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Type: Journal article
Title: Performance of a mobile single-lead electrocardiogram technology for atrial fibrillation screening in a semirural African population: insights from "The Heart of Ethiopia: Focus on Atrial Fibrillation" (TEFF-AF) study
Author: Pitman, B.M.
Chew, S.-H.
Wong, C.X.
Jaghoori, A.
Iwai, S.
Thomas, G.
Chew, A.
Sanders, P.
Lau, D.H.
Citation: JMIR mHealth and uHealth, 2021; 9(5):e24470-1-e24470-10
Publisher: JMIR Publications
Issue Date: 2021
ISSN: 2291-5222
Statement of
Bradley M Pitma, Sok-Hui, Christopher X Wong, Amenah Jaghoori, Shinsuke Iwai, Gijo Thomas ... et al.
Abstract: BACKGROUND: Atrial fibrillation (AF) screening using mobile single-lead electrocardiogram (ECG) devices has demonstrated variable sensitivity and specificity. However, limited data exists on the use of such devices in low-resource countries. OBJECTIVE: The goal of the research was to evaluate the utility of the KardiaMobile device's (AliveCor Inc) automated algorithm for AF screening in a semirural Ethiopian population. METHODS: Analysis was performed on 30-second single-lead ECG tracings obtained using the KardiaMobile device from 1500 TEFF-AF (The Heart of Ethiopia: Focus on Atrial Fibrillation) study participants. We evaluated the performance of the KardiaMobile automated algorithm against cardiologists' interpretations of 30-second single-lead ECG for AF screening. RESULTS: A total of 1709 single-lead ECG tracings (including repeat tracing on 209 occasions) were analyzed from 1500 Ethiopians (63.53% [953/1500] male, mean age 35 [SD 13] years) who presented for AF screening. Initial successful rhythm decision (normal or possible AF) with one single-lead ECG tracing was lower with the KardiaMobile automated algorithm versus manual verification by cardiologists (1176/1500, 78.40%, vs 1455/1500, 97.00%; P<.001). Repeat single-lead ECG tracings in 209 individuals improved overall rhythm decision, but the KardiaMobile automated algorithm remained inferior (1301/1500, 86.73%, vs 1479/1500, 98.60%; P<.001). The key reasons underlying unsuccessful KardiaMobile automated rhythm determination include poor quality/noisy tracings (214/408, 52.45%), frequent ectopy (22/408, 5.39%), and tachycardia (>100 bpm; 167/408, 40.93%). The sensitivity and specificity of rhythm decision using KardiaMobile automated algorithm were 80.27% (1168/1455) and 82.22% (37/45), respectively. CONCLUSIONS: The performance of the KardiaMobile automated algorithm was suboptimal when used for AF screening. However, the KardiaMobile single-lead ECG device remains an excellent AF screening tool with appropriate clinician input and repeat tracing. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001107112;
Keywords: atrial fibrillation
single-lead ECG
sub-Saharan Africa
Rights: © Bradley M Pitman, Sok-Hui Chew, Christopher X Wong, Amenah Jaghoori, Shinsuke Iwai, Gijo Thomas, Andrew Chew, Prashanthan Sanders, Dennis H Lau. Originally published in JMIR mHealth and uHealth (, 19.05.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
DOI: 10.2196/24470
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