Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 21, 2020
Date Accepted: Dec 12, 2020
Performance of a mobile single-lead electrocardiogram technology for atrial fibrillation screening in a semi-rural African population: Insights from the TEFF-AF Study
ABSTRACT
Background:
Atrial fibrillation (AF) screening using mobile single-lead electrocardiogram (EKG) devices has demonstrated variable sensitivity and specificity. However, limited data exists on the usage of such devices in low resource countries.
Objective:
To evaluate the utility of the KardiaMobile device (KM, AliveCor Inc, CA, USA) for AF screening in a semi-rural Ethiopian population.
Methods:
Thirty second single-lead EKG tracings obtained using the KM device from 1,500 TEFF-AF (The hEart oF Ethiopia: Focus on Atrial Fibrillation; ACTR Number: 12619001107112) study participants were analyzed. We evaluated the KM device performance for AF screening by comparing KM’s automated algorithm with cardiologist’s interpretation.
Results:
A total of 1,709 single-lead EKG tracings (including repeat tracing on 209 occasions) were analyzed from 1,500 Ethiopians (64% male, 35±13 years old) who presented for AF screening. Initial successful rhythm decision (“normal” or “possible AF”) with one single-lead EKG tracing was lower with the KM automated algorithm versus manual verification by cardiologists (78% vs. 97%, P<.001). Repeat single-lead EKG tracings in 209 individuals improved overall rhythm decision, but the KM automated algorithm remained inferior (87% vs. 99%, P<.001). The key reasons underlying unsuccessful KM automated rhythm determination (n=408 traces) include poor quality/noisy tracings (52%), frequent ectopy (5%) and tachycardia (>100bpm; 41%). The sensitivity and specificity of KM automated rhythm diagnosis was 81% and 78% respectively.
Conclusions:
The performance of the KM single-lead EKG device with automated algorithm was sub-optimal when used for AF screening. Repeat KM tracing and physician’s input are necessary for improving rhythm decision success. Clinical Trial: ACTR Number: 12619001107112
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