Advertisement

Effectiveness of the Chest Strap Electrocardiogram to Detect Atrial Fibrillation

Published:February 23, 2019DOI:https://doi.org/10.1016/j.amjcard.2019.02.028
      Atrial fibrillation (AF) is a significant cause of cardioembolic strokes. AF is often symptomless and intermittent, making its detection challenging. The aim of this study was to assess the possibility to use a chest strap (Suunto Movesense) to detect AF both by cardiologists and automated algorithms. A single channel electrocardiogram (ECG) from a chest strap of 220 patients (107 AF and 111 sinus rhythm SR with 2 inconclusive rhythms) were analyzed by 2 cardiologists (Doc1 and Doc2) and 2 different algorithms (COSEn and AFEvidence). A 3-lead Holter served as the gold standard ECG for rhythm analysis. Both cardiologists evaluated the quality of the chest strap ECG to be superior to the quality of the Holter ECG; p <0.05/p <0.001 (Doc1/Doc 2). Accurate automated algorithm-based AF detection was achieved with sensitivity of 95.3%/96.3% and specificity of 95.5/98.2% with 2 AF detection algorithms from chest strap and 93.5%/97.2% and 98.2%/95.5% from Holter, respectively. P waves were detectable in 93.7% (Doc1) and 94.6% (Doc2) of the cases from the chest strap ECG with sinus rhythm and 98.2% (Doc1) and 95.5% (Doc2) from the Holter (p = n.s). In conclusion, the ECGs from both methods enabled AF detection by a cardiologist and by automated algorithms. Both methods studied enabled P-wave detection in sinus rhythm.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ferro J.M.
        Cardioembolic stroke: an update.
        Lancet Neurol. 2003; 2: 177-188
        • Freedman B.
        • Potpara T.S.
        • Lip G.Y.
        Stroke prevention in atrial fibrillation.
        Lancet. 2016; 388: 806-817
        • Bang O.Y.
        • Ovbiagele B.
        • Kim J.S.
        Evaluation of cryptogenic stroke with advanced diagnostic techniques.
        Stroke. 2014; 45: 1186-1194
        • Hart R.G.
        • Diener H.C.
        • Coutts S.B.
        • Easton J.D.
        • Granger C.B.
        • O'Donnell M.J.
        • Sacco R.L.
        • Connolly S.J.
        • Cryptogenic Stroke/ESUS International Working Group
        Embolic strokes of undetermined source: the case for a new clinical construct.
        Lancet Neurol. 2014; 13: 429-438
        • Hart R.G.
        • Pearce L.A.
        • Aguilar M.I.
        Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.
        Ann Intern Med. 2007; 146: 857-867
        • Saxena R.
        • Koudstaal P.J.
        Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attack.
        Cochrane Database Syst Rev. 2004; 4CD000185
        • Kirchhof P.
        • Benussi S.
        • Kotecha D.
        • Ahlsson A.
        • Atar D.
        • Casadei B.
        • Castella M.
        • Diener H.C.
        • Heidbuchel H.
        • Hendriks J.
        • Hindricks G.
        • Manolis A.S.
        • Oldgren J.
        • Popescu B.A.
        • Schotten U.
        • Van Putte B.
        • Vardas P.
        • Agewall S.
        • Camm J.
        • Baron Esquivias G.
        • Budts W.
        • Carerj S.
        • Casselman F.
        • Coca A.
        • De Caterina R.
        • Deftereos S.
        • Dobrev D.
        • Ferro J.M.
        • Filippatos G.
        • Fitzsimons D.
        • Gorenek B.
        • Guenoun M.
        • Hohnloser S.H.
        • Kolh P.
        • Lip G.Y.
        • Manolis A.
        • McMurray J.
        • Ponikowski P.
        • Rosenhek R.
        • Ruschitzka F.
        • Savelieva I.
        • Sharma S.
        • Suwalski P.
        • Tamargo J.L.
        • Taylor C.J.
        • Van Gelder I.C.
        • Voors A.A.
        • Windecker S.
        • Zamorano J.L.
        • Zeppenfeld K.
        2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
        Eur Heart J. 2016; 37: 2893-2962
        • Cooke G.
        • Doust J.
        • Sanders S.
        Is pulse palpation helpful in detecting atrial fibrillation? A systematic review.
        J Fam Pract. 2006; 55: 130-134
        • Lau J.K.
        • Lowres N.
        • Neubeck L.
        • Brieger D.B.
        • Sy R.W.
        • Galloway C.D.
        • Albert D.E.
        • Freedman S.B.
        iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke.
        Int J Cardiol. 2013; 165: 193-194
        • Kaleschke G.
        • Hoffmann B.
        • Drewitz I.
        • Steinbeck G.
        • Naebauer M.
        • Goette A.
        • Breithardt G.
        • Kirchhof P.
