Department of Anesthesia, Tampere University Hospital, Tampere, Finland.
Physiol Meas. 2018 Jun 27;39(6):065007. doi: 10.1088/1361-6579/aac9a9.
Atrial fibrillation (AF) causes marked risk for patients, while silent fibrillation may remain unnoticed if not suspected and screened. Development of comfortable yet accurate beat-to-beat heart rate (HR) monitoring with good AF detection sensitivity would facilitate screening and improve treatment. The purpose of this study was to evaluate whether a wrist-worn photoplethysmography (PPG) device can be used to monitor beat-to-beat HR accurately during post-operative treatment in patients suffering from AF and whether wrist-PPG can be used to distinguish AF from sinus rhythm (SR).
Twenty-nine patients (14 with AF, 15 with SR, mean age 71.5 years) with multiple comorbidities were monitored during routine post-operative treatment. The monitoring included standard ECG, finger PPG monitoring and a wrist-worn PPG monitor with green and infrared light sources. The HR from PPG sensors was compared against ECG-derived HR.
The wrist PPG technology had very good HR and beat detection accuracy when using green light. For the SR group, the mean absolute error (MAE) for HR was 1.50 bpm, and for the inter-beat intervals (IBI), the MAE was 7.64 ms. For the AF group, the MAE for HR was 4.28 bpm and for IBI, the MAE was 14.67 ms. Accuracy for the infrared (IR) channel was worse. Finger PPG provided similar accuracy for HR and better accuracy for the IBI. AF detection sensitivity using green light was 99.0% and the specificity was 93.0%. Performance can be improved by discarding unreliable IBI periods.
Results suggest that wrist PPG measurement allows accurate HR and beat-to-beat HR monitoring also in AF patients, and could be used for differentiating between SR and AF with very good sensitivity.
心房颤动（AF）会给患者带来显著风险，如果没有被怀疑和筛查，无声的房颤可能会被忽视。开发一种舒适且准确的实时心率（HR）监测方法，具有良好的房颤检测灵敏度，将有助于筛查并改善治疗效果。本研究旨在评估腕部光体积描记法（PPG）设备是否可用于监测 AF 术后患者的实时 HR，以及腕部 PPG 是否可用于区分 AF 与窦性心律（SR）。
对 29 名患有多种合并症的患者（AF 患者 14 名，SR 患者 15 名，平均年龄 71.5 岁）进行常规术后治疗监测。监测包括标准心电图、指端 PPG 监测和腕部带有绿光和红外光源的 PPG 监测仪。将 PPG 传感器的 HR 与心电图衍生的 HR 进行比较。
当使用绿光时，腕部 PPG 技术具有非常好的 HR 和心跳检测准确性。对于 SR 组，HR 的平均绝对误差（MAE）为 1.50 bpm，IBI 的 MAE 为 7.64 ms。对于 AF 组，HR 的 MAE 为 4.28 bpm，IBI 的 MAE 为 14.67 ms。IR 通道的准确性较差。指端 PPG 为 HR 提供了相似的准确性，为 IBI 提供了更好的准确性。绿光下的 AF 检测灵敏度为 99.0%，特异性为 93.0%。通过丢弃不可靠的 IBI 时段，可以提高性能。
结果表明，腕部 PPG 测量允许在 AF 患者中进行准确的 HR 和实时 HR 监测，并且可以非常灵敏地用于区分 SR 和 AF。
