Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Entrévägen 2, 182 88, Stockholm, Sweden.
Department of Cardiology, Danderyd University Hospital, Entrévägen 2, 182 88, Stockholm, Sweden.
Europace. 2024 Mar 30;26(4). doi: 10.1093/europace/euae079.
In the current guidelines, smartphone photoplethysmography (PPG) is not recommended for diagnosis of atrial fibrillation (AF), without a confirmatory electrocardiogram (ECG) recording. Previous validation studies have been performed under supervision in healthcare settings, with limited generalizability of the results. We aim to investigate the diagnostic performance of a smartphone-PPG method in a real-world setting, with ambulatory unsupervised smartphone-PPG recordings, compared with simultaneous ECG recordings and including patients with atrial flutter (AFL).
Unselected patients undergoing direct current cardioversion for treatment of AF or AFL were asked to perform 1-min heart rhythm recordings post-treatment, at least twice daily for 30 days at home, using an iPhone 7 smartphone running the CORAI Heart Monitor PPG application simultaneously with a single-lead ECG recording (KardiaMobile). Photoplethysmography and ECG recordings were read independently by two experienced readers. In total, 280 patients recorded 18 005 simultaneous PPG and ECG recordings. Sufficient quality for diagnosis was seen in 96.9% (PPG) vs. 95.1% (ECG) of the recordings (P < 0.001). Manual reading of the PPG recordings, compared with manually interpreted ECG recordings, had a sensitivity, specificity, and overall accuracy of 97.7%, 99.4%, and 98.9% with AFL recordings included and 99.0%, 99.7%, and 99.5%, respectively, with AFL recordings excluded.
A novel smartphone-PPG method can be used by patients unsupervised at home to achieve accurate heart rhythm diagnostics of AF and AFL with very high sensitivity and specificity. This smartphone-PPG device can be used as an independent heart rhythm diagnostic device following cardioversion, without the requirement of confirmation with ECG.
目前的指南不建议使用智能手机光体积描记法（PPG）诊断心房颤动（AF），而需要进行心电图（ECG）记录的确认。以前的验证研究是在医疗保健环境中进行的，受到监督，结果的普遍性有限。我们旨在研究一种智能手机-PPG 方法在真实环境中的诊断性能，该方法使用非监督的智能手机-PPG 记录，与同时的 ECG 记录进行比较，并包括房扑（AFL）患者。
未选择的因 AF 或 AFL 而行直流电复律治疗的患者被要求在治疗后在家中至少每天进行两次 1 分钟的心律记录，使用运行 CORAI Heart Monitor PPG 应用程序的 iPhone 7 智能手机同时进行单导联 ECG 记录（KardiaMobile）。PPG 和 ECG 记录由两名有经验的读者独立读取。共有 280 名患者记录了 18005 次同时的 PPG 和 ECG 记录。诊断质量足够的记录分别为 96.9%（PPG）和 95.1%（ECG）（P<0.001）。与手动解读 ECG 记录相比，手动解读 PPG 记录对 AFL 记录的敏感性、特异性和总准确性分别为 97.7%、99.4%和 98.9%，排除 AFL 记录后分别为 99.0%、99.7%和 99.5%。
一种新的智能手机-PPG 方法可让患者在家中进行非监督使用，以实现 AF 和 AFL 的精确心律诊断，具有非常高的敏感性和特异性。这种智能手机-PPG 设备可在电复律后用作独立的心律诊断设备，无需进行 ECG 确认。
