TY  - JOUR
AU  - Pitman, Bradley M
AU  - Chew, Sok-Hui
AU  - Wong, Christopher X
AU  - Jaghoori, Amenah
AU  - Iwai, Shinsuke
AU  - Thomas, Gijo
AU  - Chew, Andrew
AU  - Sanders, Prashanthan
AU  - Lau, Dennis H
PY  - 2021
DA  - 2021/5/19
TI  - 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
JO  - JMIR Mhealth Uhealth
SP  - e24470
VL  - 9
IS  - 5
KW  - atrial fibrillation
KW  - screening
KW  - sub-Saharan Africa
KW  - single-lead ECG
AB  - 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 
SN  - 2291-5222
UR  - https://mhealth.jmir.org/2021/5/e24470
UR  - https://doi.org/10.2196/24470
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34009129
DO  - 10.2196/24470
ID  - info:doi/10.2196/24470
ER  -