Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 2, 2020
Date Accepted: Mar 11, 2021
Diagnostic Accuracy of Ambulatory Devices in Detecting Atrial Fibrillation: A Systematic Review and Meta-Analysis
ABSTRACT
Background:
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide. Early diagnosis of AF is crucial for preventing AF-related morbidity, mortality, and economic burden, yet the detection of the disease remains challenging. The 12-lead electrocardiogram (ECG) is the gold standard for the diagnosis of AF. Because of technological advances, ambulatory devices may serve as convenient screening tools for AF.
Objective:
The objective of our study was to investigate the diagnostic accuracy of two relatively new technologies used in ambulatory devices, Non-12-lead electrocardiogram (ECG) and photoplethysmography (PPG), in detecting AF. We performed a meta-analysis to evaluate the diagnostic accuracy of non-12-lead ECG and PPG compared to the reference standard 12-lead ECG. We also performed a subgroup analysis to assess robustness in different population.
Methods:
This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE and EMBASE were systematically searched from 1 January 2015 to 20 March 2020. A bivariate model was used to pool estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the summary receiver operating curve (SROC) as the main diagnostic measures. Study quality was evaluated using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool.
Results:
Fifteen studies using either non-12-lead ECG or PPG for detecting AF, comprising 2625 participants and 6663 assessments, met the inclusion criteria. The pooled estimates of sensitivity, specificity, PLR, NLR, and diagnostic odds ratio for the detection of AF were 0.89 (95% CI 0.81–0.94), 0.95 (95% CI 0.90–0.97), 16.27 (95% CI 7.89–33.56), 0.12 (95% CI 0.07–0.21), and 158.97 (95% CI 47.55–531.49) for non-12-lead ECG devices, and 0.95 (95% CI 0.94–0.96), 0.97 (95% CI 0.92–0.99), 24.63 (95% CI 13.17–46.06), 0.05 (95% CI 0.04–0.07), and 568.19 (95% CI 256.64–1257.92) for PPG devices, respectively.
Conclusions:
Both non-12-lead ECG and PPG offer a convenient screening option for AF. However, the study population affects the diagnostic accuracy of non-12-lead ECG technology. Overall, PPG yielded a higher diagnostic accuracy in terms of sensitivity, and its diagnostic performance was less affected by the study population.
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