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Santala OE, Lipponen JA, Jäntti H, Rissanen TT, Tarvainen MP, Väliaho ES, Rantula OA, Naukkarinen NS, Hartikainen JEK, Martikainen TJ, Halonen J. Novel Technologies in the Detection of Atrial Fibrillation: Review of Literature and Comparison of Different Novel Technologies for Screening of Atrial Fibrillation. Cardiol Rev 2024; 32:440-447. [PMID: 36946975 PMCID: PMC11296284 DOI: 10.1097/crd.0000000000000526] [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] [Indexed: 03/23/2023]
Abstract
Atrial fibrillation (AF) is globally the most common arrhythmia associated with significant morbidity and mortality. It impairs the quality of the patient's life, imposing a remarkable burden on public health, and the healthcare budget. The detection of AF is important in the decision to initiate anticoagulation therapy to prevent thromboembolic events. Nonetheless, AF detection is still a major clinical challenge as AF is often paroxysmal and asymptomatic. AF screening recommendations include opportunistic or systematic screening in patients ≥65 years of age or in those individuals with other characteristics pointing to an increased risk of stroke. The popularities of well-being and taking personal responsibility for one's own health are reflected in the continuous development and growth of mobile health technologies. These novel mobile health technologies could provide a cost-effective solution for AF screening and an additional opportunity to detect AF, particularly its paroxysmal and asymptomatic forms.
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Affiliation(s)
- Onni E. Santala
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka A. Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika P. Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Eemu-Samuli Väliaho
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli A. Rantula
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Noora S. Naukkarinen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha E. K. Hartikainen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Jari Halonen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
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Hibbitt K, Brimicombe J, Cowie MR, Dymond A, Freedman B, Griffin SJ, Hobbs FDRI, Lindén HC, Lip GYH, Mant J, McManus RJ, Pandiaraja M, Williams K, Charlton PH. Reliability of single-lead electrocardiogram interpretation to detect atrial fibrillation: insights from the SAFER feasibility study. Europace 2024; 26:euae181. [PMID: 38941497 PMCID: PMC11249076 DOI: 10.1093/europace/euae181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/14/2024] [Indexed: 06/30/2024] Open
Abstract
AIMS Single-lead electrocardiograms (ECGs) can be recorded using widely available devices such as smartwatches and handheld ECG recorders. Such devices have been approved for atrial fibrillation (AF) detection. However, little evidence exists on the reliability of single-lead ECG interpretation. We aimed to assess the level of agreement on detection of AF by independent cardiologists interpreting single-lead ECGs and to identify factors influencing agreement. METHODS AND RESULTS In a population-based AF screening study, adults aged ≥65 years old recorded four single-lead ECGs per day for 1-4 weeks using a handheld ECG recorder. Electrocardiograms showing signs of possible AF were identified by a nurse, aided by an automated algorithm. These were reviewed by two independent cardiologists who assigned participant- and ECG-level diagnoses. Inter-rater reliability of AF diagnosis was calculated using linear weighted Cohen's kappa (κw). Out of 2141 participants and 162 515 ECGs, only 1843 ECGs from 185 participants were reviewed by both cardiologists. Agreement was moderate: κw = 0.48 (95% confidence interval, 0.37-0.58) at participant level and κw = 0.58 (0.53-0.62) at ECG level. At participant level, agreement was associated with the number of adequate-quality ECGs recorded, with higher agreement in participants who recorded at least 67 adequate-quality ECGs. At ECG level, agreement was associated with ECG quality and whether ECGs exhibited algorithm-identified possible AF. CONCLUSION Inter-rater reliability of AF diagnosis from single-lead ECGs was found to be moderate in older adults. Strategies to improve reliability might include participant and cardiologist training and designing AF detection programmes to obtain sufficient ECGs for reliable diagnoses.
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Affiliation(s)
- Katie Hibbitt
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Martin R Cowie
- Royal Brompton Hospital, Faculty of Medicine & Lifesciences, Kings College London, London SW3 6NP, UK
| | - Andrew Dymond
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Ben Freedman
- Heart Research Institute, University of Sydney, Sydney 2006, Australia
| | - Simon J Griffin
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - F D R ichard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Madhumitha Pandiaraja
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Kate Williams
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Peter H Charlton
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
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Parisi EJ, Chung EH. Palpitations in athletes: diagnosis, workup and treatment. Heart 2024; 110:963-969. [PMID: 37562948 DOI: 10.1136/heartjnl-2022-321726] [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] [Indexed: 08/12/2023] Open
Abstract
Palpitations are a common reason for athletes to seek medical care. Although often benign, palpitations may serve as a harbinger for underling cardiac pathology. Given the unique challenges in this population, this review will serve to discuss the basic underlying pathophysiology, which may predispose athletes to palpitations. In addition, we will review the aetiologies, diagnostic evaluation, management and counselling strategies for some of the most common diagnoses seen in athletes.
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Affiliation(s)
- Erika J Parisi
- Internal Medicine/Cardiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eugene H Chung
- Internal Medicine/Cardiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Rebolledo‐Del Toro M, Carvajalino‐Galeano AB, Pinto‐Brito C, Muñoz‐Velandia OM, García‐Peña ÁA. Use of portable single-lead electrocardiogram device as an alternative for QTc monitoring in critically ill patients. Ann Noninvasive Electrocardiol 2024; 29:e13116. [PMID: 38627955 PMCID: PMC11021801 DOI: 10.1111/anec.13116] [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: 01/03/2024] [Revised: 02/13/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Acquired QT prolongation is frequent and leads to a higher mortality rate in critically ill patients. KardiaMobile 1L® (KM1L) is a portable, user-friendly single lead, mobile alternative to conventional 12-lead electrocardiogram (12-L ECG) that could be more readily available, potentially facilitating more frequent QTc assessments in intensive care units (ICU); however, there is currently no evidence to validate this potential use. METHODS We conducted a prospective diagnostic test study comparing QT interval measurement using KM1L with conventional 12-L ECG ordered for any reason in patients admitted to an ICU. We compared the mean difference using a paired t-test, agreement using Bland-Altman analysis, and Lin's concordance coefficient, numerical precision (proportion of QT measurements with <10 ms difference between KM1L and conventional 12-L ECG), and clinical precision (concordance for adequate discrimination of prolonged QTc). RESULTS We included 114 patients (61.4% men, 60% cardiovascular etiology of hospitalization) with 131 12-L ECG traces. We found no statistical difference between corrected QT measurements (427 ms vs. 428 ms, p = .308). Lin's concordance coefficient was 0.848 (95% CI 0.801-0.894, p = .001). Clinical precision was excellent in males and substantial in females (Kappa 0.837 and 0.781, respectively). Numerical precision was lower in patients with vasoactive drugs (-13.99 ms), QT-prolonging drugs (13.84 ms), antiarrhythmic drugs (-12.87 ms), and a heart rate (HR) difference of ≥5 beats per minute (bpm) between devices (-11.26 ms). CONCLUSION Our study validates the clinical viability of KM1L, a single-lead mobile ECG device, for identifying prolonged QT intervals in ICU patients. Caution is warranted in patients with certain medical conditions that may affect numerical precision.
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Affiliation(s)
- Martin Rebolledo‐Del Toro
- Division of CardiologyHospital Universitario San IgnacioBogotaColombia
- Department of Internal MedicinePontificia Universidad JaverianaBogotaColombia
| | | | | | - Oscar Mauricio Muñoz‐Velandia
- Department of Internal MedicinePontificia Universidad JaverianaBogotaColombia
- Department of Internal MedicineHospital Universitario San IgnacioBogotaColombia
| | - Ángel Alberto García‐Peña
- Division of CardiologyHospital Universitario San IgnacioBogotaColombia
- Department of Internal MedicinePontificia Universidad JaverianaBogotaColombia
- Department of Internal MedicineHospital Universitario San IgnacioBogotaColombia
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Karregat EPM, de Koning MA, Himmelreich JCL, Koetsier DW, de Jong JSSG, Moll van Charante EP, Harskamp RE, Lucassen WAM. Evaluation of the introduction of a single-lead ECG device and digital cardiologist consultation platform among general practitioners in the Netherlands. Prim Health Care Res Dev 2024; 25:e18. [PMID: 38634311 DOI: 10.1017/s1463423624000057] [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] [Indexed: 04/19/2024] Open
Abstract
AIM To evaluate the use of a single-lead electrocardiography (1L-ECG) device and digital cardiologist consultation platform in diagnosing arrhythmias among general practitioners (GPs). BACKGROUND Handheld 1L-ECG offers a user-friendly alternative to conventional 12-lead ECG in primary care. While GPs can safely rule out arrhythmias on 1L-ECG recordings, expert consultation is required to confirm suspected arrhythmias. Little is known about GPs' experiences with both a 1L-ECG device and digital consultation platform for daily practice. METHODS We used two distinct methods in this study. First, in an observational study, we collected and described all cases shared by GPs within a digital cardiologist consultation platform initiated by a local GP cooperative. This GP cooperative distributed KardiaMobile 1L-ECG devices among all affiliated GPs (n = 203) and invited them to this consultation platform. In the second part, we used an online questionnaire to evaluate the experiences of these GPs using the KardiaMobile and consultation platform. FINDINGS In total, 98 (48%) GPs participated in this project, of whom 48 (49%) shared 156 cases. The expert panel was able to provide a definitive rhythm interpretation in 130 (83.3%) shared cases and answered in a median of 4 min (IQR: 2-18). GPs responding to the questionnaire (n = 43; 44%) thought the KardiaMobile was of added value for rhythm diagnostics in primary care (n = 42; 98%) and easy to use (n = 41; 95%). Most GPs (n = 36; 84%) valued the feedback from the cardiologists in the consultation platform. GPs experienced this project to have a positive impact on both the quality of care and diagnostic efficiency for patients with (suspected) cardiac arrhythmias. Although we lack a comprehensive picture of experienced impediments by GPs, solving technical issues was mentioned to be helpful for further implementation. More research is needed to explore reasons of GPs not motivated using these tools and to assess real-life clinical impact.
