Highlights
- •The AliveCor Kardia allows for a highly accurate rhythm diagnosis.
- •A novel parasternal lead adds valuable diagnostic information.
- •Recordings should be reviewed by an experienced cardiologist.
Abstract
Introduction
The AliveCor Kardia ECG monitor (ACK) offers a smartphone-based one-lead ECG recording
for the detection of atrial fibrillation. We compared ACK lead I recordings with the
12-lead ECG and introduce a novel parasternal lead (NPL).
Methods
Consecutive cardiac inpatients were recruited. In all patients a 12-lead ECG, ACK
lead I and NPL were obtained. Two experienced electrophysiologists were blinded and
separately evaluated all ECG. We calculated sensitivity, specificity, and predictive
values of the ACK ECG compared to the 12-lead ECG.
Results
296 ECG from 99 patients (38 female, age 64 ± 15 years, BMI 27.8 ± 5.1 kg/m2) were analyzed. 20% of ACK lead I recordings contained a critical amount of artifact.
The electrophysiologists’ interpretation of the ACK recordings yielded a sensitivity
of 100% and specificity of 94% for atrial fibrillation or flutter in lead I (κ = 0.90) and a sensitivity of 96% and specificity of 97% in the NPL (κ = 0.92). The ACK diagnostic algorithm displayed a significantly lower sensitivity
(55–70%), specificity (60–69%), and accuracy (κ = 0.4–0.53) but a high negative predictive value (100%). Patients with atrial flutter
(n = 5) and with ventricular stimulation (n = 12) had a high likelihood of being misclassified by the algorithm.
Conclusion
The AliveCor Kardia ECG monitor allows a highly accurate detection of atrial fibrillation
by an interpreting electrophysiologist both in the standard lead I and a novel parasternal
lead. The diagnostic algorithm offered by the system may be useful in screening recordings
for further review. Diagnostic challenges present in atrial flutter and ventricular
pacemaker stimulation.
Keywords
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Article info
Publication history
Published online: December 02, 2019
Accepted:
November 26,
2019
Received in revised form:
November 24,
2019
Received:
July 11,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
