Wireless Smartphone ECG Enables Large-Scale Screening
Wireless Smartphone ECG Enables Large-Scale Screening
Twelve-Lead ECG as a Cardiovascular Screening Tool. Background The ubiquitous presence of internet-connected phones and tablets presents a new opportunity for cost-effective and efficient electrocardiogram (ECG) screening and on-demand diagnosis. Wireless, single-lead real-time ECG monitoring supported by iOS and android devices can be obtained quickly and on-demand. ECGs can be immediately downloaded and reviewed using any internet browser.
Objective We compared the standard 12-lead ECG to the smartphone ECG in healthy young adults, elite athletes, and cardiology clinic patients. Accuracy for determining baseline ECG intervals and rate and rhythm was assessed.
Methods In 381 participants, 30-second lead I ECG waveforms were obtained using an iPhone case or iPad. Standard 12-lead ECGs were acquired immediately after the smartphone tracing was obtained. De-identified ECGs were interpreted by automated algorithms and adjudicated by two board-certified electrophysiologists.
Results Both smartphone and standard ECGs detected atrial rate and rhythm, AV block, and QRS delay with equal accuracy. Sensitivities ranged from 72% (QRS delay) to 94% (atrial fibrillation). Specificities were all above 94% for both modalities.
Conclusion Smartphone ECG accurately detects baseline intervals, atrial rate, and rhythm and enables screening in diverse populations. Efficient ECG analysis using automated discrimination and an enhanced smartphone application with notification capabilities are features that can be easily incorporated into the acquisition process.
The standard 12-lead electrocardiogram (ECG) has been extensively examined as a cardiovascular screening tool. However, studied across multiple populations, large-scale screening has been shown to lack sensitivity, specificity, and cost effectiveness and requires that 12-lead ECG machines be immediately available.
One of the most significant opportunities for ECG screening is to prevent morbid events in the detection of atrial fibrillation (AF), a common arrhythmia that increases with age and is often asymptomatic and associated with significant morbidity and mortality.
Elite athletes have 2.5 times the risk of sudden death and the 12-lead ECG as an athletic preparticipation screening tool can detect 70–90% of serious abnormalities and has a negative predictive value of 99.98%. However, the ECG's high false-positive rate has inhibited widespread adoption, and the American Heart Association does not recommend that athletic screening include a 12-lead ECG in the absence of significant history, clinical signs, or symptoms of cardiovascular disease.
Advances in wireless technology and digital communication enables real-time ECG recording and viewing directly on a smart phone or tablet without the need for an ECG machine, leads, or experienced personnel. The technology is FDA approved and is available as a prescriptive or over-the-counter diagnostic. Waveform images are stored on the recording device, and instantaneously ported to the internet. The ECGs can be viewed as PDF documents or using any internet browser. A recent economic analysis of smartphone enabled ECG showed that community screening for AF in patients above age 65 was cost-effective.
We sought to determine smartphone enabled ECG acquisition accuracy and effectiveness in screening large at-risk populations, such as cardiology clinic patients, elite athletes, and asymptomatic young adults.
Abstract and Introduction
Abstract
Twelve-Lead ECG as a Cardiovascular Screening Tool. Background The ubiquitous presence of internet-connected phones and tablets presents a new opportunity for cost-effective and efficient electrocardiogram (ECG) screening and on-demand diagnosis. Wireless, single-lead real-time ECG monitoring supported by iOS and android devices can be obtained quickly and on-demand. ECGs can be immediately downloaded and reviewed using any internet browser.
Objective We compared the standard 12-lead ECG to the smartphone ECG in healthy young adults, elite athletes, and cardiology clinic patients. Accuracy for determining baseline ECG intervals and rate and rhythm was assessed.
Methods In 381 participants, 30-second lead I ECG waveforms were obtained using an iPhone case or iPad. Standard 12-lead ECGs were acquired immediately after the smartphone tracing was obtained. De-identified ECGs were interpreted by automated algorithms and adjudicated by two board-certified electrophysiologists.
Results Both smartphone and standard ECGs detected atrial rate and rhythm, AV block, and QRS delay with equal accuracy. Sensitivities ranged from 72% (QRS delay) to 94% (atrial fibrillation). Specificities were all above 94% for both modalities.
Conclusion Smartphone ECG accurately detects baseline intervals, atrial rate, and rhythm and enables screening in diverse populations. Efficient ECG analysis using automated discrimination and an enhanced smartphone application with notification capabilities are features that can be easily incorporated into the acquisition process.
Introduction
The standard 12-lead electrocardiogram (ECG) has been extensively examined as a cardiovascular screening tool. However, studied across multiple populations, large-scale screening has been shown to lack sensitivity, specificity, and cost effectiveness and requires that 12-lead ECG machines be immediately available.
One of the most significant opportunities for ECG screening is to prevent morbid events in the detection of atrial fibrillation (AF), a common arrhythmia that increases with age and is often asymptomatic and associated with significant morbidity and mortality.
Elite athletes have 2.5 times the risk of sudden death and the 12-lead ECG as an athletic preparticipation screening tool can detect 70–90% of serious abnormalities and has a negative predictive value of 99.98%. However, the ECG's high false-positive rate has inhibited widespread adoption, and the American Heart Association does not recommend that athletic screening include a 12-lead ECG in the absence of significant history, clinical signs, or symptoms of cardiovascular disease.
Advances in wireless technology and digital communication enables real-time ECG recording and viewing directly on a smart phone or tablet without the need for an ECG machine, leads, or experienced personnel. The technology is FDA approved and is available as a prescriptive or over-the-counter diagnostic. Waveform images are stored on the recording device, and instantaneously ported to the internet. The ECGs can be viewed as PDF documents or using any internet browser. A recent economic analysis of smartphone enabled ECG showed that community screening for AF in patients above age 65 was cost-effective.
We sought to determine smartphone enabled ECG acquisition accuracy and effectiveness in screening large at-risk populations, such as cardiology clinic patients, elite athletes, and asymptomatic young adults.
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