Volume 11, Issue 9, Pages (September 2014)

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Volume 11, Issue 9, Pages 1575-1583 (September 2014) P-wave evidence as a method for improving algorithm to detect atrial fibrillation in insertable cardiac monitors Helmut Pürerfellner, MD, FHRS, Evgeny Pokushalov, MD, Shantanu Sarkar, PhD, Jodi Koehler, MS, Ren Zhou, MS, Lubos Urban, MD, Gerhard Hindricks, MD, FHRS Heart Rhythm Volume 11, Issue 9, Pages 1575-1583 (September 2014) DOI: 10.1016/j.hrthm.2014.06.006 Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 1 Initial segment of a 2-minute detection period illustrating the P-wave evidence accumulation procedure. The inset illustrates the procedure for P-wave averaging every 4 beats that meet the rate and irregularity criteria. Heart Rhythm 2014 11, 1575-1583DOI: (10.1016/j.hrthm.2014.06.006) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 2 Schematic for the combination of the P-wave evidence algorithm with the R-R interval–based AF detection algorithm. AF = atrial fibrillation; ECG = electrocardiogram. Heart Rhythm 2014 11, 1575-1583DOI: (10.1016/j.hrthm.2014.06.006) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 3 Definitions of true-positive, false-positive, false-negative, and true-negative duration used for the computation of episode and duration detection performance metrics. AF = atrial fibrillation; FN = false negative; FP = false positive; ICM = insertable cardiac monitor; NPV = negative predictive value; PPV = positive predictive value; TN = true negative; TP = true positive. Heart Rhythm 2014 11, 1575-1583DOI: (10.1016/j.hrthm.2014.06.006) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 4 (A) Duration detection sensitivity and specificity and (B) episode detection sensitivity and PPV as a function of the detection threshold and mode of operation of the P-wave evidence algorithm compared with the R-R interval–based earlier algorithm (P-wave evidence “off”). PPV = positive predictive value. Heart Rhythm 2014 11, 1575-1583DOI: (10.1016/j.hrthm.2014.06.006) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 5 (A) Proportion of false-positive and false-negative duration and (B) the number of false-positive and false-negative episodes for the different intention of usage settings using the P-wave evidence algorithm improvement compared with the R-R interval–based earlier algorithm. AF = atrial fibrillation. Heart Rhythm 2014 11, 1575-1583DOI: (10.1016/j.hrthm.2014.06.006) Copyright © 2014 Heart Rhythm Society Terms and Conditions

Figure 6 Example of an episode that was detected by the original R-R interval–based algorithm that is no longer detected by the improved algorithm using evidence of P waves. Heart Rhythm 2014 11, 1575-1583DOI: (10.1016/j.hrthm.2014.06.006) Copyright © 2014 Heart Rhythm Society Terms and Conditions