JMIR Publications

ABSTRACT

Background:

Atrial fibrillation (AF) is the most common cardiac arrhythmia and associated with an increased risk of stroke, thromboembolic events and reduced quality of life. A single-lead electrocardiogram (ECG) for 30 seconds is recognized as a diagnostic standard in current guidelines.

Objective:

The aim of this study was to investigate the feasibility and accuracy of a mobile single-lead ECG device for screening AF in both inpatient and outpatient populations.

Methods:

This was a multicenter cross-sectional study at three university hospitals and three general medical practices. An FDA-approved single-lead ECG (AliveCor KardiaMobile) was used to measure the heart rhythm. Sensitivity, specificity, positive and negative predictive value for the detection of AF was quantified. Secondary outcomes included feasibility parameters defined as measurement faults and patient’s awareness of the diagnosis of ‘Atrial fibrillation’.

Results:

Overall, 237 patients were enrolled in the study (43 outpatients, 194 inpatients). The device detected AF in 50/237 measurements, resulting in a rate of 21.1%. Unknown AF was detected in 1.7%. The algorithm provided an automatic diagnosis for 95.3% (41/43) of the outpatients and 85.6% (166/194) of the inpatients. Overall, measurement faults occurred in 16% (38/237) of all measurements with slightly more problems in the inpatient (17.5%) than in the outpatient sector (9.3%), p=0.25. In inpatients and outpatients, sensitivity for the detection of AF was 59.5%/50.5%; specificity 99.2%/97.2% resulting in a positive predictive value of 97.8%/92.0% and a negative predictive value of 79.9%/75.8% respectively. A minority of patients (6.3%) use telemedicine applications regularly.

Conclusions:

Screening of patients using mobile single-lead ECGs revealed a high rate of AF, which increased with age. Wearables may have the opportunity to identify AF at an early stage and improve the current screening procedure. Clinical Trial: NA