Accuracy and clinical relevance of the single-lead Apple Watch electrocardiogram to identify atrial fibrillation

Shari Pepplinkhuizen; Wiert F Hoeksema; Willeke van der Stuijt; Nicole J van Steijn; Michiel M Winter; Arthur A M Wilde; Lonneke Smeding; Reinoud E Knops

doi:10.1016/j.cvdhj.2022.10.004

Accuracy and clinical relevance of the single-lead Apple Watch electrocardiogram to identify atrial fibrillation

Cardiovasc Digit Health J. 2022 Dec 15;3(6 Suppl):S17-S22. doi: 10.1016/j.cvdhj.2022.10.004. eCollection 2022 Dec.

Authors

Shari Pepplinkhuizen^{1

2}, Wiert F Hoeksema^{1

2}, Willeke van der Stuijt^{1

2}, Nicole J van Steijn^{1

2}, Michiel M Winter^{1

2}, Arthur A M Wilde^{1

2}, Lonneke Smeding^{1

2}, Reinoud E Knops^{1

2}

Affiliations

¹ Amsterdam UMC Location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam, The Netherlands.
² Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands.

Abstract

Background: The Apple Watch (AW) is the first commercially available wearable device with built-in electrocardiogram (ECG) electrodes to perform a single-lead ECG to detect atrial fibrillation (AF).

Methods: Patients with AF who were scheduled for electrical cardioversion (ECV) were included in this study. The AW ECGs were obtained pre-ECV and post-ECV. In case of an unclassified recording, the AW ECG was obtained up to 3 times. The 12-lead ECG was used as the reference standard. Sensitivity, specificity, and kappa coefficient were calculated.

Results: In total, 74 patients were included. Mean age was 67.1 ± 12.3 years and 20.3% were female. In total 65 AF and 64 sinus rhythm measurements were obtained. The first measurement with the AW showed a sensitivity of 93.5% and specificity of 100% (κ = 0.94). A second measurement resulted in a sensitivity of 94.6% and specificity of 100% (κ = 0.95). A third measurement resulted in a sensitivity of 93% and a specificity of 96.5% (κ = 0.90). Adjudication of unclassified recordings by a physician reduced the total unclassified recordings from 27.9% to 1.6%, but also reduced the accuracy. The kappa coefficient for unclassified single-lead ECGs was 0.58.

Conclusion: The single-lead ECG of the AW shows a high accuracy for identifying AF in a clinical setting. Repeating the recording once decreases the total of unclassified recordings; however, a third recording resulted in a lower accuracy and the occurrence of false-positive measurements. Unclassified results of the AW can be reduced by physicians' interpretation of the single-lead ECG; however, the interrater agreement is only moderate.

Keywords: Accuracy; Apple Watch; Atrial fibrillation; Single-lead ECG; Wearables.