Accuracy of Physicians Interpreting Photoplethysmography and Electrocardiography Tracings to Detect Atrial Fibrillation: INTERPRET-AF.

Henri Gruwez,Dominik Linz,Laurent Pison,Tine Proesmans,Martin Manninger,David Duncker,Hein Heidbuchel,Pieter Vandervoort,Stijn Evens,Peter Haemers

doi:10.3389/fcvm.2021.734737

Abstract

Aims: This study aims to compare the performance of physicians to detect atrial fibrillation (AF) based on photoplethysmography (PPG), single-lead ECG and 12-lead ECG, and to explore the incremental value of PPG presentation as a tachogram and Poincaré plot, and of algorithm classification for interpretation by physicians.Methods and Results: Email invitations to participate in an online survey were distributed among physicians to analyse almost simultaneously recorded PPG, single-lead ECG and 12-lead ECG traces from 30 patients (10 in sinus rhythm (SR), 10 in SR with ectopic beats and 10 in AF). The task was to classify the readings as ‘SR', ‘ectopic/missed beats', ‘AF', ‘flutter' or ‘unreadable'. Sixty-five physicians detected or excluded AF based on the raw PPG waveforms with 88.8% sensitivity and 86.3% specificity. Additional presentation of the tachogram plus Poincaré plot significantly increased sensitivity and specificity to 95.5% (P < 0.001) and 92.5% (P < 0.001), respectively. The algorithm information did not further increase the accuracy to detect AF (sensitivity 97.5%, P = 0.556; specificity 95.0%, P = 0.182). Physicians detected AF on single-lead ECG tracings with 91.2% sensitivity and 93.9% specificity. Diagnostic accuracy was also not optimal on full 12-lead ECGs (93.9 and 98.6%, respectively). Notably, there was no significant difference between the performance of PPG waveform plus tachogram and Poincaré, compared to a single-lead ECG to detect or exclude AF (sensitivity P = 0.672; specificity P = 0.536).Conclusion: Physicians can detect AF on a PPG output with equivalent accuracy compared to single-lead ECG, if the PPG waveforms are presented together with a tachogram and Poincaré plot and the quality of the recordings is high.

Highlights

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with an estimated number of 30–100 million patients worldwide [1]
The main finding is that physicians can detect AF on a PPG output with equivalent accuracy compared to single-lead ECG in high-quality recordings
To achieve this performance level, a tachogram and Poincaré plot should be provided to facilitate the interpretation of the PPG waveform

Summary

Introduction

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with an estimated number of 30–100 million patients worldwide [1]. Frequent or long term ECG monitoring is cumbersome and photoplethysmography (PPG) has emerged as a non-intrusive modality to monitor the heart rate and rhythm. A variety of mobile devices, including smartphones and smartwatches, enable PPG-based heart rhythm monitoring through their built-in cameras and/or photodetectors [4]. Data on the performance of physicians to accurately detect AF based on PPG output is lacking. This study aims to, to systematically determine and compare the accuracy of qualitative PPG, single-lead ECG and 12-lead ECG analysis by physicians to differentiate between AF and non-AF rhythms. This study aims to explore the incremental value of PPG presentation as a tachogram and Poincaré plot, and of algorithm classification for interpretation by physicians. This study aims to evaluate the influence of prior PPG experience

Methods

Results

Discussion

Conclusion