Key result
All devices demonstrated high accuracy in atrial fibrillation detection, but the Withings algorithm had significantly fewer uninterpretable results (5%) compared to Kardia 6L (31%, p<0.001), while Kardia 6L was most accurate for QRS morphology (90%).
Why the study?
Various ECG-based devices are available for home monitoring, but their reliability in adults with CHD is unknown.
Do ECG-based home monitoring devices accurately detect atrial fibrillation, QRS morphology, and QTc intervals compared to standard 12-lead ECG in adults with congenital heart disease?
Cross-Sectional (n=176)
Single-blind
No
Do ECG-based home monitoring devices accurately detect atrial fibrillation, QRS morphology, and QTc intervals compared to standard 12-lead ECG in adults with congenital heart disease?
In adults with congenital heart disease, ECG-based home monitoring devices show high accuracy for AF detection, with Kardia 6L performing best for overall evaluation including QRS morphology and QTc duration.
May support device selection to reduce uninterpretable AF tracings in youth; leaves open prospective validation before practice change.
BACKGROUND: Various electrocardiogram (ECG)-based devices are available for home monitoring, but the reliability in adults with CHD is unknown. Therefore, we determined the accuracy of different ECG-based devices compared to the standard 12-lead ECG in adult CHD. METHODS AND RESULTS: This is a single-centre, prospective, cross-sectional study in 176 consecutive adults with CHD (54% male, age 40 ± 16.6 years, 24% severe CHD, 84% previous surgery, 3% atrial fibrillation (AF), 24% right bundle branch block). Diagnostic accuracy of the Withings Scanwatch (lead I), Eko DUO (precordial lead), and Kardia 6L (six leads) was determined in comparison to the standard 12-lead ECG on several tasks: 1) AF classification (percentage correct), 2) QRS-morphology classification (percentage correct), and 3) ECG intervals calculation (QTc time ≤ 40 ms difference). Both tested AF algorithms had high accuracy (Withings: 100%, Kardia 6L: 97%) in ECGs that were classified. However, the Withings algorithm classified fewer ECGs as inconclusive (5%) compared to 31% of Kardia (p < 0.001). Physician evaluation of Kardia correctly classified QRS morphology more frequently (90% accuracy) compared to Eko DUO (84% accuracy) (p = 0.03). QTc was underestimated on all ECG-based devices (p < 0.01). QTc duration accuracy was acceptable in only 51% of Withings versus 70% Eko and 74% Kardia (p < 0.001 for both comparisons). CONCLUSIONS: Although all devices demonstrated high accuracy in AF detection, the Withings automatic algorithm had fewest uninterpretable results. Kardia 6L was most accurate in overall evaluation such as QRS morphology and QTc duration. These findings can inform both patients and caregivers for optimal choice of home monitoring.
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Pengel et al. (2022) conducted a cross-sectional in Congenital Heart Disease (CHD) (n=176). ECG-based home monitoring devices (Withings Scanwatch, Eko DUO, Kardia 6L) vs. Standard 12-lead ECG was evaluated on Diagnostic accuracy for atrial fibrillation (AF) detection, QRS morphology, and ECG intervals compared to 12-lead ECG. All devices demonstrated high accuracy in atrial fibrillation detection, but the Withings algorithm had significantly fewer uninterpretable results (5%) compared to Kardia 6L (31%, p<0.001), while Kardia 6L was most accurate for QRS morphology (90%).
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