Key result
PPG-smartwatches detect AF in ~43% of cryptogenic stroke patients but false positives raise accuracy concerns.
Why the study?
Undiagnosed AF is a potential underlying cause of cryptogenic stroke, and prolonged screening with a PPG smartwatch might offer a solution for detecting AF.
Does 28 days of semi-continuous AF monitoring using a PPG-smartwatch improve atrial fibrillation detection compared to 48 h Holter monitoring in patients with cryptogenic stroke?
Observational (n=37)
No
Does 28 days of semi-continuous AF monitoring using a PPG-smartwatch improve atrial fibrillation detection compared to 48 h Holter monitoring in patients with cryptogenic stroke?
Absolute Event Rate: 43.2% vs 0%
While PPG-smartwatches detected a high rate of potential atrial fibrillation in cryptogenic stroke patients, significant discrepancies with concurrent Holter monitoring suggest many detections are false positives, limiting the current clinical utility of this screening strategy.
Should not yet change post-stroke AF screening practice; leaves open PPG-smartwatch accuracy validation versus Holter.
Introduction: Undiagnosed atrial fibrillation (AF) is a potential underlying cause of cryptogenic stroke. Prolonged screening for AF using a photoplethysmography (PPG) smartwatch might offer a solution for detecting AF in patients with cryptogenic stroke. In this study, we aim to investigate this strategy by comparing AF detection rates using a PPG-smartwatch and 48 h Holter monitor. Methods: From December 2019, patients with cryptogenic stroke were included to undergo 28 days of semi-continuous AF monitoring using a Fitbit smartwatch with a PPG-based FibriCheck algorithm, with simultaneous Holter monitoring during the first 48 h. From April 2021, a detailed screening log was installed to characterize potential study participants. Results: After logged screening of 1,312 patients, enrollment was prematurely halted due to slower-than-expected inclusion rates. 40.8% of the screened patients had cryptogenic stroke, of which 92.5% were non-eligible for inclusion due to logistical, technological, and study-related challenges. Of the 43 patients enrolled, 37 completed PPG monitoring using a smartwatch. 43% of patients had PPG-detected AF in the 28 days after cryptogenic stroke. During the first 48 h, PPG-based screening detected AF in 2 patients, whereas no AF was detected using concurrent Holter monitoring. Conclusion: The PPG-smartwatch detected AF in 43% of the participants after cryptogenic stroke. However, discrepancies with concurrent Holter monitoring raise major concerns about the accuracy of the detected PPG-based AF. Moreover, the feasibility of a PPG-based screening strategy is limited due to logistical and technological challenges, partly inherent to cryptogenic stroke patients.
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Huntelaar et al. (2024) conducted an observational in Cryptogenic stroke (n=37). Photoplethysmography (PPG) smartwatch vs. Holter monitoring was evaluated on Atrial fibrillation detection. A PPG-smartwatch detected atrial fibrillation in 43.2% of patients over 28 days after cryptogenic stroke, but false positives compared to concurrent Holter monitoring raise concerns about its accuracy.
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