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Accuracy of pulsatile photoplethysmography applications or handheld devices vs. 12-lead ECG for atrial fibrillation screening: a systematic review and meta-analysis

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Abstract

Background

The relative accuracy of pulsatile photoplethysmography applications (PPG) or handheld (HH) devices compared with the gold standard 12-lead electrocardiogram (ECG) for the diagnosis of atrial fibrillation is unknown.

Methods

Digital databases were searched to identify relevant articles. Raw data were pooled using a bivariate model to calculate diagnostic accuracy measures and estimate Hierarchical Summary Receiver Operating Characteristic (HSROC).

Results

A total of 10 articles comprising 4296 patients (mean age 68.9 years, with 56% males) were included in the analysis. Compared with EKG, the pooled sensitivity of PPG and HH devices in AF detection was 0.93 (95% CI 0.87–0.96; p < 0.05) and 0.87 (95% CI. 0.74–0.94; p < 0.05), respectively. The pooled specificity of PPG and HH devices in AF detection was 0.91 (95% CI 0.88–0.94; p < 0.05) and 0.96 (95% CI 0.90–0.98; p < 0.05), respectively. The diagnostic odds ratio was 129 and 144 for PPG and HH devices, respectively. Fagan’s nomogram showed the probability of a patient having AF and normal rhythm on PPG or HH devices was 2–3%, while the post-test probability of having AF with an irregular R-R interval on PPG or HH devices was 73% and 82%, respectively. The scatter plot of positive and negative likelihood ratio showed high confirmation of AF and reliability of exclusion of absence of irregular R-R intervals (positive likelihood ratio > 10, and negative likelihood ratio < 0.1) on HH devices while PPG was used as confirmation only.

Conclusions

The PPG or HH devices can serve as a reliable alternative for the detection of AF.

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Author information

Authors and Affiliations

  1. Cardiology, West Virginia University, Morgantown, WV, USA

    Yasar Sattar & David Song

  2. Internal Medicine, Guntur Medical College, Guntur, Punjab, India

    Deepika Sarvepalli

  3. Internal Medicine, Saint Mary Mercy Hospital, Livonia, MI, USA

    Syeda Ramsha Zaidi

  4. Cardiology, Thomas Jefferson University, Philadelphia, PA, USA

    Waqas Ullah

  5. Internal Medicine, Institute of Medical Sciences, Islamabad, Pakistan

    Junaid Arshad

  6. Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA

    Tanveer Mir, Mohamed Zghouzi & MChadi Alraies

  7. Cardiology, Weill Cornell University, Doha, Qatar

    Islam Y. Elgendy

  8. Cardiology, University of Massachusetts Medical School, Worcester, MA, USA

    Waqas Qureshi

  9. Cardiology, Spectrum Health Heart and Vascular, Michigan State University, Grand Rapids, MI, USA

    Nagib Chalfoun

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  1. Yasar Sattar
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Highlights

• The present study is the largest evidence on the diagnostic accuracy of the smartphone app-based pulsatile photoplethysmography (PPG) or handheld (HH) devices used in the screening of atrial fibrillation (AF).

• PPG or HH devices have a very high sensitivity and specificity for detecting an irregular R-R interval (AF).

• Smartphone app-based PPG and HH devices have high diagnostic yield with high PLR and NLR.

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Sattar, Y., Song, D., Sarvepalli, D. et al. Accuracy of pulsatile photoplethysmography applications or handheld devices vs. 12-lead ECG for atrial fibrillation screening: a systematic review and meta-analysis. J Interv Card Electrophysiol 65, 33–44 (2022). https://doi.org/10.1007/s10840-021-01068-x

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