@Article{info:doi/10.2196/16443,
author="Kwon, Soonil
and Hong, Joonki
and Choi, Eue-Keun
and Lee, Byunghwan
and Baik, Changhyun
and Lee, Euijae
and Jeong, Eui-Rim
and Koo, Bon-Kwon
and Oh, Seil
and Yi, Yung",
title="Detection of Atrial Fibrillation Using a Ring-Type Wearable Device (CardioTracker) and Deep Learning Analysis of Photoplethysmography Signals: Prospective Observational Proof-of-Concept Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="21",
volume="22",
number="5",
pages="e16443",
keywords="atrial fibrillation; deep learning; diagnosis; photoplethysmography; wearable electronic devices",
abstract="Background: Continuous photoplethysmography (PPG) monitoring with a wearable device may aid the early detection of atrial fibrillation (AF). Objective: We aimed to evaluate the diagnostic performance of a ring-type wearable device (CardioTracker, CART), which can detect AF using deep learning analysis of PPG signals. Methods: Patients with persistent AF who underwent cardioversion were recruited prospectively. We recorded PPG signals at the finger with CART and a conventional pulse oximeter before and after cardioversion over a period of 15 min (each instrument). Cardiologists validated the PPG rhythms with simultaneous single-lead electrocardiography. The PPG data were transmitted to a smartphone wirelessly and analyzed with a deep learning algorithm. We also validated the deep learning algorithm in 20 healthy subjects with sinus rhythm (SR). Results: In 100 study participants, CART generated a total of 13,038 30-s PPG samples (5850 for SR and 7188 for AF). Using the deep learning algorithm, the diagnostic accuracy, sensitivity, specificity, positive-predictive value, and negative-predictive value were 96.9{\%}, 99.0{\%}, 94.3{\%}, 95.6{\%}, and 98.7{\%}, respectively. Although the diagnostic accuracy decreased with shorter sample lengths, the accuracy was maintained at 94.7{\%} with 10-s measurements. For SR, the specificity decreased with higher variability of peak-to-peak intervals. However, for AF, CART maintained consistent sensitivity regardless of variability. Pulse rates had a lower impact on sensitivity than on specificity. The performance of CART was comparable to that of the conventional device when using a proper threshold. External validation showed that 94.99{\%} (16,529/17,400) of the PPG samples from the control group were correctly identified with SR. Conclusions: A ring-type wearable device with deep learning analysis of PPG signals could accurately diagnose AF without relying on electrocardiography. With this device, continuous monitoring for AF may be promising in high-risk populations. Trial Registration: ClinicalTrials.gov NCT04023188; https://clinicaltrials.gov/ct2/show/NCT04023188 ",
issn="1438-8871",
doi="10.2196/16443",
url="http://www.jmir.org/2020/5/e16443/",
url="https://doi.org/10.2196/16443",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348254"
}