An extensive quantitative analysis of the effects of errors in beat-to-beat intervals on all commonly used HRV parameters.

Heart rate variability (HRV) analysis is often used to estimate human health and fitness status. More specifically, a range of parameters that express the variability in beat-to-beat intervals are calculated from electrocardiogram beat detections. Since beat detection may yield erroneous interval data, these errors travel through the processing chain and may result in misleading parameter values that can lead to incorrect conclusions. In this study, we utilized Monte Carlo simulation on real data, Kolmogorov-Smirnov tests and Bland-Altman analysis to carry out extensive analysis of the noise sensitivity of different HRV parameters. The used noise models consider Gaussian and student-t distributed noise. As a result we observed that commonly used HRV parameters (e.g. pNN50 and LF/HF ratio) are especially sensitive to noise and that all parameters show biases to some extent. We conclude that researchers should be careful when reporting different HRV parameters, consider the distributions in addition to mean values, and consider reference data if applicable. The analysis of HRV parameter sensitivity to noise and resulting biases presented in this work generalizes over a wide population and can serve as a reference and thus provide a basis for the decision about which HRV parameters to choose under similar conditions.

Heart rate variability and perception of mental stress among medical students and residents at an emergency department.

BACKGROUND: When Medical Residents (MR) and Medical Students (MS) are assigned to the demanding environment of an Emergency they inevitably encounter stress. The aims of this study are to measure short-term heart rate variability (HRV) before and after shifts, estimate perceived stress levels, and assess the recovery patterns after their shifts. METHODS: We assessed HRV parameters in MS and MR using the wristband physiological monitor Polar® Verify Sense before and after day (DS) and night shifts (NS). Perceived stress levels were evaluated using the simplified State Trait Anxiety Inventory (STAI-S6) and the Subjective Units of Distress Scale. RESULTS: This study included 60 participants of which 55% were female with a mean age of 26 years. MS presented significant reduction in sympathetic nervous system index after DS [0.68 (0.01-2.42) vs -0.22 (-0.75-1.13), p < 0.01] and NS [0.87 (-0.28-1.45) vs 0.06 (-0.70-1.04), p < 0.01], while MR maintained the same levels of sympathetic activity [DS: 1.17 (0.04 -2.88) vs 0.93 (0.50-1.41), p = 0.14; NS: 1.37 (0.76-2.21) vs 1.29 (0.35-2.18), p = 0.40]. Psychological data from STAI-S6 showed statistically significant differences when comparing before and after DS in both groups, with more perceived stress after than before DS (MS: 12 ± 4 vs 14 ± 4, p = 0.04; MR: 14 ± 4 vs 16 ± 4, p = 0.04), which was not observed at NS (MS: 12 ± 3 vs 12 ± 3, p = 0.84; MR: 15 ± 3 vs 15 ± 4, p = 0.40). CONCLUSIONS: Short-term HRV recordings before and after day or night shifts among MR and MS revealed heightened sympathetic activity preceding each shift, with a more sustained increase observed in the MR population and more perceived stress after day shifts in both groups.

To what degree patient-reported symptoms of central sensitization, kinesiophobia, disability, sleep, and life quality associated with 24-h heart rate variability and actigraphy measurements?

