Diagnostic Accuracy of a Smartphone-Operated, Single-Lead Electrocardiography Device for Detection of Rhythm and Conduction Abnormalities in Primary Care

Jelle C L Himmelreich; Evert P M Karregat; Wim A M Lucassen; Henk C P M van Weert; Joris R de Groot; M Louis Handoko; Robin Nijveldt; Ralf E Harskamp

doi:10.1370/afm.2438

Diagnostic Accuracy of a Smartphone-Operated, Single-Lead Electrocardiography Device for Detection of Rhythm and Conduction Abnormalities in Primary Care

Ann Fam Med. 2019 Sep;17(5):403-411. doi: 10.1370/afm.2438.

Authors

Jelle C L Himmelreich¹, Evert P M Karregat², Wim A M Lucassen², Henk C P M van Weert², Joris R de Groot³, M Louis Handoko⁴, Robin Nijveldt⁵, Ralf E Harskamp²

Affiliations

¹ Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands [email protected].
² Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands.
³ Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
⁴ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
⁵ Radboud University Medical Center, Department of Cardiology, Nijmegen, The Netherlands.

Abstract

Purpose: To validate a smartphone-operated, single-lead electrocardiography (1L-ECG) device (AliveCor KardiaMobile) with an integrated algorithm for atrial fibrillation (AF) against 12-lead ECG (12L-ECG) in a primary care population.

Methods: We recruited consecutive patients who underwent 12L-ECG for any nonacute indication. Patients held a smartphone with connected 1L-ECG while local personnel simultaneously performed 12L-ECG. All 1L-ECG recordings were assessed by blinded cardiologists as well as by the smartphone-integrated algorithm. The study cardiologists also assessed all 12L-recordings in random order as the reference standard. We determined the diagnostic accuracy of the 1L-ECG in detecting AF or atrial flutter (AFL) as well as any rhythm abnormality and any conduction abnormality with the simultaneously performed 12L-ECG as the reference standard.

Results: We included 214 patients from 10 Dutch general practices. Mean ± SD age was 64.1 ± 14.7 years, and 53.7% of the patients were male. The 12L-ECG diagnosed AF/AFL, any rhythm abnormality, and any conduction abnormality in 23, 44, and 28 patients, respectively. The 1L-ECG as assessed by cardiologists had a sensitivity and specificity for AF/AFL of 100% (95% CI, 85.2%-100%) and 100% (95% CI, 98.1%-100%). The AF detection algorithm had a sensitivity and specificity of 87.0% (95% CI, 66.4%-97.2%) and 97.9% (95% CI, 94.7%-99.4%). The 1L-ECG as assessed by cardiologists had a sensitivity and specificity for any rhythm abnormality of 90.9% (95% CI, 78.3%-97.5%) and 93.5% (95% CI, 88.7%-96.7%) and for any conduction abnormality of 46.4% (95% CI, 27.5%-66.1%) and 100% (95% CI, 98.0%-100%).

Conclusions: In a primary care population, a smartphone-operated, 1L-ECG device showed excellent diagnostic accuracy for AF/AFL and good diagnostic accuracy for other rhythm abnormalities. The 1L-ECG device was less sensitive for conduction abnormalities.

Keywords: atrial fibrillation; cardiac arrhythmia; cardiac complexes, premature; cardiac conduction system disease; electrocardiography; medical device; single-lead.

Publication types

Research Support, Non-U.S. Gov't
Validation Study

MeSH terms

Aged
Algorithms
Atrial Fibrillation / diagnosis*
Electrocardiography / instrumentation*
Female
Heart Conduction System / diagnostic imaging*
Humans
Male
Middle Aged
Netherlands
Primary Health Care / methods*
Sensitivity and Specificity
Smartphone*