Atrial fibrillation detection with and without atrial activity analysis using lead-I mobile ECG technology

Abstract

ObjectiveThis paper presents the performance of an atrial fibrillation (AF) detection algorithm in a lead-I mobile ECG setting. Our aim is to demonstrate that false positive cases occurring due to non-AF arrhythmias can be significantly reduced by taking atrial activity into account in addition to heart rhythm. MethodsAF detection was carried out in two ways: only by heart rhythm assessment based on Poincaré plot of RR intervals (A1), and by also performing P wave analysis on the average majority cycle (A2). ResultsThe algorithm was tested on the PhysioNet MIT-BIH Atrial Fibrillation Database, Long-Term AF Database, MIT-BIH Arrhythmia Database, and MIT-BIH Normal Sinus Rhythm Database. A1 produced an average sensitivity (Se) of 97.64 % and specificity (Sp) of 93.06 %. A2 resulted Se = 96.52 % and Sp = 99.12 %. Additionally, clinical data acquisition was performed by the Sanatmetal WIWE mobile ECG system. On the latter records, Se = 100 % and Sp = 95.31 % were obtained with A1, while A2 resulted Se = 100 % and Sp = 100 %. ConclusionAtrial activity analysis significantly increased Sp in records with frequent premature beats (by almost 12 %) and marked sinus arrhythmia (by 7.5 %). Based on our results and data from the literature, we suggest that AF detection methods should be tested more carefully on non-AF arrhythmia cases. Applied in WIWE, the A2 version of our algorithm outperforms the AF detectors of current single-channel mobile ECG systems. SignificanceThe results contribute to the significant reduction of false positive AF detections in lead-I mobile ECG technology.