OBJECTIVES: Chronic musculoskeletal pain is associated with decreased parasympathetic and increased sympathetic activity in the autonomic nervous system. The objective of this study was to determine the associations between objective measures of heart rate variability (a measure of autonomic nervous system function), actigraphy (a measure of activity and sleep quality), respiration rates, and subjective patient-reported outcome measures (PROMs) of central sensitization, kinesiophobia, disability, the effect of pain on sleep, and life quality. METHODS: Thirty-eight study subjects were divided into two subgroups, including low symptoms of central sensitization (n = 18) and high symptoms of central sensitization (n = 20), based on patient-reported scores on the Central Sensitization Inventory (CSI). Heart rate variability (HRV) and actigraphy measurements were carried out simultaneously in 24 h measurement during wakefulness and sleep. RESULTS: A decrease in HRV during the first 2 h of sleep was stronger in the low CSI subgroup compared to the high CSI subgroup. Otherwise, all other HRV and actigraphy parameters and subjective measures of central sensitization, disability, kinesiophobia, the effect of pain on sleep, and quality of life showed only little associations. DISCUSSION: The high CSI subgroup reported significantly more severe symptoms of disability, kinesiophobia, sleep, and quality of life compared to the low CSI subgroup. However, there were only small and nonsignificant trend in increased sympathetic nervous system activity and poorer sleep quality on the high central sensitization subgroup. Moreover, very little differences in respiratory rates were found between the groups.

Effectiveness of an Occupational Well-being Intervention Among Nurse Educators: A Quasi-Experimental Study.

BACKGROUND: Occupational well-being supports the retention of the nurse educator workforce and their ability to manage workload. There is a research gap regarding interventions promoting occupational well-being. PURPOSE: To evaluate the effectiveness of an 8-workweek digital occupational well-being intervention using self-conducted exercises among nurse educators in secondary vocational nursing schools in Finland. METHODS: A quasi-experimental study design was applied using an intervention group (n = 37) and a control group (n = 40). Data were collected at baseline, post, and 1-month follow-up using a questionnaire and a heart rate sensor to assess the resource-workload-balance and its associating and promoting factors. RESULTS: This study found no statistical effects on the resource-workload-balance. Positive effects were found on associating factors (general well-being) and promoting factors (recovery experiences and self-regulation). CONCLUSIONS: Self-Help INtervention for Educators (SHINE) has the potential to promote recovery experiences during working hours; however, the intervention needs more investigation.

Novel Technologies in the Detection of Atrial Fibrillation: Review of Literature and Comparison of Different Novel Technologies for Screening of Atrial Fibrillation.

Atrial fibrillation (AF) is globally the most common arrhythmia associated with significant morbidity and mortality. It impairs the quality of the patient's life, imposing a remarkable burden on public health, and the healthcare budget. The detection of AF is important in the decision to initiate anticoagulation therapy to prevent thromboembolic events. Nonetheless, AF detection is still a major clinical challenge as AF is often paroxysmal and asymptomatic. AF screening recommendations include opportunistic or systematic screening in patients ≥65 years of age or in those individuals with other characteristics pointing to an increased risk of stroke. The popularities of well-being and taking personal responsibility for one's own health are reflected in the continuous development and growth of mobile health technologies. These novel mobile health technologies could provide a cost-effective solution for AF screening and an additional opportunity to detect AF, particularly its paroxysmal and asymptomatic forms.

Enhancing Inhibitory Control in Older Adults: A Biofeedback Study.

Multidomain interventions based on bio-/neurofeedback have proven useful in improving executive functions. The present study aimed to explore the potential efficacy and feasibility of an intervention that combined Heart Rate Variability Biofeedback (HRV-BF) and Near Infrared Hemoencephalography Neurofeedback (nirHEG-NF) on inhibitory control (IC) of healthy older adults. Thirty-four participants were randomly assigned to two groups: the biofeedback group (received a 10-week combined intervention of HRV-BF and nirHEG-NF) and the active control group (received a similar protocol without real-time biofeedback). Besides cognitive outcomes, the study examined pre- and post-changes in autonomic regulation and prefrontal blood oxygenation at rest and during training. Results revealed training-induced inhibitory control gains in one of the two interference tasks, whereas no effect was found on response inhibition. After the intervention, HRV increased in participants with the lowest levels of HRV at baseline. Although older adults increased blood oxygenation during training, no significant pre- and post-changes were found in blood flow oxygenation. These findings not only suggest that HRV-BF and nirHEG-NF potentially improve performance in certain subcomponents of inhibition (i.e., interference vs. response inhibition), but it may also be beneficial for parasympathetic activity in participants with low HRV and for increasing blood flow oxygenation on prefrontal areas during training.