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Affiliation(s)
- Evert P M Karregat
- Department of General Practice, Amsterdam Public Health, Amsterdam University Medical Centers location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marlou A de Koning
- Department of General Practice, Amsterdam Public Health, Amsterdam University Medical Centers location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jelle C L Himmelreich
- Department of General Practice, Amsterdam Public Health, Amsterdam University Medical Centers location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - David W Koetsier
- Regionale Organisatie Huisartsen Amsterdam, Amsterdam, the Netherlands
| | - Jonas S S G de Jong
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam Public Health, Amsterdam University Medical Centers location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Public & Occupational Health, Amsterdam UMC, Amsterdam Public Health, Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam Public Health, Amsterdam University Medical Centers location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wim A M Lucassen
- Department of General Practice, Amsterdam Public Health, Amsterdam University Medical Centers location AMC, University of Amsterdam, Amsterdam, the Netherlands
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Daniëls F, Ramdjan TTTK, Mánfai B, Adiyaman A, Smit JJJ, Delnoy PPHM, Elvan A. Detection of atrial fibrillation in persons aged 65 years and above using a mobile electrocardiogram device. Neth Heart J 2024; 32:160-166. [PMID: 38015347 PMCID: PMC10951181 DOI: 10.1007/s12471-023-01828-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Untreated atrial fibrillation (AF) often results in increased morbidity and mortality. Opportunistic AF screening in persons aged ≥ 65 years is recommended to identify patients with AF in order to prevent AF-related complications. OBJECTIVE The aim of this study was to assess the feasibility of screening persons for AF with the Kardia mobile electrocardiogram device (MED) and to determine the percentage of newly detected AF cases by selective population screening in the Netherlands. METHODS Persons aged ≥ 65 years, without a medical history of AF, in nursing homes, at public events or visiting the general practitioner (GP) were approached to participate. A Kardia MED smartphone ECG (sECG) was recorded and the CHA2DS2-VASc score was calculated. An automated AF algorithm classified the sECGs as 'sinus rhythm', 'AF' or 'unclassified'. In the case of AF, participants were referred to their GP. All sECGs were assessed by blinded experts. RESULTS A total of 2168 participants were screened for AF. According to the expert's interpretation, 2.5% had newly detected AF, of whom 76.4% never experienced palpitations and 89.1% had a CHA2DS2-VASc score ≥ 2. The algorithm result was unclassified in 12.2% of cases, of which 95.5% were interpretable by experts. With expert opinion as the gold standard and excluding unclassified sECGs, the Kardia MED's negative and positive predictive value for detecting AF was 99.8% and 60.0%, respectively. CONCLUSION Screening for AF using the Kardia MED is feasible and results in 2.5% newly detected AF cases. Expert interpretation of algorithm outcomes AF and unclassified is recommended.
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Affiliation(s)
- Fenna Daniëls
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands.
| | | | - Balázs Mánfai
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Jaap Jan J Smit
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | | | - Arif Elvan
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
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7
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Fu F, Zhong D, Liu J, Xu T, Shen Q, Wang W, Zhu S, Li J. Wearable 12-Lead ECG Acquisition Using a Novel Deep Learning Approach from Frank or EASI Leads with Clinical Validation. Bioengineering (Basel) 2024; 11:293. [PMID: 38534567 DOI: 10.3390/bioengineering11030293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
The 12-lead electrocardiogram (ECG) is crucial in assessing patient decisions. However, portable ECG devices capable of acquiring a complete 12-lead ECG are scarce. For the first time, a deep learning-based method is proposed to reconstruct the 12-lead ECG from Frank leads (VX, VY, and VZ) or EASI leads (VES, VAS, and VAI). The innovative ECG reconstruction network called M2Eformer is composed of a 2D-ECGblock and a ProbDecoder module. The 2D-ECGblock module adaptively segments EASI leads into multi-periods based on frequency energy, transforming the 1D time series into a 2D tensor representing within-cycle and between-cycle variations. The ProbDecoder module aims to extract Probsparse self-attention and achieve one-step output for the target leads. Experimental results from comparing recorded and reconstructed 12-lead ECG using Frank leads indicate that M2Eformer outperforms traditional ECG reconstruction methods on a public database. In this study, a self-constructed database (10 healthy individuals + 15 patients) was utilized for the clinical diagnostic validation of ECG reconstructed from EASI leads. Subsequently, both the ECG reconstructed using EASI and the recorded 12-lead ECG were subjected to a double-blind diagnostic experiment conducted by three cardiologists. The overall diagnostic consensus among three cardiology experts, reaching a rate of 96%, indicates the significant utility of EASI-reconstructed 12-lead ECG in facilitating the diagnosis of cardiac conditions.
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Affiliation(s)
- Fan Fu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
| | - Dacheng Zhong
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
| | - Jiamin Liu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
| | - Tianxiang Xu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
| | - Qin Shen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Wang
- The Jiangsu Engineering Research Center of Province Intelligent Wearable Monitoring and Rehabilitation Device, Nanjing Medical University, Nanjing 211166, China
| | - Songsheng Zhu
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing 211166, China
| | - Jianqing Li
- The Engineering Research Center of Intelligent Theranostics Technology and Instruments, Ministry of Education, Nanjing Medical University, Nanjing 211166, China
- The State Key Laboratory of Bioelectronics, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
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8
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Jortveit J, Boskovic M, Sandberg EL, Vegsundvåg J, Halvorsen S. High Diagnostic Accuracy of Long-Term Electrocardiogram Interpretation by General Practitioners. Int J Telemed Appl 2024; 2024:6624344. [PMID: 38425473 PMCID: PMC10904176 DOI: 10.1155/2024/6624344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
Aims Traditional long-term ECG monitoring systems have primarily been used by cardiologist. New remote and wearable easy-to-use devices have led to increased use of ECG recordings also outside cardiology clinics. The aims of this study were to assess the feasibility and diagnostic accuracy of interpretation of the one-lead ECG recordings from a patch ECG device (ECG247 Smart Heart Sensor system) by general practitioners (GP). Methods Norwegian GPs were invited to digitally assess 10 long-term ECG recordings with different arrhythmias performed by the ECG247 Smart Heart Sensor system. For all ECG examinations, the presence/absence of different arrhythmias was registered. Results A total of 40 GPs accepted the invitation and assessed all the 10 long-term ECG recordings. All the tests were assessed as interpretable by all the GPs. Arrhythmias (atrial fibrillation/flutter, supraventricular tachycardia, and ventricular tachycardia) were correctly identified in most cases, with sensitivity of 98% (95% CI 95-99%), specificity of 75% (95% CI 68-82%), and diagnostic accuracy of 89% (85-92%). Incorrect automatic system algorithm interpretations were rarely corrected by the GPs. Conclusion GPs interpreted one-lead recordings by the ECG247 Smart Heart Sensor system with high diagnostic accuracy for common arrhythmias. However, in cases with rare arrhythmias, we recommend consulting a cardiologist to confirm the diagnosis before treatment is initiated. This trial is registered with NCT04700865.
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Affiliation(s)
- Jarle Jortveit
- Department of Cardiology, Sorlandet Hospital, Arendal, Norway
| | | | | | - Jonas Vegsundvåg
- Department of Primary Health Care Services, Aalesund Municipality, Aalesund, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Manetas-Stavrakakis N, Sotiropoulou IM, Paraskevas T, Maneta Stavrakaki S, Bampatsias D, Xanthopoulos A, Papageorgiou N, Briasoulis A. Accuracy of Artificial Intelligence-Based Technologies for the Diagnosis of Atrial Fibrillation: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6576. [PMID: 37892714 PMCID: PMC10607777 DOI: 10.3390/jcm12206576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia with a high burden of morbidity including impaired quality of life and increased risk of thromboembolism. Early detection and management of AF could prevent thromboembolic events. Artificial intelligence (AI)--based methods in healthcare are developing quickly and can be proved as valuable for the detection of atrial fibrillation. In this metanalysis, we aim to review the diagnostic accuracy of AI-based methods for the diagnosis of atrial fibrillation. A predetermined search strategy was applied on four databases, the PubMed on 31 August 2022, the Google Scholar and Cochrane Library on 3 September 2022, and the Embase on 15 October 2022. The identified studies were screened by two independent investigators. Studies assessing the diagnostic accuracy of AI-based devices for the detection of AF in adults against a gold standard were selected. Qualitative and quantitative synthesis to calculate the pooled sensitivity and specificity was performed, and the QUADAS-2 tool was used for the risk of bias and applicability assessment. We screened 14,770 studies, from which 31 were eligible and included. All were diagnostic accuracy studies with case-control or cohort design. The main technologies used were: (a) photoplethysmography (PPG) with pooled sensitivity 95.1% and specificity 96.2%, and (b) single-lead ECG with pooled sensitivity 92.3% and specificity 96.2%. In the PPG group, 0% to 43.2% of the tracings could not be classified using the AI algorithm as AF or not, and in the single-lead ECG group, this figure fluctuated between 0% and 38%. Our analysis showed that AI-based methods for the diagnosis of atrial fibrillation have high sensitivity and specificity for the detection of AF. Further studies should examine whether utilization of these methods could improve clinical outcomes.
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Affiliation(s)
- Nikolaos Manetas-Stavrakakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 157 28 Athens, Greece; (I.M.S.); (A.B.)
| | - Ioanna Myrto Sotiropoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 157 28 Athens, Greece; (I.M.S.); (A.B.)
| | | | | | | | | | | | - Alexandros Briasoulis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 157 28 Athens, Greece; (I.M.S.); (A.B.)
