Visual Reassessment with Flux-Interval Plot Configuration after Automatic Classification for Accurate Atrial Fibrillation Detection by Photoplethysmography

Atrial fibrillation (AFib) is a common type of arrhythmia that is often clinically asymptomatic, which increases the risk of stroke significantly but can be prevented with anticoagulation. The photoplethysmogram (PPG) has recently attracted a lot of attention as a surrogate for electrocardiography (ECG) on atrial fibrillation (AFib) detection, with its out-of-hospital usability for rapid screening or long-term monitoring. Previous studies on AFib detection via PPG signals have achieved good results, but were short of intuitive criteria like ECG p-wave absence or not, especially while using interval randomness to detect AFib suffering from conjunction with premature contractions (PAC/PVC). In this study, we newly developed a PPG flux (pulse amplitude) and interval plots-based methodology, simply comprising an irregularity index threshold of 20 and regression error threshold of 0.06 for the precise automatic detection of AFib. The proposed method with automated detection on AFib shows a combined sensitivity, specificity, accuracy, and precision of 1, 0.995, 0.995, and 0.952 across the 460 samples. Furthermore, the flux-interval plot configuration also acts as a very intuitive tool for visual reassessment to confirm the automatic detection of AFib by its distinctive plot pattern compared to other cardiac rhythms. The study demonstrated that exclusive 2 false-positive cases could be corrected after the reassessment. With the methodology’s background theory well established, the detection process automated and visualized, and the PPG sensors already extensively used, this technology is very user-friendly and convincing for promoted to in-house AFib diagnostics.