Effects of weight loss through lifestyle changes on heart rate variability in overweight and obese patients: A systematic review.

BACKGROUND & AIMS: The effects of calorie restriction and physical activity on autonomic regulation and cardiac vagal control in overweight and obese individuals remain inconsistent. Thus, this systematic review aimed to evaluate the weight loss effects through lifestyle changes on heart rate variability (HRV) markers in overweight and obese subjects. METHODS: A systematic search for studies published up to November 2021 was conducted in MEDLINE, Embase, EBSCO host and VHL REGIONAL/LILACS. The main outcomes were changes in HRV indices from pre- and post-nutritional intervention and exercise in overweight and obese individuals. This review was registered in PROSPERO: CRD42021274467. RESULTS: The literature search retrieved 959 articles, of which 12 were included in this review. The intervention in nine studies was diet only, in two studies was diet and exercise, and in one study diet was compared to diet and exercise. The weight loss was greater than 10% in four studies and between 5 and 10% in three studies. Most of the studies revealed that weight loss through lifestyle changes seems to promote beneficial effects on HRV, restoring sympathovagal balance by increasing parasympathetic activity and reducing sympathetic activation. CONCLUSION: This systematic review exhibited the beneficial effects of weight loss through lifestyle changes on cardiac autonomic control in overweight and obese individuals. Future investigations need standardization of HRV indices for better interpretation of autonomic function in different clinical situations.

From skinner box to daily life: Sign-tracker phenotype co-segregates with impulsivity, compulsivity, and addiction tendencies in humans.

Pavlovian conditioning holds the potential to incentivize environmental cues, leading to approach behavior toward them, even outside our awareness. Animal models suggest that this is particularly true for the so-called sign-tracker (ST) phenotype, which is considered to reflect a predisposition toward developing addiction-related behaviours. Despite its potential clinical relevance, few studies have demonstrated the translational validity of this model, likely due to difficulties in studying Pavlovian processes in humans. To fill this gap, we combined an ecological momentary assessment with ambulatory peripheral autonomic monitoring to test the hypothesis that traits associated with ST in preclinical studies would be associated with attribution of high incentive salience to reward-related cues. Several times for 2 days, participants were asked to rate the attractiveness of several preselected ecological rewards (e.g., coffee) and the preceding cues (the smell of coffee) while their electrocardiogram was recorded. While no absolute difference in subjective and physiological measures of motivational approach to daily cues compared with rewards emerged, individuals with high levels of impulsivity, obsessive-compulsive, and addiction-prone behaviors rated as more attractive and showed a greater increase in sympathetic arousal to cues versus rewards. The opposite pattern emerged for those with low levels in those dispositional traits, who responded more (both subjectively and physiologically) to rewards compared with their preceding cues. This study represents an attempt to answer the call to parcel complex behaviors into smaller constructs, improving the early detection of those who are vulnerable to develop psychopathological disorders, particularly in the domain of impulse control such as addiction.

Continuous mHealth Patch Monitoring for the Algorithm-Based Detection of Atrial Fibrillation: Feasibility and Diagnostic Accuracy Study.

