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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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Saglietto A, Scarsoglio S, Canova D, De Ferrari GM, Ridolfi L, Anselmino M. Beat-to-beat finger photoplethysmography in atrial fibrillation patients undergoing electrical cardioversion. Sci Rep 2023; 13:6751. [PMID: 37185372 PMCID: PMC10130175 DOI: 10.1038/s41598-023-33952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
Atrial fibrillation (AF)-induced peripheral microcirculatory alterations have poorly been investigated. The present study aims to expand current knowledge through a beat-to-beat analysis of non-invasive finger photoplethysmography (PPG) in AF patients restoring sinus rhythm by electrical cardioversion (ECV). Continuous non-invasive arterial blood pressure and left middle finger PPG pulse oximetry waveform (POW) signals were continuously recorded before and after elective ECV of consecutive AF or atrial flutter (AFL) patients. The main metrics (mean, standard deviation, coefficient of variation), as well as a beat-to-beat analysis of the pulse pressure (PP) and POW beat-averaged value (aPOW), were computed to compare pre- and post-ECV phases. 53 patients (mean age 69 ± 8 years, 79% males) were enrolled; cardioversion was successful in restoring SR in 51 (96%) and signal post-processing was feasible in 46 (87%) patients. In front of a non-significant difference in mean PP (pre-ECV: 51.96 ± 13.25, post-ECV: 49.58 ± 10.41 mmHg; p = 0.45), mean aPOW significantly increased after SR restoration (pre-ECV: 0.39 ± 0.09, post-ECV: 0.44 ± 0.06 a.u.; p < 0.001). Moreover, at beat-to-beat analysis linear regression yielded significantly different slope (m) for the PP (RR) relationship compared to aPOW(RR) [PP(RR): 0.43 ± 0.18; aPOW(RR): 1.06 ± 0.17; p < 0.001]. Long (> 95th percentile) and short (< 5th percentile) RR intervals were significantly more irregular in the pre-ECV phases for both PP and aPOW; however, aPOW signal suffered more fluctuations compared to PP (p < 0.001 in both phases). Present findings suggest that AF-related hemodynamic alterations are more manifest at the peripheral (aPOW) rather than at the upstream macrocirculatory level (PP). Restoring sinus rhythm increases mean peripheral microvascular perfusion and decreases variability of the microvascular hemodynamic signals. Future dedicated studies are required to determine if AF-induced peripheral microvascular alterations might relate to long-term prognostic effects.
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Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy.
| | - Daniela Canova
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
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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 2023:00045415-990000000-00087. [PMID: 36946975 DOI: 10.1097/crd.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Nonoguchi NM, Soejima K, Goda A, Nishimura K, Onozuka D, Fujita S, Koyama F, Takano Y, Iguchi S, Sato H, Mohri T, Katusme Y, Tashiro M, Hoshida K, Miwa Y, Togashi I, Ueda A, Sato T, Kohno T. Accuracy of wristwatch-type photoplethysmography in detecting atrial fibrillation in daily life . EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:455-464. [PMID: 36712156 PMCID: PMC9707983 DOI: 10.1093/ehjdh/ztac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/12/2022] [Indexed: 02/01/2023]
Abstract
Aims Detection of asymptomatic paroxysmal atrial fibrillation is challenging. Smartphone- or smartwatch-based photoplethysmography is efficient at detecting irregular rhythms using pulse waves but is too complex for older patients. We aimed to evaluate the detection accuracy of atrial fibrillation by a wristwatch-type continuous pulse wave monitor (PWM) in daily life. Methods and results Patients at high risk of atrial fibrillation but with no history of atrial fibrillation (n = 163; mean CHADS2 score, 1.9) and patients with known atrial fibrillation (n = 123, including 34 with persistent atrial fibrillation) underwent PWM and telemetry electrocardiogram recording for 3 days. Risk of atrial fibrillation was judged using the 'Kyorin Atrial Fibrillation Risk Score', a scoring system based on previously reported atrial fibrillation risk scoring systems. The PWM assessed the presence of atrial fibrillation at 30 min intervals, and the results were compared with the telemetry electrocardiogram findings. The PWMs accurately diagnosed two patients with paroxysmal atrial fibrillation in the high-risk group. The PWMs accurately diagnosed 48 of the 55 patients with atrial fibrillation in the known-atrial fibrillation group. The PWM accuracy in detecting patients with atrial fibrillation was as follows: sensitivity, 98.0%; specificity, 90.6%; positive predictive value, 69.4%; negative predictive value, 99.5%. The respective values for intervals with atrial fibrillation were 86.9%, 98.8%, 89.6%, and 98.5%. Conclusion The wristwatch-type PWM has shown feasibility in detecting atrial fibrillation in daily life and showed the possibility of being used as a screening tool.
