Detection of atrial fibrillation with a smartphone camera: first prospective, international, two-centre, clinical validation study (DETECT AF PRO)

Noé Brasier, Christina J Raichle, Marcus Dörr, Adrian Becke, Vivien Nohturfft, Stefan Weber, Fabienne Bulacher, Lorena Salomon, Thierry Noah, Ralf Birkemeyer, Jens Eckstein, Noé Brasier, Christina J Raichle, Marcus Dörr, Adrian Becke, Vivien Nohturfft, Stefan Weber, Fabienne Bulacher, Lorena Salomon, Thierry Noah, Ralf Birkemeyer, Jens Eckstein

Abstract

Aims: Early detection of atrial fibrillation (AF) is essential for stroke prevention. Emerging technologies such as smartphone cameras using photoplethysmography (PPG) and mobile, internet-enabled electrocardiography (iECG) are effective for AF screening. This study compared a PPG-based algorithm against a cardiologist's iECG diagnosis to distinguish between AF and sinus rhythm (SR).

Methods and results: In this prospective, two-centre, international, clinical validation study, we recruited in-house patients with presumed AF and matched controls in SR at two university hospitals in Switzerland and Germany. In each patient, a PPG recording on the index fingertip using a regular smartphone camera followed by iECG was obtained. Photoplethysmography recordings were analysed using an automated algorithm and compared with the blinded cardiologist's iECG diagnosis. Of 672 patients recruited, 80 were excluded mainly due to insufficient PPG/iECG quality, leaving 592 patients (SR: n = 344, AF: n = 248). Based on 5 min of PPG heart rhythm analysis, the algorithm detected AF with a sensitivity of 91.5% (95% confidence interval 85.9-95.4) and specificity of 99.6% (97.8-100). By reducing analysis time to 1 min, sensitivity was reduced to 89.9% (85.5-93.4) and specificity to 99.1% (97.5-99.8). Correctly classified rate was 88.8% for 1-min PPG analysis and dropped to 60.9% when the threshold for the analysed file was set to 5 min of good signal quality.

Conclusion: This is the first prospective clinical two-centre study to demonstrate that detection of AF by using a smartphone camera alone is feasible, with high specificity and sensitivity. Photoplethysmography signal analysis appears to be suitable for extended AF screening.

Clinical trial registration: ClinicalTrials.gov, number NCT02949180, https://ichgcp.net/clinical-trials-registry/NCT02949180.

Figures

Figure 1
Figure 1
Index and middle fingers on a mobile iECG (left panel); excerpts from resulting iECGs (right panel): (A) SR, (B) SR with ectopic beats, and (C) AF (right panel). AF, atrial fibrillation; iECG, internet-enabled electrocardiography; SR, sinus rhythm.
Figure 2
Figure 2
PPG recording with a smartphone camera on the index finger (left panel); excerpts from resulting pulse waves (right panel): grey wave form indicates the pulse wave, black projected spikes indicate a regular heartbeat (A). Yellow spikes indicate an irregular heartbeat (e.g. ectopic beat) (B), red spikes an extremely irregular heart rhythm (absolut arrhythmia) (C). PPG, photoplethysmography.
Figure 3
Figure 3
Flow of participants in the DETECT AF PRO trial. AF, atrial fibrillation; iECG, internet-enabled electrocardiography; PPG, photoplethysmography; SR, sinus rhythm.

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