BACKGROUND: The detection of atrial fibrillation (AF) is a major clinical challenge as AF is often paroxysmal and asymptomatic. Novel mobile health (mHealth) technologies could provide a cost-effective and reliable solution for AF screening. However, many of these techniques have not been clinically validated. OBJECTIVE: The purpose of this study is to evaluate the feasibility and reliability of artificial intelligence (AI) arrhythmia analysis for AF detection with an mHealth patch device designed for personal well-being. METHODS: Patients (N=178) with an AF (n=79, 44%) or sinus rhythm (n=99, 56%) were recruited from the emergency care department. A single-lead, 24-hour, electrocardiogram-based heart rate variability (HRV) measurement was recorded with the mHealth patch device and analyzed with a novel AI arrhythmia analysis software. Simultaneously registered 3-lead electrocardiograms (Holter) served as the gold standard for the final rhythm diagnostics. RESULTS: Of the HRV data produced by the single-lead mHealth patch, 81.5% (3099/3802 hours) were interpretable, and the subject-based median for interpretable HRV data was 99% (25th percentile=77% and 75th percentile=100%). The AI arrhythmia detection algorithm detected AF correctly in all patients in the AF group and suggested the presence of AF in 5 patients in the control group, resulting in a subject-based AF detection accuracy of 97.2%, a sensitivity of 100%, and a specificity of 94.9%. The time-based AF detection accuracy, sensitivity, and specificity of the AI arrhythmia detection algorithm were 98.7%, 99.6%, and 98.0%, respectively. CONCLUSIONS: The 24-hour HRV monitoring by the mHealth patch device enabled accurate automatic AF detection. Thus, the wearable mHealth patch device with AI arrhythmia analysis is a novel method for AF screening. TRIAL REGISTRATION: ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335.

Altered Expiratory Flow Dynamics at Peak Exercise in Adult Men With Well-Controlled Type 1 Diabetes.

Type 1 diabetes may, in time, cause lung dysfunction including airflow limitation. We hypothesized that ventilatory flow morphology during a cardiopulmonary exercise test (CPET) would be altered in adult men with well-controlled type 1 diabetes. Thirteen men with type 1 diabetes [glycated hemoglobin A1c 59 (9) mmol/mol or 7.5 (0.8)%, duration of diabetes 12 (9) years, and age 33.9 (6.6) years] without diagnosed diabetes-related complications and 13 healthy male controls [age 37.2 (8.6) years] underwent CPET on a cycle ergometer (40 W increments every 3 min until volitional fatigue). We used a principal component analysis based method to quantify ventilatory flow dynamics throughout the CPET protocol. Last minute of each increment, peak exercise, and recovery were examined using linear mixed models, which accounted for relative peak oxygen uptake and minute ventilation. The type 1 diabetes participants had lower expiratory peak flow (P = 0.008) and attenuated slope from expiration onset to expiratory peak flow (P = 0.012) at peak exercise when compared with the healthy controls. Instead, during submaximal exercise and recovery, the type 1 diabetes participants possessed similar ventilatory flow dynamics to that of the healthy controls. In conclusion, men with relatively well-controlled type 1 diabetes and without clinical evidence of diabetes-related complications exhibited attenuated expiratory flow at peak exercise independently of peak oxygen uptake and minute ventilation. This study demonstrates that acute exercise reveals alterations in ventilatory function in men with type 1 diabetes but not until peak exercise.

The association between chronotype and sleep quality among female home care workers performing shift work.

There is a scarcity of evidence on the association between shift work, sleeping parameters, heart rate variability (HRV), and chronotype, i.e., morningness and eveningness. The aims of this study were to 1) compare participants with different chronotypes (morning (M), evening (E), or neither (N)) in terms of their total sleep time, sleep efficiency, and HRV parameters, taking their age into account, and 2) examine whether self-reported work-related stress, the length of the working career and years performing shift work affect this association. The participants of the study were home care workers working in two shifts in one municipality in Eastern Finland (N = 395). Of these, 52 females (mean age 42.78 y, SD 12.92 y) completed the study questionnaire and participated in physiological measurements. Several sleep-related parameters were assessed (total sleep time, sleep efficiency, number of awakenings, and length of awakening) and indices of autonomic nervous system based on HRV were calculated. The participants worked in two shifts: a morning shift (7:00-15:00 h) and an evening shift (14:00-21:30 h). All these parameters were assessed during the night before the first work shift (N1), the night before the second work shift (N2), the night before the final work shift (N3), and the night before the first day off work (N4). According to the results, 21.2% of the participants were M-types, 17.3% were E-types, and 61.5% were N-types. On average, the participants had been in working life for 18.8 years and performing shift work for 13.7 years. On night N3, E-types had a significantly shorter total sleep time and spent less time in bed compared to M- and N-types. The total sleep time of M-type and N-type participants was on average 66 minutes and 82 minutes longer, respectively, when compared to E-types on night N3. There were no statistically significant differences in actigraphy-based sleep quality parameters between M-, N-, and E-types on nights N1, N2, and N4. Our results together indicate that M- and N-type individuals may have better sleep quality than E-types, which was also reflected in HRV parameters. Further research with longitudinal study design and workplace interventions is needed to determine how the chronotype can be optimally and individually utilized to improve the health and well-being of morning-type and evening-type people. This is particularly important for both younger and older workers entering the workforce to support healthier and longer working lives.

