Arrhythmias & electrophysiology
Real-world validation of smartphone-based photoplethysmography for rate and rhythm monitoring in atrial fibrillation
Authors' conclusion
Smartphone applications using PPG can be used to monitor patients with AF in unsupervised real-world conditions. The accuracy of AF detection algorithms in this setting is excellent, but PPG-derived heart rate may tend to underestimate higher heart rates.
Study context
- Population
- Patients with established paroxysmal or persistent atrial fibrillation (AF), enrolled 4 weeks before AF ablation3,907 measurements
- Participants
- 50 patients
- Comparison
- Smartphone PPG vs handheld single-lead electrocardiography (ECG)
- Outcome
- Accuracy of PPG-derived heart rate and rhythm classification (AF detection)
- Follow-up
- Twice daily during 8 weeks
Methodological detailsconsecutive patients, unsupervised real-world conditions, blinded ECG adjudication by 3 cardiologists
- Consecutive patients
- Unsupervised real-world conditions
- Blinded ECG adjudication by 3 cardiologists
Performance
As reported in the abstract
AF detection by PPG (ECG reference)
| Test or model | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|
| Photoplethysmography | 98.3% (CI 96.7-99.9%) | 99.9% (CI 99.8-100.0%) | 99.6% (CI 99.1-100.0%) | 99.6% (CI 99.0-100.0%) |
Photoplethysmography
Sensitivity98.3% (CI 96.7-99.9%)
Specificity99.9% (CI 99.8-100.0%)
PPV99.6% (CI 99.1-100.0%)
NPV99.6% (CI 99.0-100.0%)
Further findings
Good signal quality, single measurement
P < 0.001
| Outcome | Underestimation (b.p.m.) (95% CI) |
|---|---|
| Heart rate in AF, PPG-derived | 6.6 (5.8 b.p.m. to 7.4 b.p.m.) |
- Good signal quality, single measurement — PPG signal quality with repeated measurements
- 96.6%
- Heart rate in AF, PPG-derived — Root mean square error
- 11.8 b.p.m.
Heart rate in AF, PPG-derived
- Increased underestimation in high heart rates (Bland-Altman)
Original publication
Real-world validation of smartphone-based photoplethysmography for rate and rhythm monitoring in atrial fibrillation. Europace. Published 17 April 2024. doi:10.
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