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DOI: 10.1055/a-1355-0610
Detektion von Vorhofflimmern mit Wearables
Die Erfassung biologischer Signale im Alltag durch Wearables ist durch den technischen Fortschritt und die breite Verfügbarkeit allgegenwärtig. Gezielt oder nebenbei ermöglichen zahlreiche Geräte die Erkennung von Herzrhythmusstörungen. Dieser Artikel gibt einen Überblick über den medizinischen Hintergrund, verfügbare Technologien, Konsequenzen aus der Detektion von Vorhofflimmern und die sich damit ergebenden Möglichkeiten und Limitationen.
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Wearables können Vorhofflimmern mit hoher Wahrscheinlichkeit erkennen. Bei einer Aufzeichnung per EKG ist eine direkte Diagnose durch einen Arzt möglich.
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Wearables generieren eine Fülle von Daten. Ein Verständnis des technischen Hintergrundes, der Arbeitsweise und Limitationen ist zur Einordnung der Ergebnisse für klinisch tätige Ärzte hilfreich und notwendig.
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Die technische Fähigkeit, Vorhofflimmern durch Wearables zu erkennen, wurde in zahlreichen Studien belegt. Ein Vorteil in der Prävention, Diagnose und Behandlung von Vorhofflimmern muss aber noch in großen, gut konzipierten Studien gezeigt werden.
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Fragen zum Umgang mit fehlerhaften Messungen und Haftung, dem Datenschutz sowie die Kosten und Vergütung bleiben derzeit noch offen.
Publication History
Article published online:
01 June 2022
© 2022. Thieme. All rights reserved.
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Literatur
- 1 Hindricks G, Potpara T, Dagres N. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). 2021; 42: 373-498 DOI: 10.1093/eurheartj/ehaa612. (PMID: 32860505)
- 2 Benjamin EJ, Go AS, Desvigne-Nickens P. et al. Research Priorities in Atrial Fibrillation Screening: A Report From a National Heart, Lung, and Blood Institute Virtual Workshop. Circulation 2021; 143: 372-388 DOI: 10.1161/CIRCULATIONAHA.120.047633. (PMID: 33493033)
- 3 Veltmann C, Ehrlich J, Gassner U. et al. Wearable-based detection of arrhythmias. Position paper of the German Cardiac Society. Kardiologe 2021; 15: 341-353
- 4 Hermans ANL, Gawalko M, Dohmen L. et al. Mobile health solutions for atrial fibrillation detection and management: a systematic review. Clin Res Cardiol 2021; DOI: 10.1007/s00392-021-01941-9. (PMID: 34549333)
- 5 Bayoumy K, Gaber M, Elshafeey A. et al. Smart wearable devices in cardiovascular care: where we are and how to move forward. Nat Rev Cardiol 2021; 18: 581-599 DOI: 10.1038/s41569-021-00522-7. (PMID: 33664502)
- 6 Sana F, Isselbacher EM, Singh JP. et al. Wearable Devices for Ambulatory Cardiac Monitoring: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75: 1582-1592 DOI: 10.1016/j.jacc.2020.01.046. (PMID: 32241375)
- 7 Marketresearch Polaris. Wearable Medical Devices Market Share, Size, Trends, Industry Analysis Report, By Device Type. 2020 Accessed February 26, 2022 at: https://www.polarismarketresearch.com/industry-analysis/wearable-medical-devices-market
- 8 Zink MD, Brüser C, Stüben BO. et al. Unobtrusive nocturnal heartbeat monitoring by a ballistocardiographic sensor in patients with sleep disordered breathing. Sci Rep 2017; 7: 13175 DOI: 10.1038/s41598-017-13138-0. (PMID: 29030566)
- 9 Zink MD, Bruser C, Winnersbach P. et al. Heartbeat Cycle Length Detection by a Ballistocardiographic Sensor in Atrial Fibrillation and Sinus Rhythm. Biomed Res Int 2015; 2015: 840356 DOI: 10.1155/2015/840356. (PMID: 26229965)
- 10 Samol A, Bischof K, Luani B. et al. Single-Lead ECG Recordings Including Einthoven and Wilson Leads by a Smartwatch: A New Era of Patient Directed Early ECG Differential Diagnosis of Cardiac Diseases?. Sensors (Basel) 2019; 19: 4377 DOI: 10.3390/s19204377. (PMID: 31658713)
- 11 Dagher L, Shi H, Zhao Y. et al. Wearables in cardiology: here to stay. Heart Rhythm 2020; 17: 889-895 DOI: 10.1016/j.hrthm.2020.02.023. (PMID: 32354455)
