Accuracy of Physicians Interpreting Photoplethysmography and Electrocardiography Tracings to Detect Atrial Fibrillation: INTERPRET-AF

Henri Gruwez; Stijn Evens; Tine Proesmans; David Duncker; Dominik Linz; Hein Heidbuchel; Martin Manninger; Pieter Vandervoort; Peter Haemers; Laurent Pison

doi:10.3389/fcvm.2021.734737

Accuracy of Physicians Interpreting Photoplethysmography and Electrocardiography Tracings to Detect Atrial Fibrillation: INTERPRET-AF

Front Cardiovasc Med. 2021 Sep 20:8:734737. doi: 10.3389/fcvm.2021.734737. eCollection 2021.

Authors

Henri Gruwez^{1

2

3}, Stijn Evens⁴, Tine Proesmans⁴, David Duncker⁵, Dominik Linz⁶, Hein Heidbuchel⁷, Martin Manninger⁸, Pieter Vandervoort¹, Peter Haemers², Laurent Pison¹

Affiliations

¹ Department of Cardiology, Hospital East-Limburg, Genk, Belgium.
² Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
³ Doctoral School of Medicine and Life Science, Hasselt University, Hasselt, Belgium.
⁴ Qompium NV, Hasselt, Belgium.
⁵ Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany.
⁶ Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
⁷ Department of Cardiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium.
⁸ Department of Cardiology, Medical University of Graz, Graz, Austria.

Abstract

Aims: This study aims to compare the performance of physicians to detect atrial fibrillation (AF) based on photoplethysmography (PPG), single-lead ECG and 12-lead ECG, and to explore the incremental value of PPG presentation as a tachogram and Poincaré plot, and of algorithm classification for interpretation by physicians. Methods and Results: Email invitations to participate in an online survey were distributed among physicians to analyse almost simultaneously recorded PPG, single-lead ECG and 12-lead ECG traces from 30 patients (10 in sinus rhythm (SR), 10 in SR with ectopic beats and 10 in AF). The task was to classify the readings as 'SR', 'ectopic/missed beats', 'AF', 'flutter' or 'unreadable'. Sixty-five physicians detected or excluded AF based on the raw PPG waveforms with 88.8% sensitivity and 86.3% specificity. Additional presentation of the tachogram plus Poincaré plot significantly increased sensitivity and specificity to 95.5% (P < 0.001) and 92.5% (P < 0.001), respectively. The algorithm information did not further increase the accuracy to detect AF (sensitivity 97.5%, P = 0.556; specificity 95.0%, P = 0.182). Physicians detected AF on single-lead ECG tracings with 91.2% sensitivity and 93.9% specificity. Diagnostic accuracy was also not optimal on full 12-lead ECGs (93.9 and 98.6%, respectively). Notably, there was no significant difference between the performance of PPG waveform plus tachogram and Poincaré, compared to a single-lead ECG to detect or exclude AF (sensitivity P = 0.672; specificity P = 0.536). Conclusion: Physicians can detect AF on a PPG output with equivalent accuracy compared to single-lead ECG, if the PPG waveforms are presented together with a tachogram and Poincaré plot and the quality of the recordings is high.

Keywords: PPG (photoplethysmography); atrial fibrillaiton; digital health; electrocardiography; single-lead ECG.