What is the clinical evidence from this study?

Study design: Observational. Population: Ventricular arrhythmias (n=25). Intervention: CART-I ring-type wearable photoplethysmography sensor vs. Electrocardiogram (ECG). Primary outcome: Sensitivity to detect induced ventricular arrhythmias.

June 13, 2025Heart Rhythm11 citationsOpen Access

Ventricular arrhythmia detection with a wearable ring-type photoplethysmography sensor: A feasibility study

NSNicole J. van SteijnAmsterdam Neuroscience SPShari PepplinkhuizenAmsterdam Neuroscience PPPieter G. PostemaElectrophysiology

Key Result

The CART-I ring-type wearable photoplethysmography sensor detected induced ventricular arrhythmias with an overall sensitivity of 94%, including 100% for ventricular fibrillation and 90% for ventricular tachycardia.

Study Design

Type

Observational (n=25)

Multicenter

Structured PICO

Does a ring-type wearable photoplethysmography sensor accurately detect induced ventricular arrhythmias compared to reference electrocardiogram in patients undergoing VA induction procedures?

Population

25 adult patients undergoing procedures with induced ventricular arrhythmias, monitored with a ring-type photoplethysmography sensor to detect loss of cardiac output.

Intervention

Ring-type wearable photoplethysmography (PPG) sensor (CART-I) positioned on the finger during the procedure

Comparator

Reference electrocardiogram (ECG)

Outcome

Sensitivity to detect induced ventricular arrhythmia (defined as loss of cardiac output: flatline or decrease in amplitude ≥50%)surrogate

A ring-type wearable PPG sensor can detect induced ventricular arrhythmias with high sensitivity, suggesting its potential utility for continuous ambulatory monitoring.

Limitations

Bluetooth connectivity issues leading to data loss during procedures.
Rapid ventricular pacing during induction may cause transient drops in cardiac output, potentially inflating sensitivity.
Lack of continuous blood pressure monitoring to confirm hemodynamic instability for all episodes.
Data collected in a controlled setting with sedated patients, leaving the false positive rate in real-world settings unknown.

Abstract

BACKGROUND: Ventricular arrhythmias (VAs) are most frequently the onset of sudden cardiac death, and early detection is key for survival. Limited studies suggest that wrist-worn photoplethysmography (PPG) sensors can detect VA. Ring-type wearable PPG sensors may be more accurate; however, they have not yet been investigated. OBJECTIVE: We aimed to show the sensitivity of a ring-type wearable PPG sensor to detect induced VA. METHODS: Patients undergoing a procedure involving VA induction were included. The CART-I was positioned on the finger during the procedure, and PPG and reference electrocardiogram data were collected. A loss of cardiac output was defined as a flatline, or a decrease in amplitude of ≥50%. Sensitivity was calculated using a contingency table. Bland-Altman analysis and intraclass correlation coefficients were used to assess the agreement between PPG- and electrocardiogram-derived arrhythmia durations. RESULTS: Thirty-seven patients were enrolled, of whom 25 were included: defibrillation threshold testing (n = 16), ventricular tachycardia (VT) ablation (n = 8), and electrophysiological study (n = 1). A total of 67 VA episodes, of which 27 were ventricular fibrillation (VF) and 40 were VT episodes, were recorded. A loss of cardiac output was observed on the tachograms of all VF episodes and 36 VT episodes (90%). The sensitivity was 94% (VF, 100%; VT, 90%). The mean difference in VA duration was 0.1 seconds (95% limits of agreement -1.4 to 1.7), with an intraclass correlation coefficient of 0.998 (95% confidence interval, 0.997-0.999), indicating excellent agreement. CONCLUSION: This study suggests that a ring-type wearable device can detect, with high sensitivity, changes in arterial pulse flow during induced VA.

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