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.

中文翻译：

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用于房颤筛查的脉动光电容积描记应用或手持设备与 12 导联心电图的准确性：系统评价和荟萃分析

背景

与金标准 12 导联心电图 (ECG) 相比，脉动光电容积描记应用 (PPG) 或手持式 (HH) 设备在诊断心房颤动方面的相对准确性尚不清楚。

方法

搜索数字数据库以识别相关文章。使用双变量模型汇总原始数据以计算诊断准确性测量并估计分层汇总接收器操作特征（HSROC）。

结果

分析共纳入 10 篇文章，包括 4296 名患者（平均年龄 68.9 岁，男性占 56%）。与 EKG 相比，PPG 和 HH 设备在 AF 检测中的综合灵敏度分别为 0.93（95% CI 0.87–0.96；p  < 0.05）和 0.87（95% CI 0.74–0.94；p <  0.05）。PPG 和 HH 设备在 AF 检测中的综合特异性为 0.91（95% CI 0.88–0.94；p  < 0.05）和 0.96（95% CI 0.90–0.98；p < 0.05)，分别。PPG 和 HH 设备的诊断优势比分别为 129 和 144。Fagan 的列线图显示患者在 PPG 或 HH 设备上出现 AF 和正常节律的概率为 2-3%，而在 PPG 或 HH 设备上出现 AF 且 RR 间期不规则的概率分别为 73% 和 82%，分别。阳性和阴性似然比的散点图显示 AF 的高度确认和排除 HH 设备上不规则 RR 间期（阳性似然比 > 10，负似然比 <0.1）的可靠性，而 PPG 仅用作确认。

结论

PPG 或 HH 设备可以作为检测 AF 的可靠替代方案。