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Kim S, Choi Y, Lee K, Kim SH, Kim H, Shin S, Park S, Oh YS. Comparison of the 11-Day Adhesive ECG Patch Monitor and 24-h Holter Tests to Assess the Response to Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation. Diagnostics (Basel) 2023; 13:3078. [PMID: 37835822 PMCID: PMC10572592 DOI: 10.3390/diagnostics13193078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Accurate assessment of the response to the antiarrhythmic drug (AAD) in atrial fibrillation (AF) is crucial to achieve adequate rhythm control. We evaluated the effectiveness of extended cardiac monitoring using an adhesive ECG patch in the detection of drug-refractory paroxysmal AF. Patients diagnosed with paroxysmal AF and receiving AAD therapy were enrolled. The subjects simultaneously underwent 11-day adhesive ECG patch monitoring and a 24-h Holter test. The primary study outcome was a detection rate of drug-refractory AF or atrial tachycardia (AT) lasting ≥30 s. A total of 59 patients were enrolled and completed the study examinations. AF or AT was detected in 28 (47.5%) patients by an 11-day ECG patch monitor and in 8 (13.6%) patients by a 24-h Holter test (p < 0.001). The 11-day ECG patch monitor identified an additional 20 patients (33.8%) with drug-refractory AF not detected by the 24-h Holter, and as a result, the treatment plan was changed in 11 patients (10 catheter ablations, one medication change). In conclusion, extended cardiac rhythm monitoring using an adhesive ECG patch in patients with paroxysmal AF under AAD therapy led to over a threefold higher detection of drug-refractory AF episodes, compared to the 24-h Holter test.
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Affiliation(s)
- Soohyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Young Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kichang Lee
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
| | - Sung-Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hwajung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sanghoon Shin
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
| | - Soyoon Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (S.-H.K.); (H.K.); (S.S.); (S.P.)
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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11
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Klier K, Patel YJ, Schinköthe T, Harbeck N, Schmidt A. Corrected QT Interval (QTc) Diagnostic App for the Oncological Routine: Development Study. JMIR Cardio 2023; 7:e48096. [PMID: 37695655 PMCID: PMC10520775 DOI: 10.2196/48096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Numerous antineoplastic drugs such as chemotherapeutics have cardiotoxic side effects and can lead to long QT syndrome (LQTS). When diagnosed and treated in time, the potentially fatal outcomes of LQTS can be prevented. Therefore, regular electrocardiogram (ECG) assessments are critical to ensure patient safety. However, these assessments are associated with patient discomfort and require timely support of the attending oncologist by a cardiologist. OBJECTIVE This study aimed to examine whether this approach can be made more efficient and comfortable by a smartphone app (QTc Tracker), supporting single-lead ECG records on site and transferring to a tele-cardiologist for an immediate diagnosis. METHODS To evaluate the QTc Tracker, it was implemented in 54 cancer centers in Germany. In total, 266 corrected QT interval (QTc) diagnoses of 122 patients were recorded. Moreover, a questionnaire on routine ECG workflow, turnaround time, and satisfaction (1=best, 6=worst) was answered by the centers before and after the implementation of the QTc Tracker. RESULTS Compared to the routine ECG workflow, the QTc Tracker enabled a substantial turnaround time reduction of 98% (mean 2.67, 95% CI 1.72-2.67 h) and even further time efficiency in combination with a cardiologic on-call service (mean 12.10, 95% CI 5.67-18.67 min). Additionally, nurses and patients reported higher satisfaction when using the QTc Tracker. In particular, patients' satisfaction sharply improved from 2.59 (95% CI 2.41-2.88) for the routine ECG workflow to 1.25 (95% CI 0.99-1.51) for the QTc Tracker workflow. CONCLUSIONS These results reveal a significant improvement regarding reduced turnaround time and increased user satisfaction. Best patient care might be guaranteed as the exposure of patients with an uncontrolled risk of QTc prolongations can be avoided by using the fast and easy QTc Tracker. In particular, as regular side-effect monitoring, the QTc Tracker app promises more convenience for patients and their physicians. Finally, future studies are needed to empirically test the usability and validity of such mobile ECG assessment methods. TRIAL REGISTRATION ClinicalTrials.gov NCT04055493; https://classic.clinicaltrials.gov/ct2/show/NCT04055493.
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Affiliation(s)
- Kristina Klier
- Institute of Sport Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | | | - Timo Schinköthe
- CANKADO GmbH, Ottobrunn, Germany
- Research Center for Smart Digital Health, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center of the Ludwig-Maximilians-University, Munich, Germany
| | - Annette Schmidt
- Institute of Sport Science, University of the Bundeswehr Munich, Neubiberg, Germany
- Research Center for Smart Digital Health, University of the Bundeswehr Munich, Neubiberg, Germany
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12
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Weidlich S, Mannhart D, Serban T, Krisai P, Knecht S, Du Fay de Lavallaz J, Müller T, Schaer B, Osswald S, Kühne M, Sticherling C, Badertscher P. Accuracy in detecting atrial fibrillation in single-lead ECGs: an online survey comparing the influence of clinical expertise and smart devices. Swiss Med Wkly 2023; 153:40096. [PMID: 37769610 DOI: 10.57187/smw.2023.40096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Manual interpretation of single-lead ECGs (SL-ECGs) is often required to confirm a diagnosis of atrial fibrillation. However accuracy in detecting atrial fibrillation via SL-ECGs may vary according to clinical expertise and choice of smart device. AIMS To compare the accuracy of cardiologists, internal medicine residents and medical students in detecting atrial fibrillation via SL-ECGs from five different smart devices (Apple Watch, Fitbit Sense, KardiaMobile, Samsung Galaxy Watch, Withings ScanWatch). Participants were also asked to assess the quality and readability of SL-ECGs. METHODS In this prospective study (BaselWearableStudy, NCT04809922), electronic invitations to participate in an online survey were sent to physicians at major Swiss hospitals and to medical students at Swiss universities. Participants were asked to classify up to 50 SL-ECGs (from ten patients and five devices) into three categories: sinus rhythm, atrial fibrillation or inconclusive. This classification was compared to the diagnosis via a near-simultaneous 12-lead ECG recording interpreted by two independent cardiologists. In addition, participants were asked their preference of each manufacturer's SL-ECG. RESULTS Overall, 450 participants interpreted 10,865 SL-ECGs. Sensitivity and specificity for the detection of atrial fibrillation via SL-ECG were 72% and 92% for cardiologists, 68% and 86% for internal medicine residents, 54% and 65% for medical students in year 4-6 and 44% and 58% for medical students in year 1-3; p <0.001. Participants who stated prior experience in interpreting SL-ECGs demonstrated a sensitivity and specificity of 63% and 81% compared to a sensitivity and specificity of 54% and 67% for participants with no prior experience in interpreting SL-ECGs (p <0.001). Of all participants, 107 interpreted all 50 SL-ECGs. Diagnostic accuracy for the first five interpreted SL-ECGs was 60% (IQR 40-80%) and diagnostic accuracy for the last five interpreted SL-ECGs was 80% (IQR 60-90%); p <0.001. No significant difference in the accuracy of atrial fibrillation detection was seen between the five smart devices; p = 0.33. SL-ECGs from the Apple Watch were considered as having the best quality and readability by 203 (45%) and 226 (50%) participants, respectively. CONCLUSION SL-ECGs can be challenging to interpret. Accuracy in correctly identifying atrial fibrillation depends on clinical expertise, while the choice of smart device seems to have no impact.
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Affiliation(s)
- Simon Weidlich
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Diego Mannhart
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Teodor Serban
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jeanne Du Fay de Lavallaz
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tatjana Müller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
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13
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Fadlan MR, Rizal A, Satrijo B, Astiawati T, Rohman MS, Baskoro SS. Validity of MENARI plus (self-pulse assessment and clinical scoring) mobile apps for detecting atrial fibrillation in high-risk population. J Arrhythm 2023; 39:507-514. [PMID: 37560267 PMCID: PMC10407179 DOI: 10.1002/joa3.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 03/07/2023] [Accepted: 04/08/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Even before it is clinically diagnosed, atrial fibrillation (AF) can cause a stroke. This study validates self-pulse assessment and clinical scoring (MENARI Plus) based on android apps. OBJECTIVE The aim of this study was to examine the validity of AF screening using MENARI Plus compared with an ECG recording. METHODS We collected a total of 1385 subjects from high-risk population according to CHA2DS2-VASc score ≥2, attending 8 primary care centers (PCCs) in Malang between July 2021 and December 2021. Every participant underwent self-pulse assessment, and then was evaluated for MENARI Plus Score on android Apps. These cases had been classified as low or high probability for AF (cut-off score 7). After that, electrocardiography examinations were performed and classified with AF and Sinus Rhythm group. RESULTS In this study, the mean age of these patients was 61.5 ± 6.9 years old. We found that 156/1385 (11%) patients had AF. There were 68/156 (43.5%) new cases of AF. The sensitivity for self-pulse palpation was 73.1% (95% CI: 68%-76%) and specificity was 68.3% (95% CI: 65%-72%). MENARI Plus had an area under the receiver operating curve (AUC) of 0.86 (95% CI: 0.82-0.89) with sensitivity per measurement occasion was (84%, 95% CI: 82%-88%) and specificity was (87.9%, 95% CI: 82%-90%). CONCLUSION In this study, we found that MENARI Plus has high sensitivity and specificity for AF. It is therefore useful for ruling out AF. It may also be a useful screen that can be applied opportunistically for previously undetected AFs.
