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Original research article
Diagnostic assessment of a deep learning system for detecting atrial fibrillation in pulse waveforms
  1. Ming-Zher Poh1,
  2. Yukkee Cheung Poh1,
  3. Pak-Hei Chan2,
  4. Chun-Ka Wong2,
  5. Louise Pun3,
  6. Wangie Wan-Chiu Leung3,
  7. Yu-Fai Wong3,
  8. Michelle Man-Ying Wong3,
  9. Daniel Wai-Sing Chu3,
  10. Chung-Wah Siu2
  1. 1 Cardiio, Cambridge, Massachusetts, USA
  2. 2 Division of Cardiology, Department of Medicine, University of Hong Kong, Hong Kong
  3. 3 Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster, Hospital Authority, Hong Kong
  1. Correspondence to Dr Ming-Zher Poh, Cardiio, Inc., Cambridge, MA 02139, USA; mingzher{at}


Objective To evaluate the diagnostic performance of a deep learning system for automated detection of atrial fibrillation (AF) in photoplethysmographic (PPG) pulse waveforms.

Methods We trained a deep convolutional neural network (DCNN) to detect AF in 17 s PPG waveforms using a training data set of 149 048 PPG waveforms constructed from several publicly available PPG databases. The DCNN was validated using an independent test data set of 3039 smartphone-acquired PPG waveforms from adults at high risk of AF at a general outpatient clinic against ECG tracings reviewed by two cardiologists. Six established AF detectors based on handcrafted features were evaluated on the same test data set for performance comparison.

Results In the validation data set (3039 PPG waveforms) consisting of three sequential PPG waveforms from 1013 participants (mean (SD) age, 68.4 (12.2) years; 46.8% men), the prevalence of AF was 2.8%. The area under the receiver operating characteristic curve (AUC) of the DCNN for AF detection was 0.997 (95% CI 0.996 to 0.999) and was significantly higher than all the other AF detectors (AUC range: 0.924–0.985). The sensitivity of the DCNN was 95.2% (95% CI 88.3% to 98.7%), specificity was 99.0% (95% CI 98.6% to 99.3%), positive predictive value (PPV) was 72.7% (95% CI 65.1% to 79.3%) and negative predictive value (NPV) was 99.9% (95% CI 99.7% to 100%) using a single 17 s PPG waveform. Using the three sequential PPG waveforms in combination (<1 min in total), the sensitivity was 100.0% (95% CI 87.7% to 100%), specificity was 99.6% (95% CI 99.0% to 99.9%), PPV was 87.5% (95% CI 72.5% to 94.9%) and NPV was 100% (95% CI 99.4% to 100%).

Conclusions In this evaluation of PPG waveforms from adults screened for AF in a real-world primary care setting, the DCNN had high sensitivity, specificity, PPV and NPV for detecting AF, outperforming other state-of-the-art methods based on handcrafted features.

  • atrial fibrillation
  • ehealth/telemedicine/mobile health
  • premature ventricular beats

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  • M-ZP and YCP contributed equally.

  • Contributors M-ZP and YCP designed the study. LP, C-KW, WW-CL, Y-FW, MM-YW and DW-SC contributed to data acquisition. C-WS, MP-HC, C-KW, M-ZP and YCP contributed to analysis and interpretation of data. M-ZP and YCP drafted the manuscript. C-WS, MP-HC and C-KW contributed to critical revision of the manuscript for important intellectual context. All authors reviewed the manuscript and approved the final version for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests M-ZP and YCP are employees of Cardiio and have an ownership stake in the company, which holds intellectual property rights to the new algorithm tested in this work.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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