Continuous 24-h Photoplethysmogram Monitoring Enables Detection of Atrial Fibrillation.

Eemu-Samuli Väliaho,Tomi P Laitinen,Tiina M Laitinen,Noora S Naukkarinen,Jukka A Lipponen,Juha E K Hartikainen,Mika P Tarvainen,Pekka Kuoppa,Onni E Santala,Helena Jäntti,Maaret Castrén,Olli Rantula,Jari Halonen,Tuomas T Rissanen,Tero J Martikainen

doi:10.3389/fphys.2021.778775

Abstract

Aim: Atrial fibrillation (AF) detection is challenging because it is often asymptomatic and paroxysmal. We evaluated continuous photoplethysmogram (PPG) for signal quality and detection of AF.Methods: PPGs were recorded using a wrist-band device in 173 patients (76 AF, 97 sinus rhythm, SR) for 24 h. Simultaneously recorded 3-lead ambulatory ECG served as control. The recordings were split into 10-, 20-, 30-, and 60-min time-frames. The sensitivity, specificity, and F1-score of AF detection were evaluated for each time-frame. AF alarms were generated to simulate continuous AF monitoring. Sensitivities, specificities, and positive predictive values (PPVs) of the alarms were evaluated. User experiences of PPG and ECG recordings were assessed. The study was registered in the Clinical Trials database (NCT03507335).Results: The quality of PPG signal was better during night-time than in daytime (67.3 ± 22.4% vs. 30.5 ± 19.4%, p < 0.001). The 30-min time-frame yielded the highest F1-score (0.9536), identifying AF correctly in 72/76 AF patients (sensitivity 94.7%), only 3/97 SR patients receiving a false AF diagnosis (specificity 96.9%). The sensitivity and PPV of the simulated AF alarms were 78.2 and 97.2% at night, and 49.3 and 97.0% during the daytime. 82% of patients were willing to use the device at home.Conclusion: PPG wrist-band provided reliable AF identification both during daytime and night-time. The PPG data’s quality was better at night. The positive user experience suggests that wearable PPG devices could be feasible for continuous rhythm monitoring.

Highlights

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and an independent risk for stroke (Hariri et al, 2016; Morillo et al, 2017; Hindricks et al, 2021)
The final study population consisted of 173 patients; 76 patients were assigned to the AF group and 97 patients to the control SR group (Figure 1)
The study population consisted of 173 patients; 76 patients were assigned to the AF group and 97 patients to the SR group (Figure 1)

Summary

Introduction

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and an independent risk for stroke (Hariri et al, 2016; Morillo et al, 2017; Hindricks et al, 2021). Ambulatory 24-h ECG monitoring is often used for AF screening, such as in patients with cryptogenic stroke, with palpitations or after cardiac surgery. 24-h recording time is suboptimal when searching for paroxysmal AF the diagnostic yield increases with prolonged duration and increased number of screenings (Hariri et al, 2016; Diederichsen et al, 2020). It has been claimed that prolonged monitoring improves the possibility of detection of AF and reduces health resource utilization and costs, especially in patients with heart failure and post-stroke (Morillo et al, 2017). The increased mortality, morbidity and economic burden caused by AF justifies screening of the elderly population (Hindricks et al, 2021). Long-term, ambulatory ECG involves burdensome wires and adhesive electrodes causing skin irritation (Hariri et al, 2016)

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