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Affiliation(s)
- Muhamad R. Fadlan
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Ardian Rizal
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Budi Satrijo
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Tri Astiawati
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Iskak General HospitalTulung AgungEast JavaIndonesia
| | - Mohammad S. Rohman
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Shalahuddin S. Baskoro
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
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14
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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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15
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Himmelreich JC, Harskamp RE. Diagnostic accuracy of the PMcardio smartphone application for artificial intelligence-based interpretation of electrocardiograms in primary care (AMSTELHEART-1). CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023. [DOI: 10.1016/j.cvdhj.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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16
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Abstract
BACKGROUND Over the past few years, smartwatches have become increasingly popular in the monitoring of arrhythmias. Although the detection of atrial fibrillation with smartwatches has been the subject of various articles, there is no comprehensive research on the detection of arrhythmias other than atrial fibrillation. In this study, we included individual cases from the literature to identify the characteristics of patients with smartwatch-detected arrhythmias other than atrial fibrillation. METHODS PubMed, Embase, and SCOPUS were searched for case reports, case series, or cohort studies that reported individual participant-level data, until January 6, 2022. The following search string was used for each databases: ('Smart Watch' OR 'Apple Watch' OR 'Samsung Gear') AND ('Supraventricular Tachycardia' OR 'Cardiac Arrhythmia' OR 'Ventricular Tachycardia' OR 'Atrioventricular Nodal Reentry Tachycardia' OR 'Atrioventricular Reentrant Tachycardia' OR 'Heart Block' OR 'Atrial Flutter' OR 'Ectopic Atrial Tachycardia' OR 'Bradyarrhythmia'). RESULTS A total of 52 studies from PubMed, 20 studies from Embase, and 200 studies from SCOPUS were identified. After screening, 18 articles were included. A total of 22 patients were obtained from 14 case reports or case series. Four cohort studies evaluating various arrhythmias were included. Arrhythmias, including ventricular tachycardia, atrial fibrillation, atrial flutter, atrioventricular nodal reentry tachycardia, atrioventricular reentrant tachycardia, second- or third-degree atrioventricular block, and sinus bradycardia, were detected with smartwatches. CONCLUSIONS Cardiac arrhythmias other than atrial fibrillation are also commonly detected with smartwatches. Smartwatches have an important potential besides traditional methods in the detection of arrhythmias and clinical practice.
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17
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Pereira L, Plácido da Silva H. A Novel Smart Chair System for Posture Classification and Invisible ECG Monitoring. SENSORS (BASEL, SWITZERLAND) 2023; 23:719. [PMID: 36679516 PMCID: PMC9867523 DOI: 10.3390/s23020719] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
In recent years, employment in sedentary occupations has continuously risen. Office workers are more prone to prolonged static sitting, spending 65−80% of work hours sitting, increasing risks for multiple health problems, including cardiovascular diseases and musculoskeletal disorders. These adverse health effects lead to decreased productivity, increased absenteeism and health care costs. However, lack of regulation targeting these issues has oftentimes left them unattended. This article proposes a smart chair system, with posture and electrocardiography (ECG) monitoring modules, using an “invisible” sensing approach, to optimize working conditions, without hindering everyday tasks. For posture classification, machine learning models were trained and tested with datasets composed by center of mass coordinates in the seat plane, computed from the weight measured by load cells fixed under the seat. Models were trained and evaluated in the classification of five and seven sitting positions, achieving high accuracy results for all five-class models (>97.4%), and good results for some seven-class models, particularly the best performing k-NN model (87.5%). For ECG monitoring, signals were acquired at the armrests covered with conductive nappa, connected to a single-lead sensor. Following signal filtering and segmentation, several outlier detection methods were applied to remove extremely noisy segments with mislabeled R-peaks, but only DBSCAN showed satisfactory results for the ECG segmentation performance (88.21%) and accuracy (90.50%).
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Affiliation(s)
- Leonor Pereira
- IST—Instituto Superior Técnico, 1049-001 Lisboa, Portugal
| | - Hugo Plácido da Silva
- IST—Instituto Superior Técnico, 1049-001 Lisboa, Portugal
- IT—Instituto de Telecomunicações, 1049-001 Lisboa, Portugal
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18
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Paul Nordin A, Carnlöf C, Insulander P, Mohammad Ali A, Jensen-Urstad M, Saluveer O, Drca N. Validation of diagnostic accuracy of a handheld, smartphone-based rhythm recording device. Expert Rev Med Devices 2023; 20:55-61. [PMID: 36695787 DOI: 10.1080/17434440.2023.2171290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM Evaluation of the diagnostic accuracy of a rhythm recording device, for detection of atrial tachyarrhythmia (ATA) and atrial fibrillation (AF) compared to 12-lead-electrocardiogram (12-L-ECG). RESEARCH DESIGN AND METHODS Two hundred 12-L-ECGs (reference standard) and Coala Heart Monitor (CHM) recordings (index test) were collected from 189 patients. Two electrophysiologists independently performed manual analysis of all 12-L-ECGs and CHM recordings in random order. The CHM recordings were also analyzed by an automatic algorithm and compared to the results of the reference standard. RESULTS Manual analysis of CHM for ATA showed a sensitivity of 98.9% (95% confidence interval (CI): 94.0-100) and a specificity of 100% (CI: 96.6-100). Manual analysis for AF had a sensitivity of 100% (CI: 95.3-100) and a specificity of 97.5% (CI: 93.0-99.5). Automatic analysis for ATA showed a sensitivity of 93.5% (CI: 86.3-97.6) and a specificity of 92.6% (CI: 85.9-96.7). Automatic analysis for AF showed a sensitivity of 97.4% (CI: 91.0-99.7) and a specificity of 86.1% (CI: 78.6-91.7). CONCLUSION CHM has a very high accuracy for ATA and AF in manual analysis and a high accuracy for ATA and AF in automatic analysis, making the device suitable for screening.
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Affiliation(s)
- Astrid Paul Nordin
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Carina Carnlöf
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Amina Mohammad Ali
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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19
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Santala OE, Lipponen JA, Jäntti H, Rissanen TT, Tarvainen MP, Laitinen TP, Laitinen TM, Castrén M, Väliaho ES, Rantula OA, Naukkarinen NS, Hartikainen JEK, Halonen J, Martikainen TJ. Continuous mHealth Patch Monitoring for the Algorithm-Based Detection of Atrial Fibrillation: Feasibility and Diagnostic Accuracy Study. JMIR Cardio 2022; 6:e31230. [PMID: 35727618 PMCID: PMC9257607 DOI: 10.2196/31230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/27/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background The detection of atrial fibrillation (AF) is a major clinical challenge as AF is often paroxysmal and asymptomatic. Novel mobile health (mHealth) technologies could provide a cost-effective and reliable solution for AF screening. However, many of these techniques have not been clinically validated. Objective The purpose of this study is to evaluate the feasibility and reliability of artificial intelligence (AI) arrhythmia analysis for AF detection with an mHealth patch device designed for personal well-being. Methods Patients (N=178) with an AF (n=79, 44%) or sinus rhythm (n=99, 56%) were recruited from the emergency care department. A single-lead, 24-hour, electrocardiogram-based heart rate variability (HRV) measurement was recorded with the mHealth patch device and analyzed with a novel AI arrhythmia analysis software. Simultaneously registered 3-lead electrocardiograms (Holter) served as the gold standard for the final rhythm diagnostics. Results Of the HRV data produced by the single-lead mHealth patch, 81.5% (3099/3802 hours) were interpretable, and the subject-based median for interpretable HRV data was 99% (25th percentile=77% and 75th percentile=100%). The AI arrhythmia detection algorithm detected AF correctly in all patients in the AF group and suggested the presence of AF in 5 patients in the control group, resulting in a subject-based AF detection accuracy of 97.2%, a sensitivity of 100%, and a specificity of 94.9%. The time-based AF detection accuracy, sensitivity, and specificity of the AI arrhythmia detection algorithm were 98.7%, 99.6%, and 98.0%, respectively. Conclusions The 24-hour HRV monitoring by the mHealth patch device enabled accurate automatic AF detection. Thus, the wearable mHealth patch device with AI arrhythmia analysis is a novel method for AF screening. Trial Registration ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335
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Affiliation(s)
- Onni E Santala
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka A Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika P Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tomi P Laitinen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eemu-Samuli Väliaho
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli A Rantula
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Noora S Naukkarinen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha E K Hartikainen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Jari Halonen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tero J Martikainen
- Department of Emergency Care, Kuopio University Hospital, Kuopio, Finland
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20
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Bouzid Z, Al-Zaiti SS, Bond R, Sejdic E. Remote and Wearable ECG Devices with Diagnostic Abilities in Adults: A State-of-the-Science Scoping Review. Heart Rhythm 2022; 19:1192-1201. [PMID: 35276320 DOI: 10.1016/j.hrthm.2022.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
The electrocardiogram (ECG) records the electrical activity in the heart in real-time, providing an important opportunity to detecting various cardiac pathologies. The 12-lead ECG currently serves as the "standard" ECG acquisition technique for diagnostic purposes for many cardiac pathologies other than arrhythmias. However, the technical aspects of acquiring a 12-lead ECG are not easy and its usage is currently restricted to trained medical personnel, limiting the scope of its usefulness. Remote and wearable ECG devices have attempted to bridge this gap by enabling patients to take their own ECG using a simplified method at the expense of a reduced number of leads, usually a single-lead ECG. In this review article, we summarize the studies which investigate the use of remote ECG devices and their clinical utility in diagnosing cardiac pathologies. Eligible studies discussed FDA-cleared, commercially available devices that were validated on an adult population. We summarize technical logistics of signal quality and device reliability, dimensional and functional features, and diagnostic value. In summary, our synthesis shows that reduced-set ECG wearables have huge potential for long-term monitoring, particularly if paired with real-time notification techniques. Such capabilities make them primarily useful for abnormal rhythm detection and there is sufficient evidence that a remote ECG device can be more superior to traditional 12-lead ECG in diagnosing specific arrhythmias such as atrial fibrillation. However, this review identifies important challenges faced by this technology, highlighting the limited availability of clinical research examining their usefulness.
