Wrist band photoplethysmography in detection of individual pulses in atrial fibrillation and algorithm-based detection of atrial fibrillation

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1031-1038 ◽  
Author(s):  
E -S Väliaho ◽  
P Kuoppa ◽  
J A Lipponen ◽  
T J Martikainen ◽  
H Jäntti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Detection Sensitivity ◽  
Pulse Detection ◽  
Recent Onset ◽  
Detection Algorithms ◽  
Individual Pulse ◽  
Clinical Challenge ◽  
Golden Standard ◽  
Study Population ◽  
Rhythm Analysis

Aims Atrial fibrillation (AF) is the most common tachyarrhythmia and a significant cause of cardioembolic strokes. Atrial fibrillation is often intermittent and asymptomatic making detection a major clinical challenge. We evaluated a photoplethysmography (PPG) wrist band in individual pulse detection in patients with AF and tested the reliability of two commonly used algorithms for AF detection. Methods and results A 5-min PPG was recorded from patients with AF or sinus rhythm (SR) with a wrist band and analysed with two AF detection algorithms; AFEvidence and COSEn. Simultaneously registered electrocardiogram served as the golden standard for rhythm analysis and was interpreted by two cardiologists. The study population consisted of 213 (106 AF, 107 SR) patients. The wrist band PPG achieved individual pulse detection with a sensitivity of 91.7 ± 11.2% and a positive predictive value (PPV) of 97.5 ± 4.6% for AF, with a sensitivity of 99.4 ± 1.5% [7.7% (95% confidence interval, 95% CI 5.5% to 9.9%); P < 0.001] and PPV of 98.1 ± 4.1% [0.6% (95% CI −0.6% to 1.7%); P = 0.350] for SR. The pulse detection sensitivity was lower 86.7 ± 13.9% with recent-onset AF (AF duration <48 h, n = 43, 40.6%) as compared to late AF (≥48 h, n = 63, 59.4%) with 95.1 ± 7.2% [−8.3% (95% CI −12.9% to −3.7%); P = 0.001]. For the detection of AF from the wrist band PPG, the sensitivities were 96.2%/95.3% and specificity 98.1% with two algorithms. Conclusion The wrist band PPG enabled accurate algorithm-based detection of AF with two AF detection algorithms and high individual pulse detection. Algorithms allowed accurate detection of AF from the PPG. A PPG wrist band provides an easy solution for AF screening.

P6541Wrist band photoplethysmography pulse morphology-based autocorrelation analysis enables atrial fibrillation detection without the need of pulse detection

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E.-S Valiaho ◽  
P Kuoppa ◽  
J A Lipponen ◽  
T J Martikainen ◽  
H Jantti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Sensitivity And Specificity ◽  
Detection Accuracy ◽  
Pulse Detection ◽  
Golden Standard ◽  
Study Population ◽  
Pulse Waves ◽  
Promising Solution ◽  
Rhythm Analysis

Abstract Background Atrial fibrillation (AF) is often asymptomatic and intermittent making its detection a major clinical challenge. A photoplethysmography (PPG) wrist band with algorithm-based detection of AF provides a promising solution for screening of AF. However, the shapes of individual pulse waveforms vary in AF decreasing pulse detection accuracy. Purpose The purpose of this study was to evaluate the utility of PPG wrist band pulse morphology in detection of AF. Methods A 5-minute PPG was recorded with a PPG wrist band from patients with AF or sinus rhythm. A simultaneously registered ECG served as the golden standard for the rhythm analysis and was interpreted by two cardiologists. In addition to using the inter-beat-interval (IBI) based AFEvidence algorithm in comparison, we extracted a feature straight from the PPG signal, without the need of pulse detection. This feature was calculated as the average of absolute autocorrelation values over different lags. The feature describes the regularity of the PPG signal and is decreased if the shape and periodicity of pulse waves vary. The performance of this PPG morphology-based method in detection of AF was evaluated and compared to the AFEvidence. Results The study population consisted of 213 patients (106 AF, 107 sinus rhythm). The sensitivity and specificity of PPG morphology-based autocorrelation AF detection method were 98.1% and 94.4%. For AFEvidence, the sensitivity and specificity were 96.2% and 98.1%, respectively (p=0.146 between the methods, McNemar test). PPG samples of AF and sinus rhythm Conclusions The PPG morphology-based autocorrelation method detects AF with good accuracy without the need of pulse detection. The method seems promising in detection of AF and should be studied further. Acknowledgement/Funding None

224Wireless ECG embedded in a necklace enables reliable detection of atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
O E Santala ◽  
J A Lipponen ◽  
H Jantti ◽  
T T Rissanen ◽  
J Halonen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Early Stage ◽  
Public Health Problem ◽  
Detection Algorithm ◽  
University Hospital ◽  
Easy Method ◽  
Golden Standard ◽  
Study Population ◽  
Adult Volunteers

