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Letter by Kim et al Regarding Article, “Detection of Atrial Fibrillation in a Large Population Using Wearable Devices: The Fitbit Heart Study”

2023; Lippincott Williams & Wilkins; Volume: 147; Issue: 15 Linguagem: Inglês

10.1161/circulationaha.122.062711

1524-4539

Jin Un Kim, Jonathan James Hyett Bray, Mahmood Ahmad,

Atrial Fibrillation Management and Outcomes

HomeCirculationVol. 147, No. 15Letter by Kim et al Regarding Article, "Detection of Atrial Fibrillation in a Large Population Using Wearable Devices: The Fitbit Heart Study" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Kim et al Regarding Article, "Detection of Atrial Fibrillation in a Large Population Using Wearable Devices: The Fitbit Heart Study" Jin Un Kim, Jonathan Bray and Mahmood Ahmad Jin Un KimJin Un Kim https://orcid.org/0000-0002-3271-4214 Department of Cardiology, Royal Free Hospital, London, United Kingdom (J.-U.K.). , Jonathan BrayJonathan Bray https://orcid.org/0000-0003-1167-6295 Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom (J.B.). and Mahmood AhmadMahmood Ahmad Tahir Heart Institute, Rabwah, Pakistan (M.A.). Originally published10 Apr 2023https://doi.org/10.1161/CIRCULATIONAHA.122.062711Circulation. 2023;147:1186–1187To the Editor:We read about the Fitbit Heart Study from Lubitz et al with interest.1 The authors have developed a novel algorithm to use optical photoplethysmography (PPG) sensors in wearable devices. Their inclusion criteria are strict and robust by adopting continuous, 5-minute pulse windows for irregular heart rhythm detection, with a single-lead ambulatory ECG patch monitor given to, and analyzed in, patients with 11 consecutive such abnormal readings. They present a positive predictive value of 98% among a total of 1057 participants.Studies have shown that although single-lead monitoring generally provides good specificity and positive predictive values, multiple-lead studies show greater sensitivity (improvement from 95–96% to 99% in a single-lead vs 6-lead study).2 This greater sensitivity is hypothesized to be attributable to improved p-wave detection from multiple leads differentiating atrial fibrillation and sinus rhythm. A caveat to this is the major limitation of requiring 3 contact points—an issue in accessibility that wearable devices using PPG effectively overcome.Developments offering 6-lead technology for wearable devices have been made, as presented in the DoubleCheck-AF (A Wearable with Photoplethysmography and 6-lead Electrocardiography for Atrial Fibrillation Detection) validation study, where one wearable device is able to provide both continuous screening via PPG sensor as well as on-demand 6-lead ECG with no wires for rhythm confirmation.3We also suggest that the technology is validated in a wider demographic study; similar to most PPG-based studies, the participant cohort skews toward white ethnic groups in higher-income categories who are able to afford these devices, as well as those with concerns about their cardiovascular health. A cohort that reflects demographic diversity in its socioeconomic groups will be useful. From a technical perspective, the device sensors also require further validation among a population with diverse skin pigmentation and body types, as these may alter PPG-based detection of atrial fibrillation and thereby, overall detection sensitivity.4A population of interest would be participants after having a cerebrovascular event, such as stroke or transient ischemic attack. In theory, a long-term and easily worn device that monitors for AF overcomes the major limitations of the current available detection methods, namely, Holter monitoring and implantable loop recorders. Independently, these devices have greater detection rates with prolonged monitoring; however, they are limited by their respective discomfort and invasive nature. Studies have shown that wearable devices are generally well tolerated and have comparable rates of atrial fibrillation detection in this important cohort.5This novel technology has the potential to improve community diagnostics of paroxysmal arrhythmias. There are multiple areas of implementation that still require validation; however, this research provides robust data, and we commend the authors.Article InformationDisclosures None.FootnotesCirculation is available at www.ahajournals.org/journal/circReferences1. Lubitz SA, Faranesh AZ, Selvaggi C, Atlas SJ, McManus DD, Singer DE, Pagoto S, McConnell MV, Pantelopoulos A, Foulkes AS. Detection of atrial fibrillation in a large population using wearable devices: the Fitbit Heart study.Circulation. 2022; 146:1415–1424.doi: 10.1161/CIRCULATIONAHA.122.060291LinkGoogle Scholar2. Scholten J, Jansen WPJ, Horsthuis T, Mahes AD, Winter MM, Zwinderman AH, Keijer JT, Minneboo M, de Groot JR, Bokma JP. Six-lead device superior to single-lead smartwatch ECG in atrial fibrillation detection.Am Heart J. 2022; 253:53–58. doi: 10.1016/j.ahj.2022.06.010CrossrefMedlineGoogle Scholar3. Bacevicius J, Abramikas Z, Dvinelis E, Audzijoniene D, Petrylaite M, Marinskiene J, Staigyte J, Karuzas A, Juknevicius V, Jakaite R, et al. High specificity wearable device with photoplethysmography and six-lead electrocardiography for atrial fibrillation detection challenged by frequent premature contractions: DoubleCheck-AF.Front Cardiovasc Med. 2022; 9:869730. doi: 10.3389/fcvm.2022.869730CrossrefMedlineGoogle Scholar4. Fine J, Branan KL, Rodriguez AJ, Boonya-Ananta T, Ajmal , Ramella-Roman JC, McShane MJ, Coté GL. Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring.Biosensors (Basel). 2021; 11. doi: 10.3390/bios11040126CrossrefMedlineGoogle Scholar5. Jung S, Lee HA, Kang IS, Shin SH, Chang Y, Woo Shin D, Park M-S, Kim YD, Nam HS, Heo JH, et al; CANDLE-AF Trial Investigators. Clinical Implications of Atrial Fibrillation Detection Using Wearable Devices in Patients with Cryptogenic Stroke (CANDLE-AF) trial: design and rationale.Front Cardiovasc Med. 2022; 9:837958. doi: 10.3389/fcvm.2022.837958CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails April 11, 2023Vol 147, Issue 15 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.122.062711PMID: 37036907 Originally publishedApril 10, 2023 PDF download Advertisement SubjectsEthics and PolicyQuality and Outcomes