• Asami Kashiwa, Fumio Koyama, Koji Miyamoto, Tsukasa Kamakura, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Inoue, Hideo Okamura, Satoshi Nagase, Takashi Noda, Takeshi Aiba, Shinichiro Watanabe, Akihiro Goto, Satoshi Yasuda, and Kengo Kusano.
• Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
• Ann Noninvasive Electrocardiol. 2019 Mar 1; 24 (2): e12615.

BackgroundDetecting asymptomatic and undiagnosed atrial fibrillation (AF) is increasingly important. Recently, we developed a wristwatch-based pulse wave monitor (PWM; Seiko Epson, Japan) capable of long-term recording, with an automatic diagnosis algorithm that uses frequency-based pulse wave analysis. The aim of this study was to evaluate the validity of continuous pulse wave monitoring for detection of AF.MethodsDuring the electrophysiological study (EPS) in patients with AF, simultaneous pulse wave monitoring and Holter electrocardiograms (ECG) were recorded (n = 136, mean age 62.7 ± 10.9 years). The diagnostic accuracy of the PWM for AF was compared to the Holter ECG diagnosis. Standard performance metrics (sensitivity [Se], specificity [Sp], positive predictive value [PPV], and negative predictive value [NPV]) were calculated. The duration-based measurements were based on the diagnosis concordance ratios for the duration of time between diagnosis detected by the PWM and true diagnosis by the Holter ECG (AF or not AF). The episode-based performance metrics were based on the proportion of episodes appropriately detected with the PWM relative to episodes determined by the Holter ECG.ResultsThe total recording time was 1,542,770 s (AF: 270,945 s). A high diagnostic Sp (patient average: 96.4%, cumulative: 97.7%) and NPV (patient average: 95.1%, cumulative: 96.8%) were obtained in the duration-based results. In the episode-based metrics, all indices significantly improved with longer AF episode durations.ConclusionsContinuous pulse wave monitoring can provide accurate and dependable information to aid in AF diagnosis. A high validity in confirming freedom from AF was shown by a high NPV.© 2018 Wiley Periodicals, Inc.

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