = 0.003). Long QT was detected in 8/10 cases using AW-I (sensitivity 80%, specificity 100%) and in 9 patients using AW-4 (sensitivity 90%, specificity 100%, P > 0.99). Hypertrophic cardiomyopathy was correctly suspected using AW-I and AW-4 (sensitivity 92% and 85%, specificity 85%, and 100%, P > 0.99). AW-I was mostly (62%) considered normal in ARVC/D whereas AW-4 was useful in suspecting ARVC/D (100% sensitivity, 99% specificity, P = 0.004). CONCLUSIONS Detection of SCA-associated ECG abnormalities (pre-excitation, Brugada patterns, long QT, and signs suggestive of HCM and ARVC/D) is possible with an ECG smartwatch.
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Affiliation(s)
- Mathieu Nasarre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Francisco Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Samuel Buliard
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Hugo Marchand
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Saer Abu-Alrub
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
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27
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Nazarian S, Lam K, Darzi A, Ashrafian H. Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e28974. [PMID: 34448706 PMCID: PMC8433941 DOI: 10.2196/28974] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/24/2021] [Accepted: 06/14/2021] [Indexed: 01/29/2023] Open
Abstract
Background Significant morbidity, mortality, and financial burden are associated with cardiac rhythm abnormalities. Conventional investigative tools are often unsuccessful in detecting cardiac arrhythmias because of their episodic nature. Smartwatches have gained popularity in recent years as a health tool for the detection of cardiac rhythms. Objective This study aims to systematically review and meta-analyze the diagnostic accuracy of smartwatches in the detection of cardiac arrhythmias. Methods A systematic literature search of the Embase, MEDLINE, and Cochrane Library databases was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies reporting the use of a smartwatch for the detection of cardiac arrhythmia. Summary estimates of sensitivity, specificity, and area under the curve were attempted using a bivariate model for the diagnostic meta-analysis. Studies were examined for quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results A total of 18 studies examining atrial fibrillation detection, bradyarrhythmias and tachyarrhythmias, and premature contractions were analyzed, measuring diagnostic accuracy in 424,371 subjects in total. The signals analyzed by smartwatches were based on photoplethysmography. The overall sensitivity, specificity, and accuracy of smartwatches for detecting cardiac arrhythmias were 100% (95% CI 0.99-1.00), 95% (95% CI 0.93-0.97), and 97% (95% CI 0.96-0.99), respectively. The pooled positive predictive value and negative predictive value for detecting cardiac arrhythmias were 85% (95% CI 0.79-0.90) and 100% (95% CI 1.0-1.0), respectively. Conclusions This review demonstrates the evolving field of digital disease detection. The current diagnostic accuracy of smartwatch technology for the detection of cardiac arrhythmias is high. Although the innovative drive of digital devices in health care will continue to gain momentum toward screening, the process of accurate evidence accrual and regulatory standards ready to accept their introduction is strongly needed. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020213237; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213237.
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Affiliation(s)
| | - Kyle Lam
- Imperial College London, London, United Kingdom
| | - Ara Darzi
- Imperial College London, London, United Kingdom
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28
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Leroux J, Bordachar P, Strik M, Ramirez FD, Ploux S, Chabaneix-Thomas J, Jalal Z, Thambo JB. Recording an ECG With a Smartwatch in Newborns and Young Children: Feasibility and Perspectives. Can J Cardiol 2021; 37:1877-1879. [PMID: 34371118 DOI: 10.1016/j.cjca.2021.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022] Open
Abstract
Correlating symptoms with arrhythmia in neonates and young children is often difficult because of their sporadic and unpredictable nature. We show that it is possible to register an ECG with a smartwatch in neonates and young children and provide illustrative cases of supraventricular tachycardia and complete atrioventricular block identified with this technology.
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Affiliation(s)
- Justine Leroux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France.
| | - F Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Julie Chabaneix-Thomas
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Zakaria Jalal
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Jean-Benoit Thambo
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac- Bordeaux, France
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Strik M, Ploux S, Ramirez FD, Abu-Alrub S, Jaîs P, Haïssaguerre M, Bordachar P. Smartwatch-based detection of cardiac arrhythmias: Beyond the differentiation between sinus rhythm and atrial fibrillation. Heart Rhythm 2021; 18:1524-1532. [PMID: 34147700 DOI: 10.1016/j.hrthm.2021.06.1176] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/19/2022]
Abstract
Within the span of a few years, watches have functionally morphed from objects that tell time to wearable minicomputers that allow real-time recording of electrocardiograms (ECGs). Considerable information can be deduced from these single lead tracings, and it is now not uncommon to see patients in whom diagnostic tracings of clinically relevant but elusive arrhythmias are captured using a smartwatch. Empowering individuals to record their own ECG tracings in scenarios such as palpitations, syncope, and for risk stratification of sudden death intuitively has considerable potential, but its value remains to be robustly demonstrated. The main objective of this review is to describe the information that can be obtained from smartwatch-based single-lead ECG recordings beyond simply differentiating between sinus rhythm and atrial fibrillation. We also review the strengths and limitations of using these devices in clinical settings and offer potential solutions to address the latter.
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Affiliation(s)
- Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France.
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - F Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Saer Abu-Alrub
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Pierre Jaîs
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
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