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A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation

BACKGROUND: There is an increasing number of smartwatches and devices commercially available that can generate and automatically interpret an electrocardiogram (ECG). Such devices have an enormous potential to improve population screening and telemonitoring of atrial fibrillation (AF). PURPOSE: Ther...

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Autores principales: Scholten, J, Mahes, A, De Groot, J R, Winter, M M, Zwinderman, A H, Keijer, J T, Minneboo, M, Horsthuis, T, Jansen, W P J, Bokma, J P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9707874/
http://dx.doi.org/10.1093/ehjdh/ztab104.3047
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author Scholten, J
Mahes, A
De Groot, J R
Winter, M M
Zwinderman, A H
Keijer, J T
Minneboo, M
Horsthuis, T
Jansen, W P J
Bokma, J P
author_facet Scholten, J
Mahes, A
De Groot, J R
Winter, M M
Zwinderman, A H
Keijer, J T
Minneboo, M
Horsthuis, T
Jansen, W P J
Bokma, J P
author_sort Scholten, J
collection PubMed
description BACKGROUND: There is an increasing number of smartwatches and devices commercially available that can generate and automatically interpret an electrocardiogram (ECG). Such devices have an enormous potential to improve population screening and telemonitoring of atrial fibrillation (AF). PURPOSE: There is limited data on the sensitivity, specificity and interpretability of these devices and comparative studies are lacking. Our purpose was to compare three frequently used devices for AF detection. METHODS: We performed a single-center, prospective study in consecutive patients with AF presenting for electrical cardioversion (ECV). We collected a standard 12-lead ECG recording immediately followed by four times 30 seconds of ECG recordings from different devices for every patient prior to the ECV. These paired measurements were considered simultaneous. If the ECV was performed, the same measurements were repeated afterwards. The standard 12L-ECGs were interpreted by a cardiologist and used as golden standard for heart rhythm. The different devices used for the 30 second ECGs were: Withings Move ECG (lead I), Apple Watch series 5 (lead I), Kardia Mobile 6L (six leads) and Withings/Apple (1:1 ratio) on left knee (lead II). Sensitivity and specificity were determined for each AF detection algorithm excluding patients with atrial flutter (AFL) or uninterpretable ECGs. In addition, proportions of uninterpretable ECGs were determined including all patients and including only patients with sinus rhythm (SR) and compared between devices using McNemar's test. RESULTS: A total of 220 patients were included (age 70±10 years, female 35%, first ECV 44%) and in total 415 12-lead ECGs were performed (45% SR, 45% AF, 10% AFL). The sensitivity/specificity were overall similar for all devices (Withings 98%/95%, Apple 94%/98%, Kardia 99%/91%. P>0.05 for all). In detail, Kardia was the most sensitive test with highest proportion of suspected AF (57%) whereas Apple was the most specific, as shown by the highest proportion of normal heart rate results by the device (55%, P=0.003 compared to Kardia (43%)). Overall, Withings, Apple and Kardia had a comparable proportion of uninterpretable ECGs (20%, 20%, 24%, respectively. P>0.05 for all). Lead II had higher proportion of uninterpretable ECGs (32%, p<0.01 compared to all). More specifically, Kardia had a higher rate of uninterpretable ECGs in those with SR (P<0.05 compared to Withings (lead I) and Apple (lead I)). CONCLUSION: In all devices, we found sensitivity/specificity for AF detection between 91%-99%, better than previous studies reported, and 20–24% of uninterpretable ECGs. Kardia was the most sensitive device, but less useful to rule out atrial fibrillation whereas Apple had numerically highest specificity. We aim to further evaluate both cardiologist interpretation and accuracy of atrial flutter detection using different leads to inform clinical use. FUNDING ACKNOWLEDGEMENT: Type of funding sources: Public hospital(s). Main funding source(s): Tergooi Cardiology department, J.P. Bokma was supported with a research grant by Amsterdam Cardiovascular Sciences
