Accuracy of Single-Lead ECG Device for Diagnosis of Cardiac Arrhythmias
Compared Against Cardiac Electrophysiology Study
Background Single-lead ECG devices may allow detection and
diagnosis of cardiac rhythms. However, data on their accuracy for
detecting cardiac arrhythmias beyond atrial fibrillation are limited.
Objectives To determine the accuracy of the AliveCor
KardiaMobile (AC; AliveCor Inc, Mountain View, CA) for the diagnosis of
arrhythmias against gold standard cardiac electrophysiology study (EPS).
Methods Patients undergoing clinically indicated EPS underwent
simultaneous rhythms recording with an infraclavicular-placed AC,
standard 12-lead ECG and EP catheters for intracardiac electrograms.
Rhythms recorded during EPS were classified based on electrogram,
12-lead ECG and clinical findings. Blinded reviewers provided
differential diagnoses for the single-lead AC tracings; a separate
reviewer compared diagnoses made between the AC tracings and EPS
findings. Results From 49 patients, 843 cardiac rhythms were
captured during 502 AC recordings. Analysis of tracings containing sinus
rhythm (n=273) returned overall accuracy of 92%, with sensitivity and
specificity values of 93% and 92%, respectively. Accuracy for tracings
per rhythm were atrial fibrillation 91% (n=51); supraventricular
tachycardia accuracy was 89% (n=191), ventricular tachycardia 91%
(n=198), ventricular fibrillation 98% (n=11), asystole 100% (n=5).
Accuracy for supraventricular ectopy was 93% (n=28) and premature
ventricular complexes was 91% (n=86). Overall accuracy was 94% for
uninterrupted rhythms and 93% in tracings from patients with baseline
bundle branch block. Conclusions When compared against the gold
standard EPS diagnosis, interpretation of arrhythmias recorded by an
AliveCor single-lead ECG device had reasonable diagnostic accuracy.