PULSE-SMART: Pulse-Based Arrhythmia Discrimination Using a Novel Smartphone Application

J Cardiovasc Electrophysiol. 2016 Jan;27(1):51-7. doi: 10.1111/jce.12842. Epub 2015 Nov 13.


Background: Atrial fibrillation (AF) is a common and dangerous rhythm abnormality. Smartphones are increasingly used for mobile health applications by older patients at risk for AF and may be useful for AF screening.

Objectives: To test whether an enhanced smartphone app for AF detection can discriminate between sinus rhythm (SR), AF, premature atrial contractions (PACs), and premature ventricular contractions (PVCs).

Methods: We analyzed two hundred and nineteen 2-minute pulse recordings from 121 participants with AF (n = 98), PACs (n = 15), or PVCs (n = 15) using an iPhone 4S. We obtained pulsatile time series recordings in 91 participants after successful cardioversion to sinus rhythm from preexisting AF. The PULSE-SMART app conducted pulse analysis using 3 methods (Root Mean Square of Successive RR Differences; Shannon Entropy; Poincare plot). We examined the sensitivity, specificity, and predictive accuracy of the app for AF, PAC, and PVC discrimination from sinus rhythm using the 12-lead EKG or 3-lead telemetry as the gold standard. We also administered a brief usability questionnaire to a subgroup (n = 65) of app users.

Results: The smartphone-based app demonstrated excellent sensitivity (0.970), specificity (0.935), and accuracy (0.951) for real-time identification of an irregular pulse during AF. The app also showed good accuracy for PAC (0.955) and PVC discrimination (0.960). The vast majority of surveyed app users (83%) reported that it was "useful" and "not complex" to use.

Conclusion: A smartphone app can accurately discriminate pulse recordings during AF from sinus rhythm, PACs, and PVCs.

Keywords: atrial fibrillation; detection; premature beats; smartphone; technology.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Algorithms
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / physiopathology
  • Atrial Premature Complexes / diagnosis*
  • Atrial Premature Complexes / physiopathology
  • Attitude to Computers
  • Diagnosis, Differential
  • Electrocardiography
  • Female
  • Heart Rate*
  • Humans
  • Male
  • Middle Aged
  • Mobile Applications*
  • Patient Satisfaction
  • Photoplethysmography / instrumentation*
  • Predictive Value of Tests
  • Prospective Studies
  • Pulse*
  • Reproducibility of Results
  • Signal Processing, Computer-Assisted
  • Smartphone*
  • Surveys and Questionnaires
  • Telemetry / instrumentation*
  • Ventricular Premature Complexes / diagnosis*
  • Ventricular Premature Complexes / physiopathology