Smartphone detection of atrial fibrillation using photoplethysmography: a systematic review and meta-analysis

Abstract

ObjectivesTimely diagnosis of atrial fibrillation (AF) is essential to reduce complications from this increasingly common condition. We sought to assess the diagnostic accuracy of smartphone camera photoplethysmography (PPG) compared with conventional electrocardiogram (ECG) for AF detection.MethodsThis is a systematic review of MEDLINE, EMBASE and Cochrane (1980–December 2020), including any study or abstract, where smartphone PPG was compared with a reference ECG (1, 3 or 12-lead). Random effects meta-analysis was performed to pool sensitivity/specificity and identify publication bias, with study quality assessed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) risk of bias tool.Results28 studies were included (10 full-text publications and 18 abstracts), providing 31 comparisons of smartphone PPG versus ECG for AF detection. 11 404 participants were included (2950 in AF), with most studies being small and based in secondary care. Sensitivity and specificity for AF detection were high, ranging from 81% to 100%, and from 85% to 100%, respectively. 20 comparisons from 17 studies were meta-analysed, including 6891 participants (2299 with AF); the pooled sensitivity was 94% (95% CI 92% to 95%) and specificity 97% (96%–98%), with substantial heterogeneity (p<0.01). Studies were of poor quality overall and none met all the QUADAS-2 criteria, with particular issues regarding selection bias and the potential for publication bias.ConclusionPPG provides a non-invasive, patient-led screening tool for AF. However, current evidence is limited to small, biased, low-quality studies with unrealistically high sensitivity and specificity. Further studies are needed, preferably independent from manufacturers, in order to advise clinicians on the true value of PPG technology for AF detection.

Smartphone based 12 lead ECG as decision support in STEMI: a prospective, cross sectional study, non-randomised, single blinded and single-center study

“…Standard 12-lead ECG equipment could not be made available in such circumstances, but the widespread use of smartphones might provide the groundwork for a wider use of electrocardiography. [18][19][20] Our research revealed a high degree of STEMI accuracy across Spandan smartphone ECG records and traditional ECG readings. The 12 lead Spandan smartphone ECG has superior diagnostic capabilities for STEMI when compared to simultaneously conducted traditional 12L ECG in a primary care population, according to blinded cardiologists.…”

Validation of interpretation of ST-elevation myocardial infarction using the smartphone based 12 lead electrocardiograms in comparison to the cardiologist-a cross sectional study, validation study, single-center study

“…14 It would be unfeasible to provide standard 12-lead ECG devices in such settings, but smartphone penetration has already become commonplace and has potential to provide foundation for greater spread of ECG. [15][16][17] Our study showed a good degree of accuracy for STEMI between Spandan smartphone ECG and standard ECG recordings. The diagnostic properties of the 12 lead Spandan smartphone ECG as assessed by blinded cardiologists against simultaneously performed standard 12L ECG in a primary care population were excellent for STEMI.…”

Breaking the Cycle of Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation

“…However, the validation of these devices remains unclear, and the AF they describe may not be associated with the same degree of impact on stroke and thromboembolism. [ 44 , 45 ] Incident cardiac and cerebral event rates may also be dependent on the ‘severity’ of HFpEF and the degree of underlying systolic impairment in AF, even if above an LVEF of 50%. [ 46 ] The value of additional physiological assessment remains unclear (e.g.…”