Autonomic responses to tooth clenching and handgrip test.

OBJECTIVE: The aim was to study the differences in autonomic nervous system activation between maximal tooth clenching task and handgrip test during and after the tasks. Also, the possible activation of trigeminocardiac reflex during the clenching task was explored. MATERIAL AND METHODS: We compared autonomic responses to maximal tooth clenching and handgrip in 28 participants. Responses in heart rate variability, heart rate, and blood pressure were evaluated before, during, and after tests. Although all study participants were considered healthy during recruitment, 14 of them showed painful temporomandibular disorders in the clinical examination, which was taken into account in the analyses. RESULTS: Handgrip and tooth clenching caused similar autonomic responses. However, tooth clenching seemed to activate the trigeminocardiac reflex shown as clenching-related vagal activation. The painful signs of temporomandibular disorders may interfere with the heart rate variability both at the baseline and during both tests causing significant variation in them. CONCLUSIONS: Both handgrip and tooth clenching affect the autonomic nervous system function. Tooth clenching differs from the handgrip due to trigeminocardiac reflex. Painful signs of temporomandibular disorders are interfering with the results of the tests and maybe underestimated in the studies of autonomic responses to both tasks.

Cross-Cultural Adaptation, Reliability, and Psychophysical Validation of the Pain and Sleep Questionnaire Three-Item Index in Finnish.

Reciprocal relationships between chronic musculoskeletal pain and various sleep disturbances are well established. The Pain and Sleep Questionnaire three-item index (PSQ-3) is a concise, valid, and reliable patient-reported outcome measure (PROM) that directly evaluates how sleep is affected by chronic low back pain (CLBP). Translation and cross-cultural validation of The Pain and Sleep Questionnaire three-item index Finnish version (PSQ-3-FI) were conducted according to established guidelines. The validation sample was 229 subjects, including 42 pain-free controls and 187 subjects with chronic musculoskeletal pain. Our aims were to evaluate internal consistency, test-retest reliability, measurement error, structural validity, convergent validity, and discriminative validity and, furthermore, to study the relationships between dizziness, postural control on a force plate, and objective sleep quality metrics and total PSQ-3-FI score. The PSQ-3-FI demonstrated good internal consistency, excellent test-retest reliability, and small measurement error. Confirmatory factor analysis confirmed acceptable fit indices to a one-factor model. Convergent validity indicated fair to good correlation with pain history and well-established pain-related PROMs. The PSQ-3-FI total score successfully distinguished between the groups with no pain, single-site pain, and multisite pain. A higher prevalence of dizziness, more impaired postural control, and a general trend towards poorer sleep quality were observed among subjects with higher PSQ-3-FI scores. Postural control instability was more evident in eyes-open tests. The Finnish PSQ-3 translation was successfully cross-culturally adapted and validated. The PSQ-3-FI appears to be a valid and reliable PROM for the Finnish-speaking CLBP population. More widespread implementation of PSQ-3 would lead to better understanding of the direct effects of pain on sleep.

