AUTHOR=Bacevicius Justinas , Abramikas Zygimantas , Dvinelis Ernestas , Audzijoniene Deimile , Petrylaite Marija , Marinskiene Julija , Staigyte Justina , Karuzas Albinas , Juknevicius Vytautas , Jakaite Rusne , Basyte-Bacevice Viktorija , Bileisiene Neringa , Solosenko Andrius , Sokas Daivaras , Petrenas Andrius , Butkuviene Monika , Paliakaite Birute , Daukantas Saulius , Rapalis Andrius , Marinskis Germanas , Jasiunas Eugenijus , Darma Angeliki , Marozas Vaidotas , Aidietis Audrius 

TITLE=High Specificity Wearable Device With Photoplethysmography and Six-Lead Electrocardiography for Atrial Fibrillation Detection Challenged by Frequent Premature Contractions: DoubleCheck-AF

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.869730

DOI=10.3389/fcvm.2022.869730

ISSN=2297-055X

ABSTRACT=Background: Consumer smartwatches have gained attention as mobile health (mHealth)  tools able to detect atrial fibrillation (AF) using photoplethysmography (PPG) or a short strip of electrocardiogram (ECG). PPG has limited accuracy due to the movement artefacts, whereas ECG cannot be used continuously, is usually displayed as a single-lead signal and is limited in asymptomatic cases. 
Objective: DoubleCheck-AF is a validation study of a wrist-worn device dedicated to providing both continuous PPG-based rhythm monitoring and instant 6-lead ECG with no wires. We evaluated its ability to differentiate between AF and sinus rhythm (SR) with particular emphasis on the challenge of frequent premature beats.
Methods and Results: We performed a prospective, nonrandomized study of 344 participants including 121 patients in AF. To challenge the specificity of the device two control groups were selected: 95 patients in stable SR and 128 patients in SR with frequent premature ventricular or atrial contractions (PVCs/PACs). All ECG tracings were labeled by two independent diagnosis-blinded cardiologists as 'AF', 'SR' or 'Cannot be concluded'. In case of disagreement, a third cardiologist was consulted. A simultaneously recorded ECG of Holter monitor served as a reference. It revealed a high burden of ectopy in the corresponding control group: 6.2 PVCs/PACS per minute, bigeminy/trigeminy episodes in 24.2% (31/128) and runs of ≥3 beats in 9.4% (12/128) of patients. AF detection with PPG-based algorithm, ECG of the wearable and combination of both yielded sensitivity and specificity of 94.2% and 96.9%; 99.2% and 99.1%; 94.2% and 99.6%, respectively. All seven false-positive PPG-based cases were from the frequent PVCs/PACs group compared to none from the stable SR group (P < 0.001). In the majority of these cases (6/7) cardiologists were able to correct the diagnosis to SR with the help of the ECG of the device (P = 0.012).
Conclusions: This is the first wearable combining PPG-based AF detection algorithm for screening of AF together with an instant 6-lead ECG with no wires for manual rhythm confirmation. The system maintained high specificity despite a remarkable amount of frequent single or multiple premature contractions.