Abstract Funding Acknowledgements Goverment grant, Heart2save Ltd cooperation. Background/Introduction: Atrial fibrillation (AF) is the most common arrhythmia and a fast-growing public health problem worldwide. Main and the most severe complication of AF is an embolic stroke. Approximately 25% of all strokes are caused by AF. AF is often symptomless and intermittent, making its detection and diagnosing challenging. Many AF patients have both symptomatic and asymptomatic periods of arrhythmia. In addition, during the early stage of the disease, AF is often paroxysmal making the diagnosis of AF a major clinical challenge. Purpose Wearable ECG devices could enable repetitive rhythm monitoring over a long term and thus improve the probability of AF detection. Wearable devices have the advantage of being easily available. However, they also need to be reliable and their design should appeal customers. Our aim was to study the suitability and reliability of novel measurement technique (necklace-ECG, Figure1) for the diagnosis of AF. Methods The study population consisted of 145 adult volunteers at Kuopio University Hospital emergency department (66 AF and 79 sinus rhythm (SR), diagnosed from continuous 3-lead ECG recording. All study subjects performed a thirty-second self-performed ECG recording with a single-lead necklace-embedded ECG recorder (necklace-ECG) keeping the recorder between palms of their hands. The ECG recordings were analyzed with automatic AF detection algorithm. Two cardiologists interpreted independently in blinded fashion the necklace-ECG recordings and simultaneously registered 3-lead ECGs which served as golden standard for the final rhythm diagnosis. Results Necklace-ECG produced an interpretable ECG recording in 91.0%/86.2% patients (Doc1/Doc2, respectively). Additionally, 93.1% of ECG recordings were interpretable by the automatic analysis service (98.7% in SR patients and 86.4% of AF patients). Base on the necklace ECG recording, cardiologists were able to diagnose AF with sensitivity of 98.2%/96.3% (Doc1/Doc2, respectively) and specificity of 100% (Doc1 and Doc2, respectively). The automatic arrhythmia algorithm diagnosed AF with sensitivity of 94.7% and specificity of 100%. Conclusions The necklace-ECG device produces ECG recording with sufficient quality for the detection of AF with good sensitivity and specificity as evaluated both by cardiologist and automated AF-detection algorithm. Thus, wearable necklace-ECG provides a new and easy method for screening, identifying and diagnosing AF. Abstract Figure 1

scholarly journals Wrist Band Photoplethysmography Autocorrelation Analysis Enables Detection of Atrial Fibrillation Without Pulse Detection

2021 ◽  
Vol 12 ◽  
Author(s):  
Eemu-Samuli Väliaho ◽  
Pekka Kuoppa ◽  
Jukka A. Lipponen ◽  
Juha E. K. Hartikainen ◽  
Helena Jäntti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Characteristic Curve ◽  
Pulse Interval ◽  
Detection Accuracy ◽  
Monitoring Method ◽  
Pulse Detection ◽  
Detection Algorithms ◽  
Pulse Waves ◽  
Predictor Model ◽  
Atrial Fibrillation Detection

Atrial fibrillation is often asymptomatic and intermittent making its detection challenging. A photoplethysmography (PPG) provides a promising option for atrial fibrillation detection. However, the shapes of pulse waves vary in atrial fibrillation decreasing pulse and atrial fibrillation detection accuracy. This study evaluated ten robust photoplethysmography features for detection of atrial fibrillation. The study was a national multi-center clinical study in Finland and the data were combined from two broader research projects (NCT03721601, URL: https://clinicaltrials.gov/ct2/show/NCT03721601 and NCT03753139, URL: https://clinicaltrials.gov/ct2/show/NCT03753139). A photoplethysmography signal was recorded with a wrist band. Five pulse interval variability, four amplitude features and a novel autocorrelation-based morphology feature were calculated and evaluated independently as predictors of atrial fibrillation. A multivariate predictor model including only the most significant features was established. The models were 10-fold cross-validated. 359 patients were included in the study (atrial fibrillation n = 169, sinus rhythm n = 190). The autocorrelation univariate predictor model detected atrial fibrillation with the highest area under receiver operating characteristic curve (AUC) value of 0.982 (sensitivity 95.1%, specificity 93.7%). Autocorrelation was also the most significant individual feature (p &lt; 0.00001) in the multivariate predictor model, detecting atrial fibrillation with AUC of 0.993 (sensitivity 96.4%, specificity 96.3%). Our results demonstrated that the autocorrelation independently detects atrial fibrillation reliably without the need of pulse detection. Combining pulse wave morphology-based features such as autocorrelation with information from pulse-interval variability it is possible to detect atrial fibrillation with high accuracy with a commercial wrist band. Photoplethysmography wrist bands accompanied with atrial fibrillation detection algorithms utilizing autocorrelation could provide a computationally very effective and reliable wearable monitoring method in screening of atrial fibrillation.

scholarly journals Clinical challenge II: Management of recent onset atrial fibrillation

1996 ◽  
Vol 17 (suppl C) ◽  
pp. 41-47 ◽  
Author(s):  
C. Fresco ◽  
A. Proclemer ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Recent Onset ◽  
Clinical Challenge ◽  
Onset Atrial Fibrillation