Automatic Mobile Health Arrhythmia Monitoring for the Detection of Atrial Fibrillation: Prospective Feasibility, Accuracy, and User Experience Study.

BACKGROUND: Atrial fibrillation (AF) is the most common tachyarrhythmia and associated with a risk of stroke. The detection and diagnosis of AF represent a major clinical challenge due to AF's asymptomatic and intermittent nature. Novel consumer-grade mobile health (mHealth) products with automatic arrhythmia detection could be an option for long-term electrocardiogram (ECG)-based rhythm monitoring and AF detection. OBJECTIVE: We evaluated the feasibility and accuracy of a wearable automated mHealth arrhythmia monitoring system, including a consumer-grade, single-lead heart rate belt ECG device (heart belt), a mobile phone application, and a cloud service with an artificial intelligence (AI) arrhythmia detection algorithm for AF detection. The specific aim of this proof-of-concept study was to test the feasibility of the entire sequence of operations from ECG recording to AI arrhythmia analysis and ultimately to final AF detection. METHODS: Patients (n=159) with an AF (n=73) or sinus rhythm (n=86) were recruited from the emergency department. A single-lead heart belt ECG was recorded for 24 hours. Simultaneously registered 3-lead ECGs (Holter) served as the gold standard for the final rhythm diagnostics and as a reference device in a user experience survey with patients over 65 years of age (high-risk group). RESULTS: The heart belt provided a high-quality ECG recording for visual interpretation resulting in 100% accuracy, sensitivity, and specificity of AF detection. The accuracy of AF detection with the automatic AI arrhythmia detection from the heart belt ECG recording was also high (97.5%), and the sensitivity and specificity were 100% and 95.4%, respectively. The correlation between the automatic estimated AF burden and the true AF burden from Holter recording was >0.99 with a mean burden error of 0.05 (SD 0.26) hours. The heart belt demonstrated good user experience and did not significantly interfere with the patient's daily activities. The patients preferred the heart belt over Holter ECG for rhythm monitoring (85/110, 77% heart belt vs 77/109, 71% Holter, P=.049). CONCLUSIONS: A consumer-grade, single-lead ECG heart belt provided good-quality ECG for rhythm diagnosis. The mHealth arrhythmia monitoring system, consisting of heart-belt ECG, a mobile phone application, and an automated AF detection achieved AF detection with high accuracy, sensitivity, and specificity. In addition, the mHealth arrhythmia monitoring system showed good user experience. TRIAL REGISTRATION: ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335.

Work community factors, occupational well-being and work ability in home care: A structural equation modelling.

AIM: To examine how work community factors are related to occupational well-being and work ability, and how occupational well-being is related to work ability. DESIGN: A cross-sectional study was conducted among home care workers in one municipality in Finland. METHODS: A self-administered survey on work and well-being was filled out by 167 employees working two shifts in 2019. Structural equation modelling was used to analyse the association between work community factors, occupational well-being and work ability. RESULTS: The only work community factor directly affecting Occupational well-being was Information and work organization; the effect of the other two factors, Social support and Influence on work shifts, was indirect. All work community factors indirectly affected Work ability. Home care should emphasize information provision and work organization with optimal time use. This requires social support, a well-functioning work atmosphere and providing employees with opportunities for influence and participation.

Heart rate variability and chronotype - a systematic review.

