Six-lead electrocardiography compared to single-lead electrocardiography and photoplethysmography of a wrist-worn device for atrial fibrillation detection controlled by premature atrial or ventricular contractions: six is smarter than one

Justinas Bacevicius; Neringa Taparauskaite; Ricardas Kundelis; Daivaras Sokas; Monika Butkuviene; Guoste Stankeviciute; Zygimantas Abramikas; Aiste Pilkiene; Ernestas Dvinelis; Justina Staigyte; Julija Marinskiene; Deimile Audzijoniene; Marija Petrylaite; Edvardas Jukna; Albinas Karuzas; Vytautas Juknevicius; Rusne Jakaite; Viktorija Basyte-Bacevice; Neringa Bileisiene; Ignas Badaras; Margarita Kiseliute; Gintare Zarembaite; Modestas Gudauskas; Eugenijus Jasiunas; Linda Johnson; Vaidotas Marozas; Audrius Aidietis

doi:10.3389/fcvm.2023.1160242

Six-lead electrocardiography compared to single-lead electrocardiography and photoplethysmography of a wrist-worn device for atrial fibrillation detection controlled by premature atrial or ventricular contractions: six is smarter than one

Front Cardiovasc Med. 2023 Jun 9:10:1160242. doi: 10.3389/fcvm.2023.1160242. eCollection 2023.

Authors

Justinas Bacevicius^{1

2}, Neringa Taparauskaite^{1

2}, Ricardas Kundelis^{1

2}, Daivaras Sokas³, Monika Butkuviene³, Guoste Stankeviciute¹, Zygimantas Abramikas^{1

2}, Aiste Pilkiene¹, Ernestas Dvinelis^{1

2}, Justina Staigyte^{1

2}, Julija Marinskiene^{1

2}, Deimile Audzijoniene^{1

2}, Marija Petrylaite^{1

2}, Edvardas Jukna^{1

2}, Albinas Karuzas^{1

2}, Vytautas Juknevicius^{1

2}, Rusne Jakaite^{1

2}, Viktorija Basyte-Bacevice¹, Neringa Bileisiene^{1

2}, Ignas Badaras^{1

2}, Margarita Kiseliute¹, Gintare Zarembaite¹, Modestas Gudauskas^{1

2}, Eugenijus Jasiunas⁴, Linda Johnson⁵, Vaidotas Marozas^{3

6}, Audrius Aidietis^{1

2}

Affiliations

¹ Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
² Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
³ Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania.
⁴ Center of Informatics and Development, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
⁵ Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
⁶ Electronics Engineering Department, Kaunas University of Technology, Kaunas, Lithuania.

Abstract

Background: Smartwatches are commonly capable to record a lead-I-like electrocardiogram (ECG) and perform a photoplethysmography (PPG)-based atrial fibrillation (AF) detection. Wearable technologies repeatedly face the challenge of frequent premature beats, particularly in target populations for screening of AF.

Objective: To investigate the potential diagnostic benefit of six-lead ECG compared to single-lead ECG and PPG-based algorithm for AF detection of the wrist-worn device.

Methods and results: From the database of DoubleCheck-AF 249 adults were enrolled in AF group (n = 121) or control group of SR with frequent premature ventricular (PVCs) or atrial (PACs) contractions (n = 128). Cardiac rhythm was monitored using a wrist-worn device capable of recording continuous PPG and simultaneous intermittent six-lead standard-limb-like ECG. To display a single-lead ECG, the six-lead ECGs were trimmed to lead-I-like ECGs. Two diagnosis-blinded cardiologists evaluated reference, six-lead and single-lead ECGs as "AF", "SR", or "Cannot be concluded". AF detection based on six-lead ECG, single-lead ECG, and PPG yielded a sensitivity of 99.2%, 95.7%, and 94.2%, respectively. The higher number of premature beats per minute was associated with false positive outcomes of single-lead ECG (18.80 vs. 5.40 beats/min, P < 0.01), six-lead ECG (64.3 vs. 5.8 beats/min, P = 0.018), and PPG-based detector (13.20 vs. 5.60 beats/min, P = 0.05). Single-lead ECG required 3.4 times fewer extrasystoles than six-lead ECG to result in a false positive outcome. In a control subgroup of PACs, the specificity of six-lead ECG, single-lead ECG, and PPG dropped to 95%, 83.8%, and 90%, respectively. The diagnostic value of single-lead ECG (AUC 0.898) was inferior to six-lead ECG (AUC 0.971) and PPG-based detector (AUC 0.921). In a control subgroup of PVCs, the specificity of six-lead ECG, single-lead ECG, and PPG was 100%, 96.4%, and 96.6%, respectively. The diagnostic value of single-lead ECG (AUC 0.961) was inferior to six-lead ECG (AUC 0.996) and non-inferior to PPG-based detector (AUC 0.954).

Conclusions: A six-lead wearable-recorded ECG demonstrated the superior diagnostic value of AF detection compared to a single-lead ECG and PPG-based AF detection. The risk of type I error due to the widespread use of smartwatch-enabled single-lead ECGs in populations with frequent premature beats is significant.

Keywords: digital; mHealth; multiple-lead ECG; remote monitoring; smartWatch; telemedicine; wearable.

© 2023 Bacevicius, Taparauskaite, Kundelis, Sokas, Butkuviene, Stankeviciute, Abramikas, Pilkiene, Dvinelis, Staigyte, Marinskiene, Audzijoniene, Petrylaite, Jukna, Karuzas, Juknevicius, Jakaite, Basyte-Bacevice, Bileisiene, Badaras, Kiseliute, Zarembaite, Gudauskas, Jasiunas, Johnson, Marozas and Aidietis.

Grants and funding

This work was supported by the European Regional Development Fund (01.2.2-LMT-K-718-03-0027) under grant agreement with the Research Council of Lithuania (LMTLT).