        Prospective, multicentre validation of a simple, patient-operated electrocardiographic system for the detection of arrhythmias and electrocardiographic changes.
        Europace. 2009; 11: 1362-1368
        • Tieleman R.G.
        • Plantinga Y.
        • Rinkes D.
        • Bartels G.L.
        • Posma J.L.
        • Cator R.
        • Hofman C.
        • Houben R.P.
        Validation and clinical use of a novel diagnostic device for screening of atrial fibrillation.
        Europace. 2014; 16: 1291-1295
        • Wiesel J.
        • Fitzig L.
        • Herschman Y.
        • Messineo F.C.
        Detection of atrial fibrillation using a modified microlife blood pressure monitor.
        Am J Hypertens. 2009; 22: 848-852
        • Verberk W.J.
        • Omboni S.
        • Kollias A.
        • Stergiou G.S.
        Screening for atrial fibrillation with automated blood pressure measurement: research evidence and practice recommendations.
        Int J Cardiol. 2016; 203: 465-473
        • McManus D.D.
        • Lee J.
        • Maitas O.
        • Esa N.
        • Pidikiti R.
        • Carlucci A.
        • Harrington J.
        • Mick E.
        • Chon K.H.
        A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation.
        Heart Rhythm. 2013; 10: 315-319
        • Nemati S.
        • Ghassemi M.M.
        • Ambai V.
        • Isakadze N.
        • Levantsevych O.
        • Shah A.
        • Clifford G.D.
        Monitoring and detecting atrial fibrillation using wearable technology.
        in: Conf Proc IEEE Eng Med Biol Soc. 2016. 2016: 3394-3397
        • McMANUS D.D.
        • Chong J.W.
        • Soni A.
        • Saczynski J.S.
        • Esa N.
        • Napolitano C.
        • Darling C.E.
        • Boyer E.
        • Rosen R.K.
        • Floyd K.C.
        • Chon K.H.
        PULSE-SMART: pulse-based arrhythmia discrimination using a novel smartphone application.
        J Cardiovasc Electrophysiol. 2016; 27: 51-57
        • Freedman B.
        • Camm J.
        • Calkins H.
        • Healey J.S.
        • Rosenqvist M.
        • Wang J.
        • Albert C.M.
        • Anderson C.S.
        • Antoniou S.
        • Benjamin E.J.
        • Boriani G.
        • Brachmann J.
        • Brandes A.
        • Chao T.F.
        • Conen D.
        • Engdahl J.
        • Fauchier L.
        • Fitzmaurice D.A.
        • Friberg L.
        • Gersh B.J.
        • Gladstone D.J.
        • Glotzer T.V.
        • Gwynne K.
        • Hankey G.J.
        • Harbison J.
        • Hillis G.S.
        • Hills M.T.
        • Kamel H.
        • Kirchhof P.
        • Kowey P.R.
        • Krieger D.
        • Lee V.W.Y.
        • Levin L.A.
        • Lip G.Y.H.
        • Lobban T.
        • Lowres N.
        • Mairesse G.H.
        • Martinez C.
        • Neubeck L.
        • Orchard J.
        • Piccini J.P.
        • Poppe K.
        • Potpara T.S.
        • Puererfellner H.
        • Rienstra M.
        • Sandhu R.K.
        • Schnabel R.B.
        • Siu C.W.
        • Steinhubl S.
        • Svendsen J.H.
        • Svennberg E.
        • Themistoclakis S.
        • Tieleman R.G.
        • Turakhia M.P.
        • Tveit A.
        • Uittenbogaart S.B.
        • Van Gelder I.C.
        • Verma A.
        • Wachter R.
        • Yan B.P.
        • AF-Screen Collaborators
        Screening for atrial fibrillation: a report of the AF-SCREEN International Collaboration.
        Circulation. 2017; 135: 1851-1867
        • Lown M.
        • Yue A.M.
        • Shah B.N.
        • Corbett S.J.
        • Lewith G.
        • Stuart B.
        • Garrard J.
        • Brown M.
        • Little P.
        • Moore M.
        Screening for atrial fibrillation using economical and accurate technology (from the SAFETY study).
        Am J Cardiol. 2018; 122: 1339-1344
        • Sarkar S.
        • Ritscher D.
        • Mehra R.
        A detector for a chronic implantable atrial tachyarrhythmia monitor.
        IEEE Trans Biomed Eng. 2008; 55: 1219-1224
        • Lake D.E.
        • Moorman J.R.
        Accurate estimation of entropy in very short physiological time series: the problem of atrial fibrillation detection in implanted ventricular devices.
        Am J Physiol Heart Circ Physiol. 2011; 300: H319-H325
        • Seet R.C.
        • Friedman P.A.
        • Rabinstein A.A.
        Prolonged rhythm monitoringfor the detection of occult paroxysmal atrial fibrillation in ischemic stroke of unknown cause.
        Circulation. 2011; 124: 477-486