There is a scarcity of evidence on the association between heart rate variability (HRV) and chronotype, i.e., morningness and eveningness. The aim of this systematic review was to examine the association between chronotype, HRV, mood and stress response. We searched PubMed, Web of Science, Scopus, Cinahl, PsycINFO and Google Scholar for peer-reviewed articles published in English between January 2000 and June 2020. A total of 11 articles met the inclusion criteria and were on study population, assessment of HRV and chronotype, main results and study limitations. Seven of the included studies were experimental and four were crossovers. The sample size varied from 9 to 221 participants, and both females and males were included. HRV was assessed using mostly time-domain and frequency-domain parameters; nonlinear parameters were used in only one study. The most used assessments for measuring chronotype were the Horne-Östberg Morningness-Eveningness Questionnaire (MEQ) and the Munich Chronotype Questionnaire (MCTQ). The results showed that chronotype was associated with HRV, but the study designs were situation-specific, focusing, for example, on the effects of shiftwork, stressful situations, exercise, or sleep deprivation on HRV. In addition, some studies showed that evening types (E-type) performed better during evening or nighttime tasks, whereas morning types (M-type) performed better during morning activities. Specifically, E-types showed decreased HRV and HRV recovery in relation to tasks performed during morning or daytime when compared to M-types. As the findings are somewhat contradictory and include some methodological limitations (e.g., small sample sizes, age groups), it is important for future studies to evaluate the association between chronotype and HRV in a longitudinal setting. In addition, further research is needed to determine how chronotype can be optimally and individually utilized to increase the health and well-being of M-type and E-type individuals.

Wrist Band Photoplethysmography Autocorrelation Analysis Enables Detection of Atrial Fibrillation Without Pulse Detection.

Atrial fibrillation is often asymptomatic and intermittent making its detection challenging. A photoplethysmography (PPG) provides a promising option for atrial fibrillation detection. However, the shapes of pulse waves vary in atrial fibrillation decreasing pulse and atrial fibrillation detection accuracy. This study evaluated ten robust photoplethysmography features for detection of atrial fibrillation. The study was a national multi-center clinical study in Finland and the data were combined from two broader research projects (NCT03721601, URL: https://clinicaltrials.gov/ct2/show/NCT03721601 and NCT03753139, URL: https://clinicaltrials.gov/ct2/show/NCT03753139). A photoplethysmography signal was recorded with a wrist band. Five pulse interval variability, four amplitude features and a novel autocorrelation-based morphology feature were calculated and evaluated independently as predictors of atrial fibrillation. A multivariate predictor model including only the most significant features was established. The models were 10-fold cross-validated. 359 patients were included in the study (atrial fibrillation n = 169, sinus rhythm n = 190). The autocorrelation univariate predictor model detected atrial fibrillation with the highest area under receiver operating characteristic curve (AUC) value of 0.982 (sensitivity 95.1%, specificity 93.7%). Autocorrelation was also the most significant individual feature (p < 0.00001) in the multivariate predictor model, detecting atrial fibrillation with AUC of 0.993 (sensitivity 96.4%, specificity 96.3%). Our results demonstrated that the autocorrelation independently detects atrial fibrillation reliably without the need of pulse detection. Combining pulse wave morphology-based features such as autocorrelation with information from pulse-interval variability it is possible to detect atrial fibrillation with high accuracy with a commercial wrist band. Photoplethysmography wrist bands accompanied with atrial fibrillation detection algorithms utilizing autocorrelation could provide a computationally very effective and reliable wearable monitoring method in screening of atrial fibrillation.

Necklace-embedded electrocardiogram for the detection and diagnosis of atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is the major cause of stroke since approximately 25% of all strokes are of cardioembolic-origin. The detection and diagnosis of AF are often challenging due to the asymptomatic and intermittent nature of AF. HYPOTHESIS: A wearable electrocardiogram (ECG)-device could increase the likelihood of AF detection. The aim of this study was to evaluate the feasibility and reliability of a novel, consumer-grade, single-lead ECG recording device (Necklace-ECG) for screening, identifying and diagnosing of AF both by a cardiologist and automated AF-detection algorithms. METHODS: A thirty-second ECG was recorded with the Necklace-ECG device from two positions; between the palms (palm) and between the palm and the chest (chest). Simultaneously registered 3-lead ECGs (Holter) served as a golden standard for the final rhythm diagnosis. Two cardiologists interpreted independently in a blinded fashion the Necklace-ECG recordings from 145 patients (66 AF and 79 sinus rhythm, SR). In addition, the Necklace-ECG recordings were analyzed with an automatic AF detection algorithm. RESULTS: Two cardiologists diagnosed the correct rhythm of the interpretable Necklace-ECG with a mean sensitivity of 97.2% and 99.1% (palm and chest, respectively) and specificity of 100% and 98.5%. The automatic arrhythmia algorithm detected the correct rhythm with a sensitivity of 94.7% and 98.3% (palm and chest) and specificity of 100% of the interpretable measurements. CONCLUSIONS: The novel Necklace-ECG device is able to detect AF with high sensitivity and specificity as evaluated both by cardiologists and an automated AF-detection algorithm. Thus, the wearable Necklace-ECG is a new, promising method for AF screening. CLINICAL TRIAL REGISTRATION: Study was registered in the ClinicalTrials.gov database (NCT03753139).

