Inconclusive Single-Lead ECGs From Smart-Devices: Impact of Baseline ECG Anomalies

Isenegger, C; Mannhart, D; Weidlich, S; Brügger, J; Serban, T; Jordan, F; Krisai, P; Knecht, S; Schaerli, N; Subin, B; Mosher, L; du Fay de Lavallaz, J; Schaer, B; Mahfoud, F; Kühne, M; Sticherling, C; Badertscher, P

doi:10.1016/j.jacep.2025.04.027

Arrhythmias & electrophysiology

Inconclusive Single-Lead ECGs From Smart-Devices: Impact of Baseline ECG Anomalies

JACC Clin ElectrophysiolPublished 18 Jun 2025prospective study

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Authors' conclusion

Automated rhythm classification is highly susceptible to baseline ECG anomalies. This study provides insights into the most appropriate patient population for smart device-based arrhythmia monitoring and offers guidance for selecting the optimal smart device tailored to individual patient characteristics.

Study context

Population: Consecutive patients undergoing electrophysiological procedures at a tertiary referral center, each recording a 12-lead ECG followed by single-lead electrocardiograms (SL-ECGs) with 5 smart devices (AliveCor KardiaMobile, Apple Watch 6, Fitbit Sense, Samsung Galaxy Watch 3, and Withings ScanWatch)participants (29% female, mean age 66 years), generating 1,280 recorded SL-ECGs
Participants: 256 patients

Exposure: Inconclusive SL-ECGs vs conclusive SL-ECGs
Inconclusive SL-ECGsn = 242
Outcome: SL-ECGs classified as inconclusive by at least 1 smart device

Methodological detailsconsecutive patients, tertiary referral center

Consecutive patients
Tertiary referral center

Main finding

As reported in the abstract

Inconclusive SL-ECGs

242 SL-ECGs

19%

Observational data: associations, not effects.

Further findings

Presence of any ECG anomaly · significantly higher in inconclusive SL-ECGs

P < 0.001

Inconclusive SL-ECGs74%

Conclusive SL-ECGs42%

Inconclusive classification by ECG anomaly

Comparison	← Lower odds ←→ Higher odds →	OR (95% CI)
Ventricular pacing	0.050.21520	6.35 (3.84–10.61)
Conduction delay	0.050.21520	2.42 (1.82–3.22)
Low voltage	0.050.21520	2.37 (1.75–3.21)
Minor artifact	0.050.21520	1.72 (1.17–2.51)
Major artifact	0.050.21520	10.62 (6.78–16.99)
Premature atrial complex	0.050.21520	2.23 (1.29–3.74)
Premature ventricular complex	0.050.21520	1.94 (1.29–2.89)
	0.050.21520Odds ratio (log scale)

Differences between smart devices

Notable differences were found between the assessed smart devices

Original publication

Inconclusive Single-Lead ECGs From Smart-Devices: Impact of Baseline ECG Anomalies. JACC Clin Electrophysiol. Published 18 June 2025. doi:10.1016/j.jacep.2025.04.027

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Summarised from the published abstract; every number is checked against it