Brito Rita, Mondouagne Louis-Paulin, Stettler Carine, Combescure Christophe, Burri Haran
University of Geneva, Geneva, Switzerland.
Cardiology Department, Geneva University Hospital, Geneva, Switzerland.
J Electrocardiol. 2018 Nov-Dec;51(6):1135-1140. doi: 10.1016/j.jelectrocard.2018.10.093. Epub 2018 Oct 18.
Handheld ECG recorders may have algorithms which automatically inform the user of presence of arrhythmia. The main objectives of this study were to evaluate the accuracy of the arrhythmia diagnosis algorithm of Beurer ME90 recorder to diagnose atrial fibrillation (AF)/flutter, and to evaluate whether recording technique (finger versus precordial) affects diagnostic performance.
Consecutive patients admitted at the cardiology ward of a tertiary care hospital were enrolled. Handheld ECG recordings were performed by holding the device between index fingers (lead I), and by applying it to the chest (modified V4, mV4), with 12‑lead ECGs serving as the gold standard for presence of arrhythmia.
A total of 127 patients were included. The automatic arrhythmia detection algorithm identified all 16 cases of AF, but specificity was poor (62-77%, with slightly better specificity of mV4 compared to lead I). Specificity improved to 84% (95% CI 76-91%) if both lead I and mV4 recordings had to be positive for diagnosis, with a positive predictive value of 48% (95% CI 30-67%). Interpretation of the tracings by an electrophysiologist was 100% specific. Atrial flutter with regular ventricular response was however missed by automatic and manual interpretation.
The automatic arrhythmia algorithm of the BeurerME90 device has excellent sensitivity for diagnosing AF, but with low specificity. Strategies such as first recording lead I (more practical to perform), and in case of arrhythmia detection, confirming with an mV4 recording, may be applied to reduce false positive readings requiring manual confirmation by a healthcare professional.
手持式心电图记录仪可能配备有能自动告知用户心律失常情况的算法。本研究的主要目的是评估Beurer ME90记录仪的心律失常诊断算法诊断心房颤动（AF）/心房扑动的准确性，并评估记录技术（手指导联与胸前导联）是否会影响诊断性能。
纳入一家三级医院心内科病房的连续入院患者。通过将设备夹在食指之间（导联I）以及将其置于胸部（改良V4，mV4）来进行手持式心电图记录，以12导联心电图作为心律失常存在与否的金标准。
共纳入127例患者。自动心律失常检测算法识别出了所有16例房颤病例，但特异性较差（62%-77%，mV4的特异性略高于导联I）。如果导联I和mV4记录均为阳性才能诊断，则特异性提高到84%（95%可信区间76%-91%），阳性预测值为48%（95%可信区间30%-67%）。电生理学家对心电图的解读特异性为100%。然而，自动和手动解读均漏诊了伴有规则心室反应的心房扑动。
Beurer ME90设备的自动心律失常算法对房颤诊断具有出色的敏感性，但特异性较低。可采用先记录导联I（操作更便捷），以及在检测到心律失常时用mV4记录进行确认等策略，以减少需要医疗专业人员手动确认的假阳性读数。