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Affiliation(s)
- Zeineb Bouzid
- Department of Electrical & Computer Engineering at Swanson School of Engineering, University of Pittsburgh; Pittsburgh, PA, USA.
| | - Salah S Al-Zaiti
- Department of Acute & Tertiary Care Nursing, University of Pittsburgh; Pittsburgh, PA, USA; Department of Emergency Medicine, University of Pittsburgh; Pittsburgh, PA, USA; Division of Cardiology, University of Pittsburgh; Pittsburgh, PA, USA
| | - Raymond Bond
- School of Computing, Ulster University; Belfast, UK
| | - Ervin Sejdic
- The Edward S. Rogers Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto; Toronto, Ontario, Canada; North York General Hospital; Toronto, Ontario, Canada
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21
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Kahwati LC, Asher GN, Kadro ZO, Keen S, Ali R, Coker-Schwimmer E, Jonas DE. Screening for Atrial Fibrillation: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 327:368-383. [PMID: 35076660 DOI: 10.1001/jama.2021.21811] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Atrial fibrillation (AF), the most common arrhythmia, increases the risk of stroke. OBJECTIVE To review the evidence on screening for AF in adults without prior stroke to inform the US Preventive Services Task Force. DATA SOURCES PubMed, Cochrane Library, and trial registries through October 5, 2020; references, experts, and literature surveillance through October 31, 2021. STUDY SELECTION Randomized clinical trials (RCTs) of screening among asymptomatic persons without known AF or prior stroke; test accuracy studies; RCTs of anticoagulation among persons with AF; systematic reviews; and observational studies reporting harms. DATA EXTRACTION AND SYNTHESIS Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted. MAIN OUTCOMES AND MEASURES Detection of undiagnosed AF, test accuracy, mortality, stroke, stroke-related morbidity, and harms. RESULTS Twenty-six studies (N = 113 784) were included. In 1 RCT (n = 28 768) of twice-daily electrocardiography (ECG) screening for 2 weeks, the likelihood of a composite end point (ischemic stroke, hemorrhagic stroke, systemic embolism, all-cause mortality, and hospitalization for bleeding) was lower in the screened group over 6.9 years (hazard ratio, 0.96 [95% CI, 0.92-1.00]; P = .045), but that study had numerous limitations. In 4 RCTs (n = 32 491), significantly more AF was detected with intermittent and continuous ECG screening compared with no screening (risk difference range, 1.0%-4.8%). Treatment with warfarin over a mean of 1.5 years in populations with clinical, mostly persistent AF was associated with fewer ischemic strokes (pooled risk ratio [RR], 0.32 [95% CI, 0.20-0.51]; 5 RCTs; n = 2415) and lower all-cause mortality (pooled RR, 0.68 [95% CI, 0.50-0.93]) compared with placebo. Treatment with direct oral anticoagulants was also associated with lower incidence of stroke (adjusted odds ratios range, 0.32-0.44) in indirect comparisons with placebo. The pooled RR for major bleeding for warfarin compared with placebo was 1.8 (95% CI, 0.85-3.7; 5 RCTs; n = 2415), and the adjusted odds ratio for major bleeding for direct oral anticoagulants compared with placebo or no treatment ranged from 1.38 to 2.21, but CIs did not exclude a null effect. CONCLUSIONS AND RELEVANCE Although screening can detect more cases of unknown AF, evidence regarding effects on health outcomes is limited. Anticoagulation was associated with lower risk of first stroke and mortality but with increased risk of major bleeding, although estimates for this harm are imprecise; no trials assessed benefits and harms of anticoagulation among screen-detected populations.
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Affiliation(s)
- Leila C Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Gary N Asher
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Zachary O Kadro
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill
| | - Susan Keen
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Rania Ali
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Emmanuel Coker-Schwimmer
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
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22
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Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Epling JW, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement. JAMA 2022; 327:360-367. [PMID: 35076659 DOI: 10.1001/jama.2021.23732] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence of AF increases with age, from less than 0.2% in adults younger than 55 years to about 10% in those 85 years or older, with a higher prevalence in men than in women. It is uncertain whether the prevalence of AF differs by race and ethnicity. Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter. OBJECTIVE To update its 2018 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the benefits and harms of screening for AF in older adults, the accuracy of screening tests, the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care, and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older adults. POPULATION Adults 50 years or older without a diagnosis or symptoms of AF and without a history of transient ischemic attack or stroke. EVIDENCE ASSESSMENT The USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined. RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF. (I statement).
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Affiliation(s)
| | - Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | | | | | | | | | - Esa M Davis
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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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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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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25
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Cullen J, Reed MJ, Muir A, Murphy R, Pollard V, Zangana G, Krupej S, Askham S, Holdsworth P, Davies L. Experience of a smartphone ambulatory ECG clinic for emergency department patients with palpitation: a single-centre cohort study. Eur J Emerg Med 2021; 28:463-468. [PMID: 34406135 DOI: 10.1097/mej.0000000000000859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND IMPORTANCE Palpitation is one of the commonest presenting complaints to the emergency department (ED). Diagnosis depends on capturing an ECG during the episode. Unlike syncope, patients retain consciousness and therefore their ability to activate an ECG event recorder. The Investigation of Palpitation in the ED study demonstrated Food and Drug Administration approved AliveCor/Kardia device that links to a smartphone app was safe and effective. A Smartphone Palpitation and Pre-syncope Ambulatory Care Clinic was therefore established. OBJECTIVES To review the first year of patients attending the service to determine the number and cost-effectiveness of cardiac dysrhythmias diagnoses. DESIGN Single-center cohort study. SETTINGS AND PARTICIPANTS Royal Infirmary of Edinburgh, UK. All patients (over 16 years) presenting consecutively to ED with palpitation or pre-syncope, whose ECG was normal, had a compatible device and where an underlying cardiac dysrhythmia was possible were enrolled. INTERVENTION Ambulatory Care Clinic utilizing the AliveCor/Kardia device. OUTCOME MEASURES AND ANALYSIS Number diagnosed with cardiac dysrhythmia and mean cost per diagnosis. MAIN RESULTS Between 24 July 2019 and 23 July 2020, 290 consecutive patients were referred of age 16-80 years (mean 43.3, SD 15.0). One hundred twenty (41.4%) were male. Two hundred thirty-seven (81.7%) were fitted with the device and 220 (75.9%) underwent full investigation. Seventeen of 237 (7.2%) patients had a cardiac diagnosis (12 atrial fibrillation/flutter, 5 supraventricular tachycardia and 1 atrial tachycardia). CONCLUSIONS There were 17 cardiac diagnoses (7.2%). The cost per symptomatic rhythm diagnosis was 358 GBP (~415 Euro) and the cost per cardiac dysrhythmia diagnosis was 4570 GBP (~5298 Euro). A smartphone-based event recorder clinic should be considered for ED palpitation patients.
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Affiliation(s)
- Julia Cullen
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh
- Acute Medicine, NHS Lothian
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh
- Acute Care Group, Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Nine Edinburgh BioQuarter, Edinburgh, UK
| | - Alexandra Muir
- Emergency Medicine Research Group Edinburgh (EMERGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh
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26
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The role of single‑lead ECG in screening for atrial fibrillation deserves more attention. Int J Cardiol 2021; 348:75. [PMID: 34856294 DOI: 10.1016/j.ijcard.2021.11.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/26/2021] [Indexed: 11/20/2022]
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27
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Federer SJ, Jones GG. Artificial intelligence in orthopaedics: A scoping review. PLoS One 2021; 16:e0260471. [PMID: 34813611 PMCID: PMC8610245 DOI: 10.1371/journal.pone.0260471] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2022] Open
Abstract
There is a growing interest in the application of artificial intelligence (AI) to orthopaedic surgery. This review aims to identify and characterise research in this field, in order to understand the extent, range and nature of this work, and act as springboard to stimulate future studies. A scoping review, a form of structured evidence synthesis, was conducted to summarise the use of AI in orthopaedics. A literature search (1946-2019) identified 222 studies eligible for inclusion. These studies were predominantly small and retrospective. There has been significant growth in the number of papers published in the last three years, mainly from the USA (37%). The majority of research used AI for image interpretation (45%) or as a clinical decision tool (25%). Spine (43%), knee (23%) and hip (14%) were the regions of the body most commonly studied. The application of artificial intelligence to orthopaedics is growing. However, the scope of its use so far remains limited, both in terms of its possible clinical applications, and the sub-specialty areas of the body which have been studied. A standardized method of reporting AI studies would allow direct assessment and comparison. Prospective studies are required to validate AI tools for clinical use.
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Affiliation(s)
- Simon J. Federer
- MSk Lab, Sir Michael Uren Hub, Imperial College London, London, United Kingdom
- * E-mail:
| | - Gareth G. Jones
- MSk Lab, Sir Michael Uren Hub, Imperial College London, London, United Kingdom
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28
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Beers L, van Adrichem LP, Himmelreich JCL, Karregat EPM, de Jong JSSG, Postema PG, de Groot JR, Lucassen WAM, Harskamp RE. Manual QT interval measurement with a smartphone-operated single-lead ECG versus 12-lead ECG: a within-patient diagnostic validation study in primary care. BMJ Open 2021; 11:e055072. [PMID: 34732504 PMCID: PMC8572408 DOI: 10.1136/bmjopen-2021-055072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/20/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine the accuracy of QT measurement in a smartphone-operated, single-lead ECG (1L-ECG) device (AliveCor KardiaMobile 1L). DESIGN Cross-sectional, within-patient diagnostic validation study. SETTING/PARTICIPANTS Patients underwent a 12-lead ECG (12L-ECG) for any non-acute indication in primary care, April 2017-July 2018. INTERVENTION Simultaneous recording of 1L-ECGs and 12L-ECGs with blinded manual QT assessment. OUTCOMES OF INTEREST: (1) Difference in QT interval in milliseconds (ms) between the devices; (2) measurement agreement between the devices (excellent agreement <20 ms and clinically acceptable agreement <40 ms absolute difference); (3) sensitivity and specificity for detection of extreme QTc (short (≤340 ms) or long (≥480 ms)), on 1L-ECGs versus 12L-ECGs as reference standard. In case of significant discrepancy between lead I/II of 12L-ECGs and 1L-ECGs, we developed a correction tool by adding the difference between QT measurements of 12L-ECG and 1L-ECGs. RESULTS 250 ECGs of 125 patients were included. The mean QTc interval, using Bazett's formula (QTcB), was 393±25 ms (mean±SD) in 1L-ECGs and 392±27 ms in lead I of 12L-ECGs, a mean difference of 1±21 ms, which was not statistically different (paired t-test (p=0.51) and Bland Altman method (p=0.23)). In terms of agreement between 1L-ECGs and lead I, QTcB had excellent agreement in 66.9% and clinically acceptable agreement in 93.4% of observations. The sensitivity and specificity of detecting extreme QTc were 0% and 99.2%, respectively. The comparison of 1L-ECG QTcB with lead II of 12L-ECGs showed a significant difference (p=<0.01), but when using a correction factor (+9 ms) this difference was cancelled (paired t-test (p=0.43) or Bland Altman test (p=0.57)). Moreover, it led to improved rates of excellent (71.3%) and clinically acceptable (94.3%) agreement. CONCLUSION Smartphone-operated 1L-ECGs can be used to accurately measure the QTc interval compared with simultaneously obtained 12L-ECGs in a primary care population. This may provide an opportunity for monitoring the effects of potential QTc-prolonging medications.