Continuous 24-h Photoplethysmogram Monitoring Enables Detection of Atrial Fibrillation.

Aim: Atrial fibrillation (AF) detection is challenging because it is often asymptomatic and paroxysmal. We evaluated continuous photoplethysmogram (PPG) for signal quality and detection of AF. Methods: PPGs were recorded using a wrist-band device in 173 patients (76 AF, 97 sinus rhythm, SR) for 24 h. Simultaneously recorded 3-lead ambulatory ECG served as control. The recordings were split into 10-, 20-, 30-, and 60-min time-frames. The sensitivity, specificity, and F1-score of AF detection were evaluated for each time-frame. AF alarms were generated to simulate continuous AF monitoring. Sensitivities, specificities, and positive predictive values (PPVs) of the alarms were evaluated. User experiences of PPG and ECG recordings were assessed. The study was registered in the Clinical Trials database (NCT03507335). Results: The quality of PPG signal was better during night-time than in daytime (67.3 ± 22.4% vs. 30.5 ± 19.4%, p < 0.001). The 30-min time-frame yielded the highest F1-score (0.9536), identifying AF correctly in 72/76 AF patients (sensitivity 94.7%), only 3/97 SR patients receiving a false AF diagnosis (specificity 96.9%). The sensitivity and PPV of the simulated AF alarms were 78.2 and 97.2% at night, and 49.3 and 97.0% during the daytime. 82% of patients were willing to use the device at home. Conclusion: PPG wrist-band provided reliable AF identification both during daytime and night-time. The PPG data's quality was better at night. The positive user experience suggests that wearable PPG devices could be feasible for continuous rhythm monitoring.

Electrical and mechanical dyssynchrony in patients with right bundle branch block.

BACKGROUND: Though fairly benign reputation, the right bundle branch block (RBBB) can cause left ventricular mechanical dyssynchrony (LVMD). Still, the relationship between electrical disturbance and LVMD is partly unclear among these patients. METHODS: Thirty patients with RBBB and 60 matching controls were studied with vector electrocardiography and myocardial perfusion imaging phase analysis. RBBB group was divided into those with and those without LVMD. RESULTS: Prevalence of LVMD among RBBB patients was 50% and among controls 22%. Odds ratio (OR) for LVMD in patients with RBBB vs controls without RBBB was 3.6 (95% CI 1.4 to 9.3). Ejection fraction (EF), end-systolic volume, the angle between QRS and T vectors, and the QRS angle in the sagittal plane were significantly different between RBBB patients with and without LVMD. The QRS duration was comparable in these groups. EF associated independently with LVMD, explaining 60% of its variation. A cut-off value of EF ≤ 55% detected LVMD in 100% specificity (sensitivity of 47%). CONCLUSION: Half of the patients with RBBB had LVMD. The OR for LVMD between RBBB and normal ECG was 3.6. It seems that EF, rather than electrical parameters, is the main determinant of LVMD. This information might be useful when evaluating indications for cardiac resynchronization therapy.