@Article{info:doi/10.2196/24470,
author="Pitman, Bradley M
and Chew, Sok-Hui
and Wong, Christopher X
and Jaghoori, Amenah
and Iwai, Shinsuke
and Thomas, Gijo
and Chew, Andrew
and Sanders, Prashanthan
and Lau, Dennis H",
title="Performance of a Mobile Single-Lead Electrocardiogram Technology for Atrial Fibrillation Screening in a Semirural African Population: Insights From ``The Heart of Ethiopia: Focus on Atrial Fibrillation'' (TEFF-AF) Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="19",
volume="9",
number="5",
pages="e24470",
keywords="atrial fibrillation; screening; sub-Saharan Africa; single-lead ECG",
abstract="Background: Atrial fibrillation (AF) screening using mobile single-lead electrocardiogram (ECG) devices has demonstrated variable sensitivity and specificity. However, limited data exists on the use of such devices in low-resource countries. Objective: The goal of the research was to evaluate the utility of the KardiaMobile device's (AliveCor Inc) automated algorithm for AF screening in a semirural Ethiopian population. Methods: Analysis was performed on 30-second single-lead ECG tracings obtained using the KardiaMobile device from 1500 TEFF-AF (The Heart of Ethiopia: Focus on Atrial Fibrillation) study participants. We evaluated the performance of the KardiaMobile automated algorithm against cardiologists' interpretations of 30-second single-lead ECG for AF screening. Results: A total of 1709 single-lead ECG tracings (including repeat tracing on 209 occasions) were analyzed from 1500 Ethiopians (63.53{\%} [953/1500] male, mean age 35 [SD 13] years) who presented for AF screening. Initial successful rhythm decision (normal or possible AF) with one single-lead ECG tracing was lower with the KardiaMobile automated algorithm versus manual verification by cardiologists (1176/1500, 78.40{\%}, vs 1455/1500, 97.00{\%}; P<.001). Repeat single-lead ECG tracings in 209 individuals improved overall rhythm decision, but the KardiaMobile automated algorithm remained inferior (1301/1500, 86.73{\%}, vs 1479/1500, 98.60{\%}; P<.001). The key reasons underlying unsuccessful KardiaMobile automated rhythm determination include poor quality/noisy tracings (214/408, 52.45{\%}), frequent ectopy (22/408, 5.39{\%}), and tachycardia (>100 bpm; 167/408, 40.93{\%}). The sensitivity and specificity of rhythm decision using KardiaMobile automated algorithm were 80.27{\%} (1168/1455) and 82.22{\%} (37/45), respectively. Conclusions: The performance of the KardiaMobile automated algorithm was suboptimal when used for AF screening. However, the KardiaMobile single-lead ECG device remains an excellent AF screening tool with appropriate clinician input and repeat tracing. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001107112; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378057{\&}isReview=true ",
issn="2291-5222",
doi="10.2196/24470",
url="https://mhealth.jmir.org/2021/5/e24470",
url="https://doi.org/10.2196/24470",
url="http://www.ncbi.nlm.nih.gov/pubmed/34009129"
}