Yuval Avidan MD , Amir Aker MD , Razi Khoury MD , Sameha Zahra MD , Nissan Ben Dov MD , Jorge E. Schliamser MD , Asaf Danon MD, MSc
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Twenty blinded physicians from 4 different specialties independently analyzed all recordings.</div></div><div><h3>Results</h3><div>Physicians’ ability to detect AFL using the AW-I lead was poor, with only 11.6% of cases correctly identified (<em>P</em> = 0.362). AFL was most often misdiagnosed as AF (55.6%), undetermined (21%), or sinus rhythm (11.8%). Diagnostic accuracy improved significantly with the AW-II lead, exceeding 80% among electrophysiologists, cardiologists, and primary care physicians (<em>P</em> = 0.001). Variable atrioventricular conduction was associated strongly with correct diagnosis exclusively through the AW-II lead (odds ratio 1.85, 95% confidence interval 1.14-3.0, <em>P</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>The standard lead-I configuration used by smartwatches is prone to misclassifying AF as AFL, particularly in the setting of variable conduction. A simple modification to lead-II positioning significantly enhances diagnostic accuracy. This adjustment may be especially valuable during post–pulmonary vein isolation surveillance and in broader clinical scenarios in which precise rhythm identification can influence therapeutic decision-making.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1149-1156"},"PeriodicalIF":2.5000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"From Wrist to Precision: Enhanced Atrial Flutter Detection with Modified Smartwatch Single-Lead Electrocardiogram Placement\",\"authors\":\"Yuval Avidan MD , Amir Aker MD , Razi Khoury MD , Sameha Zahra MD , Nissan Ben Dov MD , Jorge E. Schliamser MD , Asaf Danon MD, MSc\",\"doi\":\"10.1016/j.cjco.2025.05.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Smartwatches, such as the Apple Watch (AW), are well-established tools for detecting atrial fibrillation (AF). We hypothesize that atrial flutter (AFL) is frequently misdiagnosed using traditional single-lead electrocardiogram configurations and that modified device positioning could substantially improve diagnostic accuracy.</div></div><div><h3>Methods</h3><div>Standard smartwatch lead-I (AW-I) recordings were obtained from 75 patients, including 25 with AFL, 25 with AF, and 25 with sinus rhythm. Additionally, modified lead-II (AW-II) recordings were collected for all AFL cases, resulting in a total of 100 tracings. Twenty blinded physicians from 4 different specialties independently analyzed all recordings.</div></div><div><h3>Results</h3><div>Physicians’ ability to detect AFL using the AW-I lead was poor, with only 11.6% of cases correctly identified (<em>P</em> = 0.362). AFL was most often misdiagnosed as AF (55.6%), undetermined (21%), or sinus rhythm (11.8%). Diagnostic accuracy improved significantly with the AW-II lead, exceeding 80% among electrophysiologists, cardiologists, and primary care physicians (<em>P</em> = 0.001). Variable atrioventricular conduction was associated strongly with correct diagnosis exclusively through the AW-II lead (odds ratio 1.85, 95% confidence interval 1.14-3.0, <em>P</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>The standard lead-I configuration used by smartwatches is prone to misclassifying AF as AFL, particularly in the setting of variable conduction. A simple modification to lead-II positioning significantly enhances diagnostic accuracy. This adjustment may be especially valuable during post–pulmonary vein isolation surveillance and in broader clinical scenarios in which precise rhythm identification can influence therapeutic decision-making.</div></div>\",\"PeriodicalId\":36924,\"journal\":{\"name\":\"CJC Open\",\"volume\":\"7 9\",\"pages\":\"Pages 1149-1156\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CJC Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589790X25003968\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CJC Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589790X25003968","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
智能手表,如Apple Watch (AW),是检测心房颤动(AF)的成熟工具。我们假设使用传统的单导联心电图配置经常误诊心房扑动(AFL),并且修改设备定位可以大大提高诊断准确性。方法75例AFL患者25例,AF患者25例,窦性心律患者25例,采用智能手表标准导联- i (AW-I)记录。此外,收集了所有AFL病例的改良铅- ii (AW-II)记录,共进行了100次追踪。来自4个不同专业的20名盲法医生独立分析了所有记录。结果医师对AFL的检测能力较差,仅有11.6%的病例被正确识别(P = 0.362)。AFL最常误诊为房颤(55.6%)、不确定(21%)或窦性心律(11.8%)。AW-II导联显著提高了诊断准确性,电生理学家、心脏病专家和初级保健医生的诊断准确率超过80% (P = 0.001)。可变房室传导与完全通过AW-II导联的正确诊断密切相关(优势比1.85,95%可信区间1.14-3.0,P = 0.012)。结论智能手表使用的标准引线i配置容易将AF误认为AFL,特别是在可变导通设置下。对铅- ii定位的简单修改可显著提高诊断准确性。这种调整在肺静脉隔离后监测和更广泛的临床场景中可能特别有价值,在这些场景中,精确的节律识别可以影响治疗决策。
From Wrist to Precision: Enhanced Atrial Flutter Detection with Modified Smartwatch Single-Lead Electrocardiogram Placement
Background
Smartwatches, such as the Apple Watch (AW), are well-established tools for detecting atrial fibrillation (AF). We hypothesize that atrial flutter (AFL) is frequently misdiagnosed using traditional single-lead electrocardiogram configurations and that modified device positioning could substantially improve diagnostic accuracy.
Methods
Standard smartwatch lead-I (AW-I) recordings were obtained from 75 patients, including 25 with AFL, 25 with AF, and 25 with sinus rhythm. Additionally, modified lead-II (AW-II) recordings were collected for all AFL cases, resulting in a total of 100 tracings. Twenty blinded physicians from 4 different specialties independently analyzed all recordings.
Results
Physicians’ ability to detect AFL using the AW-I lead was poor, with only 11.6% of cases correctly identified (P = 0.362). AFL was most often misdiagnosed as AF (55.6%), undetermined (21%), or sinus rhythm (11.8%). Diagnostic accuracy improved significantly with the AW-II lead, exceeding 80% among electrophysiologists, cardiologists, and primary care physicians (P = 0.001). Variable atrioventricular conduction was associated strongly with correct diagnosis exclusively through the AW-II lead (odds ratio 1.85, 95% confidence interval 1.14-3.0, P = 0.012).
Conclusions
The standard lead-I configuration used by smartwatches is prone to misclassifying AF as AFL, particularly in the setting of variable conduction. A simple modification to lead-II positioning significantly enhances diagnostic accuracy. This adjustment may be especially valuable during post–pulmonary vein isolation surveillance and in broader clinical scenarios in which precise rhythm identification can influence therapeutic decision-making.