699 Late increase of inflammatory markers in patients with recent onset atrial fibrillation is related with cardioversion outcome

2007 ◽  
Vol 6 (1) ◽  
pp. 154-154
Author(s):  
A KALOGEROPOULOS ◽  
A RIGOPOULOS ◽  
S PAPATHANASIOU ◽  
S TSIODRAS ◽  
S DRAGOMANOVITS ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Inflammatory Markers ◽  
Recent Onset ◽  
Onset Atrial Fibrillation

scholarly journals On-Demand Mobile Health Infrastructure for Remote Rhythm Monitoring within a Wait-and-See Strategy for Recent-Onset Atrial Fibrillation: TeleWAS-AF

Cardiology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Nikki A.H.A. Pluymaekers ◽  
Rachel M.J. van der Velden ◽  
Astrid N.L. Hermans ◽  
Monika Gawalko ◽  
Saskia Buskes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Mobile Health ◽  
Treatment Decision ◽  
Care Process ◽  
Care Utilization ◽  
Recent Onset ◽  
On Demand ◽  
Wait And See ◽  
Rhythm Monitoring

Recently, we introduced the TeleCheck-AF approach, an on-demand mobile health (mHealth) infrastructure using app-based heart rate and rhythm monitoring for 7 days, to support long-term atrial fibrillation (AF) management through teleconsultation. Herein, we extend the mHealth approach to patients with recent-onset AF at the emergency department (ED). In the proposed TeleWAS-AF approach, on-demand heart rate and rhythm monitoring are used to support a wait-and-see strategy at the ED. All stable patients who present to the ED with recent-onset symptomatic AF and who are able to use mHealth solutions for heart rate and rhythm monitoring are eligible for this approach. Patients will receive both education on AF and instructions on the use of the mHealth technology before discharge from the ED. A case coordinator will subsequently check whether patients are able to activate the mHealth solution and to perform heart rate and rhythm measurements. Forty hours after AF onset, the first assessment teleconsultation with the physician will take place, determining the need for delayed cardioversion. After maximal 7 days of remote monitoring, a second assessment teleconsultation may occur, in which the rhythm can be reassessed and further treatment strategy can be discussed with the patients. This on-demand mHealth prescription increases patient involvement in the care process and treatment decision-making by encouraging self-management, while avoiding excess data-load requiring work-intensive and expensive data management. Implementation of the TeleWAS-AF approach may facilitate the management of AF in the ED and reduce the burden on the ED system, which enhances the capacity for health care utilization.

scholarly journals Atrial fibrillation progression risk factors and associated cardiovascular outcome in well-phenotyped patients: data from the AF-RISK study

EP Europace ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 352-360 ◽  
Author(s):  
Ruben R De With ◽  
Ernaldo G Marcos ◽  
Elton A M P Dudink ◽  
Henri M Spronk ◽  
Harry J G M Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Standard Deviation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Plasminogen Activator Inhibitor 1 ◽  
Atrial Volume ◽  
Standard Deviation Increase ◽  
Recent Onset ◽  
Pai 1

Abstract Aims Atrial fibrillation (AF) is a progressive disease, but identifying patients at risk for AF progression is challenging. We aimed to identify factors associated with AF progression. Methods and results Atrial fibrillation progression was assessed in 392 patients with recent-onset paroxysmal or persistent AF included in the prospective, observational, multicentre identification of a risk profile to guide atrial fibrillation (AF-RISK) study. Progression of AF was assessed by Holter monitoring and 2-week event recorder at baseline and 1-year follow-up. AF progression was defined as: (i) doubling in AF burden at 1 year compared to baseline with a minimum AF burden of 10% in paroxysmal AF; or (ii) transition from paroxysmal to persistent or permanent AF; or (iii) persistent to permanent AF. Age was 60 ± 11 years, 62% were men, and 83% had paroxysmal AF. At 1 year, 52 (13%) had AF progression (11% in paroxysmal; 26% in persistent AF). Multivariable logistic regression showed that left atrial volume [odds ratio (OR) per 10 mL 1.251, 95% confidence interval (CI) 1.078–1.450; P &lt; 0.001], N-terminal pro-B-type natriuretic peptide (NT-proBNP; OR per standard deviation increase 1.583, 95% CI 1.099–2.281; P = 0.014), and plasminogen activator inhibitor-1 (PAI-1; OR per standard deviation increase 0.660, 95% CI 0.472–0.921; P = 0.015) were associated with AF progression. In an additional follow-up of 1.9 (0.9–3.3) years patients with AF progression developed more cardiovascular events and all-cause mortality (12.4%/year vs. 2.3%/year, P &lt; 0.001). Conclusion Atrial fibrillation progression occurred in 13% of patients with recent-onset AF during 1-year follow-up. Left atrial volume, NT-proBNP, and PAI-1 were associated with AF progression. Patients with AF progression had a higher event rate. Trial registration number Clinicaltrials.gov NCT01510210.

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