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Affiliation(s)
| | - Kyoko Soejima
- Corresponding author. Tel: +81-422-47-5511, Fax: +81-422-44-4160,
| | - Ayumi Goda
- Division of Cardiovascular Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Kunihiro Nishimura
- Statistics and Data Analysis, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Daisuke Onozuka
- Statistics and Data Analysis, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Shin Fujita
- Device Application Development Department, Fujimi Plant, Seiko Epson Corporation, 281 Fujimi, Fujimi-machi, Suwa-gun, Nagano 399-0293, Japan
| | - Fumio Koyama
- Device Application Development Department, Fujimi Plant, Seiko Epson Corporation, 281 Fujimi, Fujimi-machi, Suwa-gun, Nagano 399-0293, Japan
| | - Yuichi Takano
- Device Application Development Department, Fujimi Plant, Seiko Epson Corporation, 281 Fujimi, Fujimi-machi, Suwa-gun, Nagano 399-0293, Japan
| | - Shiho Iguchi
- Nursing Department, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Hideki Sato
- Clinical Laboratory Department, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Takato Mohri
- Division of Cardiovascular Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Yumi Katusme
- Division of Cardiovascular Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Mika Tashiro
- Division of Cardiovascular Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Kyoko Hoshida
- Division of Cardiovascular Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Yosuke Miwa
- Division of Cardiovascular Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Ikuko Togashi
- Division of Advanced Arrhythmia Management, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Toshiaki Sato
- Division of Advanced Arrhythmia Management, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
| | - Takashi Kohno
- Division of Cardiovascular Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-City, Tokyo 181-8611, Japan
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Martini C, Di Maria B, Reverberi C, Tuttolomondo D, Gaibazzi N. Commercially Available Heart Rate Monitor Repurposed for Automatic Arrhythmia Detection with Snapshot Electrocardiographic Capability: A Pilot Validation. Diagnostics (Basel) 2022; 12:diagnostics12030712. [PMID: 35328265 PMCID: PMC8947007 DOI: 10.3390/diagnostics12030712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022] Open
Abstract
The usefulness of opportunistic arrhythmia screening strategies, using an electrocardiogram (ECG) or other methods for random “snapshot” assessments is limited by the unexpected and occasional nature of arrhythmias, leading to a high rate of missed diagnosis. We have previously validated a cardiac monitoring system for AF detection pairing simple consumer-grade Bluetooth low-energy (BLE) heart rate (HR) sensors with a smartphone application (RITMIA™, Heart Sentinel srl, Italy). In the current study, we test a significant upgrade to the above-mentioned system, thanks to the technical capability of new HR sensors to run algorithms on the sensor itself and to acquire, and store on-board, single-lead ECG strips. We have reprogrammed an HR monitor intended for sports use (Movensense HR+) to run our proprietary RITMIA algorithm code in real-time, based on RR analysis, so that if any type of arrhythmia is detected, it triggers a brief retrospective recording of a single-lead ECG, providing tracings of the specific arrhythmia for later consultation. We report the initial data on the behavior, feasibility, and high diagnostic accuracy of this ultra-low weight customized device for standalone automatic arrhythmia detection and ECG recording, when several types of arrhythmias were simulated under different baseline conditions. Conclusions: The customized device was capable of detecting all types of simulated arrhythmias and correctly triggered a visually interpretable ECG tracing. Future human studies are needed to address real-life accuracy of this device.
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Affiliation(s)
- Chiara Martini
- Department of Radiology, Parma University Hospital, Via Gramsci 14, 43125 Parma, Italy
- Correspondence: ; Tel.: +39-3457245174
| | | | - Claudio Reverberi
- Poliambulatorio Città di Collecchio, Str. Nazionale Est, 4/A, 43044 Collecchio, Italy;
| | - Domenico Tuttolomondo
- Non-invasive Cardiology, Parma University Hospital, Via Gramsci 14, 43125 Parma, Italy; (D.T.); (N.G.)
| | - Nicola Gaibazzi
- Non-invasive Cardiology, Parma University Hospital, Via Gramsci 14, 43125 Parma, Italy; (D.T.); (N.G.)
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