Accuracy of smartphone based electrocardiogram for the detection of rhythm abnormalities in limb lead: a cross sectional study, non-randomised, single blinded and single-center study

Authors

  • Sahil Mahajan Department of Cardiology, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India
  • Salil Garg Department of Cardiology, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India
  • Richa Sharma Department of Cardiology, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India
  • Yogendra Singh Department of Cardiology, Max Super-Speciality Hospitals, Dehradun, Uttarakhand, India
  • Nitin Chandola Research and development, Sunfox Technologies, Dehradun, Uttarakhand, India
  • Tanuj Bhatia Department of Cardiology, Shri Mahant Indresh Hospital, Dehradun, Uttarakhand, India
  • Basundhara Bansal Research and Development, Sunfox Technologies, Dehradun, Uttarakhand, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20230855

Keywords:

Cardiac arrhythmia, Smartphone, Specificity, Sensitivity, Accuracy, Validation

Abstract

Background: For the identification of arrhythmia and abnormal instances, researchers are examining the reliability of the interpretation offered by smartphone-based portable ECG monitors. The indicator of an unclear alteration in the electrical activity of the heart is a cardiac abnormality. As a result, its early and accurate identification can avoid myocardial infarction and even sudden cardiac death. Objectives of this study were to evaluate and validate the Spandan 12 lead ECG interpretation for accuracy in detection of the cardiac arrhythmias in comparison to the cardiologist diagnosis, and to evaluate the accuracy of the arrhythmia detection of Spandan ECG in comparison to the 12 lead ECG machine.

Methods: This cross-sectional study, non-randomised, single blinded and single-center study was carried out at Shri Mahant Indresh Hospital (SMIH), Dehradun, Uttarakhand, India from 1st August 2022 to 31st January 2023. All patients (n=312) visiting the electrocardiogram (ECG) room at the department of cardiology of the SMIH, Dehradun with the prescription of ECG screening during the study period were included in the study were included in the study.

Results: In total, 1528 patients with or without a history of cardiovascular disease were enrolled from outpatient and emergency departments of cardiology. A final total of 312 participants considered for accuracy of interpretation of cardiac arrhythmias detected by the standard 12 lead ECG and smartphone ECG in comparison to cardiologists’ diagnosis. Mean age (SD) was 53.90±14.52 years. The male gender (68.78%) showed the maximum frequency than female gender. True Positive cases derived from confusion matrix for 12 lead standard ECG and smartphone ECG in comparison to cardiologist diagnosis was 264 as compared to 273 from 12 lead gold standard. Sensitivity of smartphone Spandan ECG (81.23%) was comparable to gold standard 12 Lead ECG (81.49%). And, specificity, PPV and NPV of smartphone Spandan ECG was recorded to be better than gold standard 12 Lead ECG. Arrhythmia was detected correctly in 403 (70.8%) cases and 431 (61.86%) cases by smartphone ECG and 12 lead gold standards, respectively.

Conclusions: Spandan ECG device scored a high accuracy and sensitivity and high specificity. The overall accuracy of smartphone ECG in detecting the rhythm abnormalities increase by 9%, the significance rises in accuracy of computer interpretation when compared to the cardiologist’s diagnosis.

References

Brasier N, Raichle CJ, Dörr M, Becke A, Nohturfft V, Weber S, et al. Detection of atrial fibrillation with a smartphone camera: first prospective, international, two-centre, clinical validation study (DETECT AF PRO). Ep Europace. 2019;21(1):41-7.

Chandola N, Singh Y, Mahajan S, Garg S, Bansal B. An observational study on detection of atrial and ventricular arrhythmias with smartphone-based ECG. Int J Health Sci. 2022;6(4):5373-84.

Susilo CB, Jayanto I, Kusumawaty I. Understanding digital technology trends in healthcare and preventive strategy. Int J Health Med Sci. 2021;4(3):347-54.

Lohrmann G, Kaplan R, Ziegler PD, Monteiro J, Passman R. Atrial fibrillation ablation success defined by duration of recurrence on cardiac implantable electronic devices. J Cardiovascul Electrophysiol. 2020;31(12):3124-31.