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Affiliation(s)
- Lisa Beers
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisa P van Adrichem
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jelle C L Himmelreich
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert P M Karregat
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jonas S S G de Jong
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Noord-Holland, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands
| | - Wim A M Lucassen
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- General Practice, Amsterdam UMC Locatie Meibergdreef, Amsterdam, North Holland, The Netherlands
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29
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Santala OE, Halonen J, Martikainen S, Jäntti H, Rissanen TT, Tarvainen MP, Laitinen TP, Laitinen TM, Väliaho ES, Hartikainen JEK, Martikainen TJ, Lipponen JA. Automatic Mobile Health Arrhythmia Monitoring for the Detection of Atrial Fibrillation: Prospective Feasibility, Accuracy, and User Experience Study. JMIR Mhealth Uhealth 2021; 9:e29933. [PMID: 34677135 PMCID: PMC8571685 DOI: 10.2196/29933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/30/2021] [Accepted: 08/27/2021] [Indexed: 01/19/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common tachyarrhythmia and associated with a risk of stroke. The detection and diagnosis of AF represent a major clinical challenge due to AF’s asymptomatic and intermittent nature. Novel consumer-grade mobile health (mHealth) products with automatic arrhythmia detection could be an option for long-term electrocardiogram (ECG)-based rhythm monitoring and AF detection. Objective We evaluated the feasibility and accuracy of a wearable automated mHealth arrhythmia monitoring system, including a consumer-grade, single-lead heart rate belt ECG device (heart belt), a mobile phone application, and a cloud service with an artificial intelligence (AI) arrhythmia detection algorithm for AF detection. The specific aim of this proof-of-concept study was to test the feasibility of the entire sequence of operations from ECG recording to AI arrhythmia analysis and ultimately to final AF detection. Methods Patients (n=159) with an AF (n=73) or sinus rhythm (n=86) were recruited from the emergency department. A single-lead heart belt ECG was recorded for 24 hours. Simultaneously registered 3-lead ECGs (Holter) served as the gold standard for the final rhythm diagnostics and as a reference device in a user experience survey with patients over 65 years of age (high-risk group). Results The heart belt provided a high-quality ECG recording for visual interpretation resulting in 100% accuracy, sensitivity, and specificity of AF detection. The accuracy of AF detection with the automatic AI arrhythmia detection from the heart belt ECG recording was also high (97.5%), and the sensitivity and specificity were 100% and 95.4%, respectively. The correlation between the automatic estimated AF burden and the true AF burden from Holter recording was >0.99 with a mean burden error of 0.05 (SD 0.26) hours. The heart belt demonstrated good user experience and did not significantly interfere with the patient’s daily activities. The patients preferred the heart belt over Holter ECG for rhythm monitoring (85/110, 77% heart belt vs 77/109, 71% Holter, P=.049). Conclusions A consumer-grade, single-lead ECG heart belt provided good-quality ECG for rhythm diagnosis. The mHealth arrhythmia monitoring system, consisting of heart-belt ECG, a mobile phone application, and an automated AF detection achieved AF detection with high accuracy, sensitivity, and specificity. In addition, the mHealth arrhythmia monitoring system showed good user experience. Trial Registration ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335
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Affiliation(s)
- Onni E Santala
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jari Halonen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Susanna Martikainen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Center for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika P Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tomi P Laitinen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Eemu-Samuli Väliaho
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha E K Hartikainen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tero J Martikainen
- Department of Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Jukka A Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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30
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Książczyk M, Dębska-Kozłowska A, Warchoł I, Lubiński A. Enhancing Healthcare Access-Smartphone Apps in Arrhythmia Screening: Viewpoint. JMIR Mhealth Uhealth 2021; 9:e23425. [PMID: 34448723 PMCID: PMC8433858 DOI: 10.2196/23425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/04/2021] [Accepted: 07/28/2021] [Indexed: 01/23/2023] Open
Abstract
Atrial fibrillation is the most commonly reported arrhythmia and, if undiagnosed or untreated, may lead to thromboembolic events. It is therefore desirable to provide screening to patients in order to detect atrial arrhythmias. Specific mobile apps and accessory devices, such as smartphones and smartwatches, may play a significant role in monitoring heart rhythm in populations at high risk of arrhythmia. These apps are becoming increasingly common among patients and professionals as a part of mobile health. The rapid development of mobile health solutions may revolutionize approaches to arrhythmia screening. In this viewpoint paper, we assess the availability of smartphone and smartwatch apps and evaluate their efficacy for monitoring heart rhythm and arrhythmia detection. The findings obtained so far suggest they are on the right track to improving the efficacy of early detection of atrial fibrillation, thus lowering the risk of stroke and reducing the economic burden placed on public health.
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Affiliation(s)
- Marcin Książczyk
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Łódź, Poland.,Department of Noninvasive Cardiology, Medical University of Lodz, Łódź, Poland
| | - Agnieszka Dębska-Kozłowska
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Łódź, Poland
| | - Izabela Warchoł
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Łódź, Poland
| | - Andrzej Lubiński
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Łódź, Poland
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31
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Nagarajan VD, Lee SL, Robertus JL, Nienaber CA, Trayanova NA, Ernst S. Artificial intelligence in the diagnosis and management of arrhythmias. Eur Heart J 2021; 42:3904-3916. [PMID: 34392353 PMCID: PMC8497074 DOI: 10.1093/eurheartj/ehab544] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 01/06/2021] [Accepted: 07/27/2021] [Indexed: 01/05/2023] Open
Abstract
The field of cardiac electrophysiology (EP) had adopted simple artificial intelligence (AI) methodologies for decades. Recent renewed interest in deep learning techniques has opened new frontiers in electrocardiography analysis including signature identification of diseased states. Artificial intelligence advances coupled with simultaneous rapid growth in computational power, sensor technology, and availability of web-based platforms have seen the rapid growth of AI-aided applications and big data research. Changing lifestyles with an expansion of the concept of internet of things and advancements in telecommunication technology have opened doors to population-based detection of atrial fibrillation in ways, which were previously unimaginable. Artificial intelligence-aided advances in 3D cardiac imaging heralded the concept of virtual hearts and the simulation of cardiac arrhythmias. Robotics, completely non-invasive ablation therapy, and the concept of extended realities show promise to revolutionize the future of EP. In this review, we discuss the impact of AI and recent technological advances in all aspects of arrhythmia care.
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Affiliation(s)
- Venkat D Nagarajan
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.,Department of Cardiology, Doncaster and Bassetlaw Hospitals, NHS Foundation Trust, Thorne Road, Doncaster DN2 5LT, UK
| | - Su-Lin Lee
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), UCL, Foley Street, London W1W 7TS, UK
| | - Jan-Lukas Robertus
- Department of Pathology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.,National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
| | - Christoph A Nienaber
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.,National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Charles Street, Baltimore, MD 21218, USA
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.,National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, London SW3 6LY, UK
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32
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Johnson DM, Junarta J, Gerace C, Frisch DR. Usefulness of Mobile Electrocardiographic Devices to Reduce Urgent Healthcare Visits. Am J Cardiol 2021; 153:125-128. [PMID: 34229856 DOI: 10.1016/j.amjcard.2021.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 11/15/2022]
Abstract
Mobile electrocardiogram (mECG) devices are being used increasingly, supplying recordings to providers and providing automatic rhythm interpretation. Given the intermittent nature of certain cardiac arrhythmias, mECGs allow instant access to a recording device. In the current COVID-19 pandemic, efforts to limit in-person patient interactions and avoid overwhelming emergency and inpatient services would add value. Our goal was to evaluate whether a mECG device would reduce healthcare utilization overall, particularly those of urgent nature. We identified a cohort of KardiaMobile (AliveCor, USA) mECG users and compared their healthcare utilization 1 year prior to obtaining the device and 1 year after. One hundred and twenty-eight patients were studied (mean age 64, 47% female). Mean duration of follow-up pre-intervention was 9.8 months. One hundred and twenty-three of 128 individuals completed post-intervention follow-up. Patients were less likely to have cardiac monitors ordered (30 vs 6; p <0.01), outpatient office visits (525 vs 382; p <0.01), cardiac-specific ED visits (51 vs 30; p <0.01), arrhythmia related ED visits (45 vs 20; p <0.01), and unplanned arrhythmia admissions (34 vs 11; p <0.01) in the year after obtaining a KardiaMobile device compared to the year prior to obtaining the device. Mobile technology is available for heart rhythm monitoring and can give feedback to the user. This study showed a reduction of in-person, healthcare utilization with mECG device use. In conclusion, this strategy would be expected to decrease the risk of exposure to patients and providers and would avoid overwhelming emergency and inpatient services.