- 12 O'Sullivan JW, Grigg S, Crawford W. et al. Accuracy of smartphone camera applications for detecting atrial fibrillation. A systematic review and meta-analysis. JAMA Netw Open 2020; 3: e202064 DOI: 10.1001/jamanetworkopen.2020.2064. (PMID: 32354455)
- 13 Bent B, Goldstein BA, Kibbe WA. et al. Investigating sources of inaccuracy in wearable optical heart rate sensors. NPJ Digit Med 2020; 3: 18 DOI: 10.1038/s41746-020-0226-6. (PMID: 32047863)
- 14 Perez MV, Mahaffey KW, Hedlin H. et al. Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. N Engl J Med 2019; 381: 1909-1917 DOI: 10.1056/NEJMoa1901183. (PMID: 31722151)
- 15 Halcox JPJ, Wareham K, Cardew A. et al. Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study. Circulation 2017; 136: 1784-1794 DOI: 10.1161/CIRCULATIONAHA.117.030583. (PMID: 28851729)
- 16 Steinhubl SR, Waalen J, Edwards AM. et al. Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial. JAMA 2018; 320: 146-155 DOI: 10.1001/jama.2018.8102. (PMID: 29998336)
- 17 Svennberg E, Engdahl J, Al-Khalili F. et al. Mass Screening for Untreated Atrial Fibrillation: The STROKESTOP Study. Circulation 2015; 131: 2176-2184 DOI: 10.1161/CIRCULATIONAHA.114.014343. (PMID: 25910800)
- 18 Svennberg E, Friberg L, Frykman V. et al. Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial. Lancet 2021; 398: 1498-1506 DOI: 10.1016/S0140-6736(21)01637-8. (PMID: 34469764)
- 19 Zhang W, Chen Y, Miao C-Y. et al. Quarterly versus annual ECG screening for atrial fibrillation in older Chinese individuals (AF-CATCH): a prospective, randomised controlled trial. Lancet Healthy Longev 2021; 2: e470-e478
- 20 Kaasenbrood F, Hollander M, Rutten FH. et al. Yield of screening for atrial fibrillation in primary care with a hand-held, single-lead electrocardiogram device during influenza vaccination. Europace 2016; 18: 1514-1520 DOI: 10.1093/europace/euv426. (PMID: 26851813)
- 21 Zink MD, Mischke KG, Keszei AP. et al. Screen-detected atrial fibrillation predicts mortality in elderly subjects. EP Europace 2021; 23: 29-38 DOI: 10.1093/europace/euaa190. (PMID: 33020819)
- 22 Chan NY, Choy CC. Screening for atrial fibrillation in 13122 Hong Kong citizens with smartphone electrocardiogram. Heart 2017; 103: 24-31 DOI: 10.1136/heartjnl-2016-309993. (PMID: 27733533)
- 23 Lowres N, Olivier J, Chao TF. et al. Estimated stroke risk, yield, and number needed to screen for atrial fibrillation detected through single time screening: a multicountry patient-level meta-analysis of 141,220 screened individuals. PLoS Med 2019; 16: e1002903 DOI: 10.1371/journal.pmed.1002903. (PMID: 31553733)
- 24 Guo Y, Lane DA, Wang L. et al. Mobile Health Technology to Improve Care for Patients With Atrial Fibrillation. J Am Coll Cardiol 2020; 75: 1523-1534 DOI: 10.1016/j.jacc.2020.01.052. (PMID: 32241367)
- 25 Tison GH, Sanchez JM, Ballinger B. et al. Passive Detection of Atrial Fibrillation Using a Commercially Available Smartwatch. JAMA Cardiol 2018; 3: 409-416 DOI: 10.1001/jamacardio.2018.0136. (PMID: 29562087)
- 26 Fan YY, Li YG, Li J. et al. Diagnostic Performance of a Smart Device With Photoplethysmography Technology for Atrial Fibrillation Detection: Pilot Study (Pre-mAFA II Registry). JMIR Mhealth Uhealth 2019; 7: e11437 DOI: 10.2196/11437. (PMID: 30835243)
- 27 Attia ZI, Noseworthy PA, Lopez-Jimenez F. et al. An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction. Lancet 2019; 394: 861-867 DOI: 10.1016/S0140-6736(19)31721-0. (PMID: 31378392)
- 28 Kirchhof P, Camm AJ, Goette A. et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med 2020; 383: 1305-1316 DOI: 10.1056/NEJMoa2019422. (PMID: 32865375)
- 29 Siontis KC, Gersh BJ, Killian JM. et al. Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community: Characteristics and prognostic implications. Heart Rhythm 2016; 13: 1418-1424 DOI: 10.1016/j.hrthm.2016.03.003. (PMID: 26961300)
- 30 Calkins H, Hindricks G, Cappato R. et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20: e1-e160 DOI: 10.1093/europace/eux274. (PMID: 29016840)