Ding EY, Han D, Whitcomb C, Bashar SK, Adaramola O, Soni A, et al. Accuracy and usability of a novel algorithm for detection of irregular pulse using a smartwatch among older adults: observational study. JMIR Cardio. 2019;3(1):13850.

Pereira T, Tran N, Gadhoumi K, Pelter MM, Do DH, Lee RJ, et al. Photoplethysmography based atrial fibrillation detection: a review. NPJ Digit Med. 2020;3(1):3.

Proesmans T, Mortelmans C, Van Haelst R, Verbrugge F, Vandervoort P, Vaes B. Mobile phone-based use of the photoplethysmography technique to detect atrial fibrillation in primary care: diagnostic accuracy study of the fibricheck app. JMIR mHealth uHealth. 2019;7(3):12284.

O’Sullivan JW, Grigg S, Crawford W, Turakhia MP, Perez M, Ingelsson E, et al. Accuracy of smartphone camera applications for detecting atrial fibrillation: a systematic review and meta-analysis. JAMA Net Open. 2020;3(4):202064.

Ip JE. Wearable devices for cardiac rhythm diagnosis and management. JAMA. 2019;321(4):337-8.

Dörr M, Nohturfft V, Brasier N, Bosshard E, Djurdjevic A, Gross S, et al. The WATCH AF trial: SmartWATCHes for detection of atrial fibrillation. JACC Clin Electrophysiol. 2019;5(2):199-208.

Chan NY, Choy CC, Chan CK, Siu CW. Effectiveness of a nongovernmental organization–led large-scale community atrial fibrillation screening program using the smartphone electrocardiogram: an observational cohort study. Heart Rhyth. 2018;15(9):1306-11.

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS) the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Euro Heart J. 2021;42(5):373-498.

Guo Y, Wang H, Zhang H, Liu T, Liang Z, Xia Y, et al. Mobile photoplethysmographic technology to detect atrial fibrillation. J Am Coll Cardiol. 2019;74(19):2365-75.

Jiang X, Ming WK, You JH. The cost-effectiveness of digital health interventions on the management of cardiovascular diseases: systematic review. J Med Intern Res. 2019;21(6):13166.

Orchard JJ, Neubeck L, Orchard JW, Puranik R, Raju H, Freedman B, et al. ECG-based cardiac screening programs: legal, ethical, and logistical considerations. Heart Rhyth. 2019;16(10):1584-91.

Himmelreich JC, Karregat EP, Lucassen WA, van Weert HC, de Groot JR, Handoko ML, et al. Diagnostic accuracy of a smartphone-operated, single-lead electrocardiography device for detection of rhythm and conduction abnormalities in primary care. Ann Fam Med. 2019;17(5):403-11.

Towhari J, Masud N, Alanazi H. Evaluation of the diagnostic accuracy of smartphone electrocardiogram recorder compared to standard 12 lead electrocardiography in hospital settings. Saudi Med J. 2019;40(6):575.

Haberman ZC, Jahn RT, Bose R, Tun H, Shinbane JS, Doshi RN, et al. Wireless smartphone ECG enables large‐scale screening in diverse populations. J Cardiovascul Electrophysiol. 2015;26(5):520-6.

Chan NY, Choy CC. Screening for atrial fibrillation in 13 122 Hong Kong citizens with smartphone electrocardiogram. Heart. 2017;103(1):24-31.

Desteghe L, Raymaekers Z, Lutin M, Vijgen J, Dilling-Boer D, Koopman P, et al. Performance of handheld electrocardiogram devices to detect atrial fibrillation in a cardiology and geriatric ward setting. Ep Europace. 2017;19(1):29-39.

Lau JK, Lowres N, Neubeck L, Brieger DB, Sy RW, Galloway CD, et al. iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke. Int J Cardiol. 2013;165(1).

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Published

2023-03-29

How to Cite

Mahajan, S., Garg, S., Sharma, R., Singh, Y., Chandola, N., Bhatia, T., & Bansal, B. (2023). Accuracy of smartphone based electrocardiogram for the detection of rhythm abnormalities in limb lead: a cross sectional study, non-randomised, single blinded and single-center study. International Journal of Research in Medical Sciences, 11(4), 1165–1169. https://doi.org/10.18203/2320-6012.ijrms20230855

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Original Research Articles