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Affiliation(s)
- Drew M Johnson
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA.
| | - Joey Junarta
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA
| | - Christopher Gerace
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Daniel R Frisch
- Thomas Jefferson University Hospital, Department of Medicine, Division of Cardiology, Philadelphia, PA
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33
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Babusiak B, Hajducik A, Medvecky S, Lukac M, Klarak J. Design of Smart Steering Wheel for Unobtrusive Health and Drowsiness Monitoring. SENSORS 2021; 21:s21165285. [PMID: 34450727 PMCID: PMC8399225 DOI: 10.3390/s21165285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/26/2022]
Abstract
This article describes the design of a smart steering wheel intended for use in unobtrusive health and drowsiness monitoring. The aging population, cardiovascular disease, personalized medicine, and driver fatigue were significant motivations for developing a monitoring platform in cars because people spent much time in cars. The purpose was to create a unique, comprehensive monitoring system for the driver. The crucial parameters in health or drowsiness monitoring, such as heart rate, heart rate variability, and blood oxygenation, are measured by an electrocardiograph and oximeter integrated into the steering wheel. In addition, an inertial unit was integrated into the steering wheel to record and analyze the movement patterns performed by the driver while driving. The developed steering wheel was tested under laboratory and real-life conditions. The measured signals were verified by commercial devices to confirm data correctness and accuracy. The resulting signals show the applicability of the developed platform in further detecting specific cardiovascular diseases (especially atrial fibrillation) and drowsiness.
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Affiliation(s)
- Branko Babusiak
- Department of Electromagnetic and Biomedical Engineering, University of Zilina, 01026 Zilina, Slovakia
- Correspondence:
| | - Adrian Hajducik
- Department of Design and Machine Elements, University of Zilina, 01026 Zilina, Slovakia; (A.H.); (M.L.)
| | - Stefan Medvecky
- Institute of Competitiveness and Innovation, University of Zilina, 01026 Zilina, Slovakia;
| | - Michal Lukac
- Department of Design and Machine Elements, University of Zilina, 01026 Zilina, Slovakia; (A.H.); (M.L.)
| | - Jaromir Klarak
- Department of Automated Production Systems, University of Zilina, 01026 Zilina, Slovakia;
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34
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Yang TY, Huang L, Malwade S, Hsu CY, Chen YC. Diagnostic Accuracy of Ambulatory Devices in Detecting Atrial Fibrillation: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2021; 9:e26167. [PMID: 33835039 PMCID: PMC8065566 DOI: 10.2196/26167] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/07/2021] [Accepted: 03/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Early diagnosis of AF is crucial for preventing AF-related morbidity, mortality, and economic burden, yet the detection of the disease remains challenging. The 12-lead electrocardiogram (ECG) is the gold standard for the diagnosis of AF. Because of technological advances, ambulatory devices may serve as convenient screening tools for AF. OBJECTIVE The objective of this review was to investigate the diagnostic accuracy of 2 relatively new technologies used in ambulatory devices, non-12-lead ECG and photoplethysmography (PPG), in detecting AF. We performed a meta-analysis to evaluate the diagnostic accuracy of non-12-lead ECG and PPG compared to the reference standard, 12-lead ECG. We also conducted a subgroup analysis to assess the impact of study design and participant recruitment on diagnostic accuracy. METHODS This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE and EMBASE were systematically searched for articles published from January 1, 2015 to January 23, 2021. A bivariate model was used to pool estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the summary receiver operating curve (SROC) as the main diagnostic measures. Study quality was evaluated using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. RESULTS Our search resulted in 16 studies using either non-12-lead ECG or PPG for detecting AF, comprising 3217 participants and 7623 assessments. The pooled estimates of sensitivity, specificity, PLR, NLR, and diagnostic odds ratio for the detection of AF were 89.7% (95% CI 83.2%-93.9%), 95.7% (95% CI 92.0%-97.7%), 20.64 (95% CI 10.10-42.15), 0.11 (95% CI 0.06-0.19), and 224.75 (95% CI 70.10-720.56), respectively, for the automatic interpretation of non-12-lead ECG measurements and 94.7% (95% CI 93.3%-95.8%), 97.6% (95% CI 94.5%-99.0%), 35.51 (95% CI 18.19-69.31), 0.05 (95% CI 0.04-0.07), and 730.79 (95% CI 309.33-1726.49), respectively, for the automatic interpretation of PPG measurements. CONCLUSIONS Both non-12-lead ECG and PPG offered high diagnostic accuracies for AF. Detection employing automatic analysis techniques may serve as a useful preliminary screening tool before administering a gold standard test, which generally requires competent physician analyses. Subgroup analysis indicated variations of sensitivity and specificity between studies that recruited low-risk and high-risk populations, warranting future validity tests in the general population. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020179937; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=179937.
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Affiliation(s)
- Tien Yun Yang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li Huang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Shwetambara Malwade
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yi Hsu
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yang Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
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35
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Karregat EPM, Himmelreich JCL, Lucassen WAM, Busschers WB, van Weert HCPM, Harskamp RE. Evaluation of general practitioners' single-lead electrocardiogram interpretation skills: a case-vignette study. Fam Pract 2021; 38:70-75. [PMID: 32766703 PMCID: PMC8006764 DOI: 10.1093/fampra/cmaa076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Handheld single-lead electrocardiograms (1L-ECG) present a welcome addition to the diagnostic arsenal of general practitioners (GPs). However, little is known about GPs' 1L-ECG interpretation skills, and thus its reliability in real-world practice. OBJECTIVE To determine the diagnostic accuracy of GPs in diagnosing atrial fibrillation or flutter (AF/Afl) based on 1L-ECGs, with and without the aid of automatic algorithm interpretation, as well as other relevant ECG abnormalities. METHODS We invited 2239 Dutch GPs for an online case-vignette study. GPs were asked to interpret four 1L-ECGs, randomly drawn from a pool of 80 case-vignettes. These vignettes were obtained from a primary care study that used smartphone-operated 1L-ECG recordings using the AliveCor KardiaMobile. Interpretation of all 1L-ECGs by a panel of cardiologists was used as reference standard. RESULTS A total of 457 (20.4%) GPs responded and interpreted a total of 1613 1L-ECGs. Sensitivity and specificity for AF/Afl (prevalence 13%) were 92.5% (95% CI: 82.5-97.0%) and 89.8% (95% CI: 85.5-92.9%), respectively. PPV and NPV for AF/Afl were 45.7% (95% CI: 22.4-70.9%) and 98.8% (95% CI: 97.1-99.5%), respectively. GP interpretation skills did not improve in case-vignettes where the outcome of automatic AF-detection algorithm was provided. In detecting any relevant ECG abnormality (prevalence 22%), sensitivity, specificity, PPV and NPV were 96.3% (95% CI: 92.8-98.2%), 68.8% (95% CI: 62.4-74.6%), 43.9% (95% CI: 27.7-61.5%) and 97.9% (95% CI: 94.9-99.1%), respectively. CONCLUSIONS GPs can safely rule out cardiac arrhythmias with 1L-ECGs. However, whenever an abnormality is suspected, confirmation by an expert-reader is warranted.
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Affiliation(s)
- Evert P M Karregat
- Amsterdam Public Health & Amsterdam Cardiovascular Sciences Research Institute, Department of General Practice, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jelle C L Himmelreich
- Amsterdam Public Health & Amsterdam Cardiovascular Sciences Research Institute, Department of General Practice, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wim A M Lucassen
- Amsterdam Public Health & Amsterdam Cardiovascular Sciences Research Institute, Department of General Practice, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wim B Busschers
- Amsterdam Public Health & Amsterdam Cardiovascular Sciences Research Institute, Department of General Practice, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Amsterdam Public Health & Amsterdam Cardiovascular Sciences Research Institute, Department of General Practice, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Amsterdam Public Health & Amsterdam Cardiovascular Sciences Research Institute, Department of General Practice, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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36
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Witvliet MP, Karregat EPM, Himmelreich JCL, de Jong JSSG, Lucassen WAM, Harskamp RE. Usefulness, pitfalls and interpretation of handheld single‑lead electrocardiograms. J Electrocardiol 2021; 66:33-37. [PMID: 33725506 DOI: 10.1016/j.jelectrocard.2021.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
Single‑lead electrocardiograms (1 L-ECGs) are increasingly used in (pre)clinical settings for the detection and monitoring of a range of rhythm and conduction disorders. In this short communication paper, we aim to provide an overview of the usefulness and potential pitfalls when implementing 1 L-ECGs into everyday clinical practice. Moreover, we provide recommendations for improving signal quality, as well as a systematic approach to the interpretation of 1 L-ECGs, which is somewhat different from standard 12‑lead ECGs. Clinicians can use our illustrations and checklist as guidance when recording and interpreting 1 L-ECGs.
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Affiliation(s)
- M Patrick Witvliet
- Amsterdam UMC, location AMC, University of Amsterdam, Department of General Practice, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Evert P M Karregat
- Amsterdam UMC, location AMC, University of Amsterdam, Department of General Practice, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jelle C L Himmelreich
- Amsterdam UMC, location AMC, University of Amsterdam, Department of General Practice, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Jonas S S G de Jong
- Onze Lieve Vrouwe Gasthuis, Department of Cardiology, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Wim A M Lucassen
- Amsterdam UMC, location AMC, University of Amsterdam, Department of General Practice, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Amsterdam UMC, location AMC, University of Amsterdam, Department of General Practice, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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37
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Bray JJH, Lloyd EF, Adenwalla F, Kelly S, Wareham K, Halcox JPJ. Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation. BMJ Open Qual 2021; 10:e001270. [PMID: 33741652 PMCID: PMC7986662 DOI: 10.1136/bmjoq-2020-001270] [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] [Received: 11/07/2020] [Revised: 02/20/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Community management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting. METHODS During the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician. RESULTS Seventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF. CONCLUSIONS We have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.
