Yasar Sattar1, David Song1, Deepika Sarvepalli2, Syeda Ramsha Zaidi3, Waqas Ullah4, Junaid Arshad5, Tanveer Mir6, Mohamed Zghouzi6, Islam Y Elgendy7, Waqas Qureshi8, Nagib Chalfoun9, MChadi Alraies10. 1. Cardiology, West Virginia University, Morgantown, WV, USA. 2. Internal Medicine, Guntur Medical College, Guntur, Punjab, India. 3. Internal Medicine, Saint Mary Mercy Hospital, Livonia, MI, USA. 4. Cardiology, Thomas Jefferson University, Philadelphia, PA, USA. 5. Internal Medicine, Institute of Medical Sciences, Islamabad, Pakistan. 6. Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA. 7. Cardiology, Weill Cornell University, Doha, Qatar. 8. Cardiology, University of Massachusetts Medical School, Worcester, MA, USA. 9. Cardiology, Spectrum Health Heart and Vascular, Michigan State University, Grand Rapids, MI, USA. 10. Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA. alraies@hotmail.com.
Abstract
BACKGROUND: The relative accuracy of pulsatile photoplethysmography applications (PPG) or handheld (HH) devices compared with the gold standard 12-lead electrocardiogram (ECG) for the diagnosis of atrial fibrillation is unknown. METHODS: Digital databases were searched to identify relevant articles. Raw data were pooled using a bivariate model to calculate diagnostic accuracy measures and estimate Hierarchical Summary Receiver Operating Characteristic (HSROC). RESULTS: A total of 10 articles comprising 4296 patients (mean age 68.9 years, with 56% males) were included in the analysis. Compared with EKG, the pooled sensitivity of PPG and HH devices in AF detection was 0.93 (95% CI 0.87-0.96; p < 0.05) and 0.87 (95% CI. 0.74-0.94; p < 0.05), respectively. The pooled specificity of PPG and HH devices in AF detection was 0.91 (95% CI 0.88-0.94; p < 0.05) and 0.96 (95% CI 0.90-0.98; p < 0.05), respectively. The diagnostic odds ratio was 129 and 144 for PPG and HH devices, respectively. Fagan's nomogram showed the probability of a patient having AF and normal rhythm on PPG or HH devices was 2-3%, while the post-test probability of having AF with an irregular R-R interval on PPG or HH devices was 73% and 82%, respectively. The scatter plot of positive and negative likelihood ratio showed high confirmation of AF and reliability of exclusion of absence of irregular R-R intervals (positive likelihood ratio > 10, and negative likelihood ratio < 0.1) on HH devices while PPG was used as confirmation only. CONCLUSIONS: The PPG or HH devices can serve as a reliable alternative for the detection of AF.
BACKGROUND: The relative accuracy of pulsatile photoplethysmography applications (PPG) or handheld (HH) devices compared with the gold standard 12-lead electrocardiogram (ECG) for the diagnosis of atrial fibrillation is unknown. METHODS: Digital databases were searched to identify relevant articles. Raw data were pooled using a bivariate model to calculate diagnostic accuracy measures and estimate Hierarchical Summary Receiver Operating Characteristic (HSROC). RESULTS: A total of 10 articles comprising 4296 patients (mean age 68.9 years, with 56% males) were included in the analysis. Compared with EKG, the pooled sensitivity of PPG and HH devices in AF detection was 0.93 (95% CI 0.87-0.96; p < 0.05) and 0.87 (95% CI. 0.74-0.94; p < 0.05), respectively. The pooled specificity of PPG and HH devices in AF detection was 0.91 (95% CI 0.88-0.94; p < 0.05) and 0.96 (95% CI 0.90-0.98; p < 0.05), respectively. The diagnostic odds ratio was 129 and 144 for PPG and HH devices, respectively. Fagan's nomogram showed the probability of a patient having AF and normal rhythm on PPG or HH devices was 2-3%, while the post-test probability of having AF with an irregular R-R interval on PPG or HH devices was 73% and 82%, respectively. The scatter plot of positive and negative likelihood ratio showed high confirmation of AF and reliability of exclusion of absence of irregular R-R intervals (positive likelihood ratio > 10, and negative likelihood ratio < 0.1) on HH devices while PPG was used as confirmation only. CONCLUSIONS: The PPG or HH devices can serve as a reliable alternative for the detection of AF.
Authors: Jeffrey M Ashburner; Steven J Atlas; David D McManus; Yuchiao Chang; Ana T Trisini Lipsanopoulos; Leila H Borowsky; Wyliena Guan; Wei He; Patrick T Ellinor; Daniel E Singer; Steven A Lubitz Journal: Am Heart J Date: 2019-06-22 Impact factor: 4.749