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spelling pubmed-97078742023-01-27 A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation Scholten, J Mahes, A De Groot, J R Winter, M M Zwinderman, A H Keijer, J T Minneboo, M Horsthuis, T Jansen, W P J Bokma, J P Eur Heart J Digit Health Abstracts BACKGROUND: There is an increasing number of smartwatches and devices commercially available that can generate and automatically interpret an electrocardiogram (ECG). Such devices have an enormous potential to improve population screening and telemonitoring of atrial fibrillation (AF). PURPOSE: There is limited data on the sensitivity, specificity and interpretability of these devices and comparative studies are lacking. Our purpose was to compare three frequently used devices for AF detection. METHODS: We performed a single-center, prospective study in consecutive patients with AF presenting for electrical cardioversion (ECV). We collected a standard 12-lead ECG recording immediately followed by four times 30 seconds of ECG recordings from different devices for every patient prior to the ECV. These paired measurements were considered simultaneous. If the ECV was performed, the same measurements were repeated afterwards. The standard 12L-ECGs were interpreted by a cardiologist and used as golden standard for heart rhythm. The different devices used for the 30 second ECGs were: Withings Move ECG (lead I), Apple Watch series 5 (lead I), Kardia Mobile 6L (six leads) and Withings/Apple (1:1 ratio) on left knee (lead II). Sensitivity and specificity were determined for each AF detection algorithm excluding patients with atrial flutter (AFL) or uninterpretable ECGs. In addition, proportions of uninterpretable ECGs were determined including all patients and including only patients with sinus rhythm (SR) and compared between devices using McNemar's test. RESULTS: A total of 220 patients were included (age 70±10 years, female 35%, first ECV 44%) and in total 415 12-lead ECGs were performed (45% SR, 45% AF, 10% AFL). The sensitivity/specificity were overall similar for all devices (Withings 98%/95%, Apple 94%/98%, Kardia 99%/91%. P>0.05 for all). In detail, Kardia was the most sensitive test with highest proportion of suspected AF (57%) whereas Apple was the most specific, as shown by the highest proportion of normal heart rate results by the device (55%, P=0.003 compared to Kardia (43%)). Overall, Withings, Apple and Kardia had a comparable proportion of uninterpretable ECGs (20%, 20%, 24%, respectively. P>0.05 for all). Lead II had higher proportion of uninterpretable ECGs (32%, p<0.01 compared to all). More specifically, Kardia had a higher rate of uninterpretable ECGs in those with SR (P<0.05 compared to Withings (lead I) and Apple (lead I)). CONCLUSION: In all devices, we found sensitivity/specificity for AF detection between 91%-99%, better than previous studies reported, and 20–24% of uninterpretable ECGs. Kardia was the most sensitive device, but less useful to rule out atrial fibrillation whereas Apple had numerically highest specificity. We aim to further evaluate both cardiologist interpretation and accuracy of atrial flutter detection using different leads to inform clinical use. FUNDING ACKNOWLEDGEMENT: Type of funding sources: Public hospital(s). Main funding source(s): Tergooi Cardiology department, J.P. Bokma was supported with a research grant by Amsterdam Cardiovascular Sciences Oxford University Press 2021-12-29 /pmc/articles/PMC9707874/ http://dx.doi.org/10.1093/ehjdh/ztab104.3047 Text en Reproduced from: European Heart Journal, Volume 42, Issue Supplement_1, October 2021, ehab724.3047, https://doi.org/10.1093/eurheartj/ehab724.3047 by permission of Oxford University Press on behalf of the European Society of Cardiology. The opinions expressed in the Journal item reproduced as this reprint are those of the authors and contributors, and do not necessarily reflect those of the European Society of Cardiology, the editors, the editorial board, Oxford University Press or the organization to which the authors are affiliated. The mention of trade names, commercial products or organizations, and the inclusion of advertisements in this reprint do not imply endorsement by the Journal, the editors, the editorial board, Oxford University Press or the organization to which the authors are affiliated. The editors and publishers have taken all reasonable precautions to verify drug names and doses, the results of experimental work and clinical findings published in the Journal. The ultimate responsibility for the use and dosage of drugs mentioned in this reprint and in interpretation of published material lies with the medical practitioner, and the editors and publisher cannot accept liability for damages arising from any error or omissions in the Journal or in this reprint. Please inform the editors of any errors. © The Author(s) 2021. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Scholten, J
Mahes, A
De Groot, J R
Winter, M M
Zwinderman, A H
Keijer, J T
Minneboo, M
Horsthuis, T
Jansen, W P J
Bokma, J P
A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation
title A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation
title_full A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation
title_fullStr A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation
title_full_unstemmed A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation
title_short A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation
title_sort comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9707874/
http://dx.doi.org/10.1093/ehjdh/ztab104.3047
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