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Affiliation(s)
- Jonathan James Hyett Bray
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
- General Medicine, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Elin Fflur Lloyd
- Cardiology, Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Firdaus Adenwalla
- Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Sarah Kelly
- Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
| | - Kathie Wareham
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
- Morriston Hospital, Swansea, Wales, UK
| | - Julian P J Halcox
- Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
- Singleton Hospital, Swansea, Wales, UK
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38
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Nederend M, Zandstra TE, Kiès P, Jongbloed MRM, Vliegen HW, Treskes RW, Schalij MJ, Atsma DE, Egorova AD. Potential of eHealth smart technology in optimization and monitoring of heart failure treatment in adults with systemic right ventricular failure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:215-223. [PMID: 36712397 PMCID: PMC9707956 DOI: 10.1093/ehjdh/ztab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 02/01/2023]
Abstract
Aims Patients with a systemic right ventricle (sRV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA are prone to heart failure and arrhythmias. This study evaluated feasibility, patient adherence, and satisfaction of a smart technology-based care pathway for heart failure treatment optimization in these patients. Methods and results Patients with symptomatic sRV failure eligible for initiation of sacubitril/valsartan were provided with four smartphone compatible devices (blood pressure monitor, weight scale, step counter, and rhythm monitor) and were managed according to a smart technology-based care pathway. Biweekly sacubitril/valsartan titration visits were replaced by electronical visits, patients were advised to continue measurements at least weekly after titration. Data of 24 consecutive sRV patients (median age 47 years, 50% female) who participated in the smart technology-based care pathway were analysed. Median home-hospital distance was 65 km (maximum 227 km). Most patients (20, 83.3%) submitted weekly measurements; 100% submitted prior to electronical visits. Titration conventionally occurs during a hospital visit. By implementing eHealth smart technology, 68 such trips to hospital were replaced by virtual visits facilitated by remote monitoring. An eHealth questionnaire was completed by 22 patients (92%), and 96% expressed satisfaction. After titration, 30 instances of remote adjustment of heart failure medication in addition to scheduled outpatient clinic visits occurred, one (4%) heart failure admission followed, despite ambulant adjustments. Five patients (21%) sent in rhythm registrations (n = 17), of these 77% showed sinus rhythm, whereas supraventricular tachycardia was detected in the remaining four registrations. Conclusion These data suggest that implementation of a smart technology-based care pathway for optimization of medical treatment sRV failure is feasible with high measurement adherence and patient satisfaction.
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Affiliation(s)
- Marieke Nederend
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Tjitske E Zandstra
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Philippine Kiès
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Monique R M Jongbloed
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Anatomy & Embryology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Hubert W Vliegen
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Roderick W Treskes
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Martin J Schalij
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,National eHealth Living Lab, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Anastasia D Egorova
- CAHAL, Center for Congenital Heart Disease Amsterdam Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands,Corresponding author. Tel: +31 71 526 2020,
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Estimating Heart Rate and Respiratory Rate from a Single Lead Electrocardiogram Using Ensemble Empirical Mode Decomposition and Spectral Data Fusion. SENSORS 2021; 21:s21041184. [PMID: 33567575 PMCID: PMC7915478 DOI: 10.3390/s21041184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
Cardiopulmonary monitoring is important and useful for diagnosing and managing multiple conditions, such as stress and sleep disorders. Wearable ambulatory systems can provide continuous, comfortable, and inexpensive means for monitoring; it always has been a research subject in recent years. Being simple and cost-effective, electrocardiogram-based commercial products can be found in the market that provides cardiac diagnostic information for assessment, including heart rate measurement and atrial fibrillation identification. Based on a data-driven and self-adaptive approach, this study aims to estimate heart rate and respiratory rate simultaneously from one lead electrocardiogram signal. In contrast to ensemble empirical mode decomposition with principle component analysis, performed in the time domain, our method uses spectral data fusion, together with intrinsic mode functions using ensemble empirical mode decomposition obtains a more accurate heart rate and respiratory rate. Equipped with a rule-based selection of defined frequency levels for respiratory rate (RR) estimation, the proposed method obtains (0.92, 1.32) beat per minute for the heart rate and (2.20, 2.92) breath per minute for the respiratory rate as their mean absolute error and root mean square error, respectively outperforming other existing methods.
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40
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Caillol T, Strik M, Ramirez FD, Abu-Alrub S, Marchand H, Buliard S, Welte N, Ploux S, Haïssaguerre M, Bordachar P. Accuracy of a Smartwatch-Derived ECG for Diagnosing Bradyarrhythmias, Tachyarrhythmias, and Cardiac Ischemia. Circ Arrhythm Electrophysiol 2021; 14:e009260. [PMID: 33441002 DOI: 10.1161/circep.120.009260] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Théo Caillol
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.)
| | | | | | | | - Hugo Marchand
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.)
| | - Samuel Buliard
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.)
| | - Nicolas Welte
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.)
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.)
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.)
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France (T.C., H.M., S.B., N.W., S.P., M.H., P.B.)
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Meskó B, Görög M. A short guide for medical professionals in the era of artificial intelligence. NPJ Digit Med 2020; 3:126. [PMID: 33043150 PMCID: PMC7518439 DOI: 10.1038/s41746-020-00333-z] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/31/2020] [Indexed: 02/08/2023] Open
Abstract
Artificial intelligence (A.I.) is expected to significantly influence the practice of medicine and the delivery of healthcare in the near future. While there are only a handful of practical examples for its medical use with enough evidence, hype and attention around the topic are significant. There are so many papers, conference talks, misleading news headlines and study interpretations that a short and visual guide any medical professional can refer back to in their professional life might be useful. For this, it is critical that physicians understand the basics of the technology so they can see beyond the hype, evaluate A.I.-based studies and clinical validation; as well as acknowledge the limitations and opportunities of A.I. This paper aims to serve as a short, visual and digestible repository of information and details every physician might need to know in the age of A.I. We describe the simple definition of A.I., its levels, its methods, the differences between the methods with medical examples, the potential benefits, dangers, challenges of A.I., as well as attempt to provide a futuristic vision about using it in an everyday medical practice.
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Affiliation(s)
- Bertalan Meskó
- The Medical Futurist Institute, Budapest, Hungary
- Semmelweis University, Budapest, Hungary
| | - Marton Görög
- The Medical Futurist Institute, Budapest, Hungary
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Prasitlumkum N, Cheungpasitporn W, Chokesuwattanaskul A, Thangjui S, Thongprayoon C, Bathini T, Vallabhajosyula S, Kanitsoraphan C, Leesutipornchai T, Chokesuwattanaskul R. Diagnostic accuracy of smart gadgets/wearable devices in detecting atrial fibrillation: A systematic review and meta-analysis. Arch Cardiovasc Dis 2020; 114:4-16. [PMID: 32921618 DOI: 10.1016/j.acvd.2020.05.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recently, smart devices have been used for medical purposes, particularly to screen for atrial fibrillation. However, current data on the diagnostic performance of these devices are scarce. AIMS We performed a systemic review and meta-analysis to assess the accuracy of atrial fibrillation diagnosis by smart gadgets/wearable devices. METHODS We comprehensively searched the MEDLINE, EMBASE and Cochrane databases for all works since the inception of each database until January 2020. Included in this review were published observational studies of the diagnostic accuracy of smartphones or smartwatches in detecting atrial fibrillation. We calculated the area under the summary receiver operating characteristic curves and pooled sensitivities and specificities. RESULTS Participants in our study were from the general population or were patients with underlying atrial fibrillation. In the overall analyses, the areas under the summary receiver operating characteristic curves were 0.96 and 0.94 for smartphones and smartwatches, respectively. Smartphones had a sensitivity of 94% and a specificity of 96%, and smartwatches showed similar diagnostic accuracy, with a specificity of 94% and a sensitivity of 93%. In subgroup analyses, we found no difference in diagnostic accuracy between photoplethysmography and single-lead electrocardiography. CONCLUSIONS This study suggests that smart devices have similar diagnostic accuracies. Regarding atrial fibrillation detection methods, there was also no difference between photoplethysmography and single-lead electrocardiography. However, further studies are warranted to determine their clinical implications in atrial fibrillation management.
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Affiliation(s)
- Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, 92521 Riverside, CA, USA.
| | - Wisit Cheungpasitporn
- Department of Medicine, University of Mississippi Medical Centre, 39216 Jackson, MS, USA
| | - Anthipa Chokesuwattanaskul
- Faculty of Medicine, King-Chulalongkorn Memorial Hospital, Chulalongkorn University, 10330 Bangkok, Thailand
| | - Sittinun Thangjui
- Faculty of Medicine, King-Chulalongkorn Memorial Hospital, Chulalongkorn University, 10330 Bangkok, Thailand
| | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, 85724 Tucson, AZ, USA
| | | | | | - Thiratest Leesutipornchai
- Faculty of Medicine, King-Chulalongkorn Memorial Hospital, Chulalongkorn University, 10330 Bangkok, Thailand
| | - Ronpichai Chokesuwattanaskul
- Faculty of Medicine, King-Chulalongkorn Memorial Hospital, Chulalongkorn University, 10330 Bangkok, Thailand; Division of Cardiac Electrophysiology, University of Michigan Health Care, 48109 Ann Arbor, MI, USA
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Abstract
Atrial fibrillation (AF) is a major cause of morbidity and mortality globally, and much of this is driven by challenges in its timely diagnosis and treatment. Existing and emerging mobile technologies have been used to successfully identify AF in a variety of clinical and community settings, and while these technologies offer great promise for revolutionizing AF detection and screening, several major barriers may impede their effectiveness. The unclear clinical significance of device-detected AF, potential challenges in integrating patient-generated data into existing healthcare systems and clinical workflows, harm resulting from potential false positives, and identifying the appropriate scope of population-based screening efforts are all potential concerns that warrant further investigation. It is crucial for stakeholders such as healthcare providers, researchers, funding agencies, insurers, and engineers to actively work together in fulfilling the tremendous potential of mobile technologies to improve AF identification and management on a population level.
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Affiliation(s)
- Eric Y Ding
- From the Department of Population and Quantitative Health Sciences and Division of Cardiology, Department of Medicine, University of Massachusetts Medical School (E.Y.D., D.D.M.)
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - David D McManus
- From the Department of Population and Quantitative Health Sciences and Division of Cardiology, Department of Medicine, University of Massachusetts Medical School (E.Y.D., D.D.M.)
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