基于智能手机的光电容积脉搏波法在心房颤动中进行心率和节律监测的真实世界验证。

Real-world validation of smartphone-based photoplethysmography for rate and rhythm monitoring in atrial fibrillation.

机构信息

Department of Cardiology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600 Genk, Belgium.

Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.

出版信息

Europace. 2024 Mar 30;26(4). doi: 10.1093/europace/euae065.

AIMS

Photoplethysmography- (PPG) based smartphone applications facilitate heart rate and rhythm monitoring in patients with paroxysmal and persistent atrial fibrillation (AF). Despite an endorsement from the European Heart Rhythm Association, validation studies in this setting are lacking. Therefore, we evaluated the accuracy of PPG-derived heart rate and rhythm classification in subjects with an established diagnosis of AF in unsupervised real-world conditions.

METHODS AND RESULTS

Fifty consecutive patients were enrolled, 4 weeks before undergoing AF ablation. Patients used a handheld single-lead electrocardiography (ECG) device and a fingertip PPG smartphone application to record 3907 heart rhythm measurements twice daily during 8 weeks. The ECG was performed immediately before and after each PPG recording and was given a diagnosis by the majority of three blinded cardiologists. A consistent ECG diagnosis was exhibited along with PPG data of sufficient quality in 3407 measurements. A single measurement exhibited good quality more often with ECG (93.2%) compared to PPG (89.5%; P < 0.001). However, PPG signal quality improved to 96.6% with repeated measurements. Photoplethysmography-based detection of AF demonstrated excellent sensitivity [98.3%; confidence interval (CI): 96.7-99.9%], specificity (99.9%; CI: 99.8-100.0%), positive predictive value (99.6%; CI: 99.1-100.0%), and negative predictive value (99.6%; CI: 99.0-100.0%). Photoplethysmography underestimated the heart rate in AF with 6.6 b.p.m. (95% CI: 5.8 b.p.m. to 7.4 b.p.m.). Bland-Altman analysis revealed increased underestimation in high heart rates. The root mean square error was 11.8 b.p.m.

CONCLUSION

Smartphone applications using PPG can be used to monitor patients with AF in unsupervised real-world conditions. The accuracy of AF detection algorithms in this setting is excellent, but PPG-derived heart rate may tend to underestimate higher heart rates.

目的

基于光电容积脉搏波（PPG）的智能手机应用程序方便了阵发性和持续性心房颤动（AF）患者的心率和节律监测。尽管得到了欧洲心律协会的认可，但在这种情况下，验证研究仍然缺乏。因此，我们评估了在非监督真实环境中，PPG 衍生的心率和节律分类在已确诊 AF 患者中的准确性。

方法和结果

连续纳入 50 例患者，在接受 AF 消融前 4 周。患者使用手持式单导联心电图（ECG）设备和指尖 PPG 智能手机应用程序，在 8 周内每天两次记录 3907 次心率测量值。每次 PPG 记录前后立即进行 ECG，并由三位盲法心脏病专家多数进行诊断。在 3407 次测量中，显示出一致的 ECG 诊断和足够质量的 PPG 数据。单次测量的质量通常比 PPG（89.5%；P < 0.001）更好。然而，PPG 信号质量通过重复测量提高到 96.6%。基于光电容积脉搏波的 AF 检测显示出极好的灵敏度[98.3%；置信区间（CI）：96.7-99.9%]、特异性（99.9%；CI：99.8-100.0%）、阳性预测值（99.6%；CI：99.1-100.0%）和阴性预测值（99.6%；CI：99.0-100.0%）。PPG 低估了 AF 中的心率，为 6.6 bpm（95%CI：5.8 bpm 至 7.4 bpm）。Bland-Altman 分析显示，在高心率时，低估程度增加。均方根误差为 11.8 bpm。