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. 2021 Jun 4;2(3):363-373.
doi: 10.1093/ehjdh/ztab050. eCollection 2021 Sep.

The photoplethysmography dictionary: practical guidance on signal interpretation and clinical scenarios from TeleCheck-AF

Rachel M J van der Velden  1 , Dominique V M Verhaert  1   2 , Astrid N L Hermans  1 , David Duncker  3 , Martin Manninger  4 , Konstanze Betz  1 , Monika Gawalko  1   5 , Lien Desteghe  6   7 , Ron Pisters  8 , Martin Hemels  8 , Laurent Pison  9 , Afzal Sohaib  10   11 , Arian Sultan  12 , Daniel Steven  12 , Petra Wijtvliet  1   13 , Dhiraj Gupta  14 , Emma Svennberg  15 , Justin C L M Luermans  1   2 , Marisevi Chaldoupi  1 , Kevin Vernooy  1   2 , Dennis den Uijl  1 , Piotr Lodzinski  5 , Ward P J Jansen  16 , Jens Eckstein  17 , Andreas Bollmann  18 , Pieter Vandervoort  19 , Harry J G M Crijns  1 , Robert Tieleman  13 , Hein Heidbuchel  7 , Nikki A H A Pluymaekers  1 , Jeroen M Hendriks  20   21 , Dominik Linz  1   2   20   22 ; TeleCheck-AF Investigators
Affiliations

The photoplethysmography dictionary: practical guidance on signal interpretation and clinical scenarios from TeleCheck-AF

Rachel M J van der Velden et al. Eur Heart J Digit Health. .

Abstract

Aims: Within the TeleCheck-AF project, numerous centres in Europe used on-demand photoplethysmography (PPG) technology to remotely assess heart rate and rhythm in conjunction with teleconsultations. Based on the TeleCheck-AF investigator experiences, we aimed to develop an educational structured stepwise practical guide on how to interpret PPG signals and to introduce typical clinical scenarios how on-demand PPG was used.

Methods and results: During an online conference, the structured stepwise practical guide on how to interpret PPG signals was discussed and further refined during an internal review process. We provide the number of respective PPG recordings (FibriCheck®) and number of patients managed within a clinical scenario during the TeleCheck-AF project. To interpret PPG recordings, we introduce a structured stepwise practical guide and provide representative PPG recordings. In the TeleCheck-AF project, 2522 subjects collected 90 616 recordings in total. The majority of these recordings were classified by the PPG algorithm as sinus rhythm (57.6%), followed by AF (23.6%). In 9.7% of recordings, the quality was too low to interpret. The most frequent clinical scenarios where PPG technology was used in the TeleCheck-AF project was a follow-up after AF ablation (1110 patients) followed by heart rate and rhythm assessment around (tele)consultation (966 patients).

Conclusion: We introduce a newly developed structured stepwise practical guide on PPG signal interpretation developed based on presented experiences from TeleCheck-AF. The present clinical scenarios for the use of on-demand PPG technology derived from the TeleCheck-AF project will help to implement PPG technology in the management of AF patients.

Keywords: Atrial fibrillation; Heart rhythm disorders; Mobile health; Photoplethysmography; Structured stepwise approach.

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Figures

Figure 1
Figure 1
Overview of photoplethysmography mechanisms.
Figure 2
Figure 2
Overview of a regular (sinus rhythm) recording. (A) Raw photoplethysmography signals of a 60-s recording. The equal distance between consecutive peaks indicates a regular rhythm. (B) The tachogram showing all consecutive pulse signal intervals. In this case the interval is regular around 1000 ms, indicating a heart rate of 60 b.p.m. (C) The Poincaré or Lorenz plot shows a condensed cluster of points, which corresponds to a regular rhythm. Small variations in all graphs are caused by respiratory variation, suggestive of sinus rhythm. b.p.m., beats per minute; PPG, photoplethysmography.
Figure 3
Figure 3
Structured stepwise practical guide on photoplethysmography signal interpretation. AF, atrial fibrillation; AVNRT, atrioventricular nodal re-entrant tachycardia; CV, cardiovascular; HR, heart rate; HRV, heart rate variability; SR, sinus rhythm.
Figure 4
Figure 4
Ectopic beats. (A) Two recordings with frequent ectopic beats. This can be seen by the bigger pauses between two consecutive beats, indicated in amber in the graphs. In the photoplethysmography signal, the distance between consecutive peaks is larger, which leads to a longer RR-interval in the tachogram and multiple clusters in the Poincaré/Lorenz plot. (B) Two examples of bigeminy episodes, in which the tachogram shows fixed coupled intervals. (C) Two examples of trigeminy episodes, in which the tachogram shows three alternating lines during the episode.
Figure 5
Figure 5
Macro re-entrant atrial tachycardia with variable conduction. (A) Presumably macro re-entrant atrial tachycardia with 4:3 conduction. (B) Presumably macro re-entrant atrial tachycardia with 3:2 conduction.
Figure 6
Figure 6
Timeline remote rate control adaption in a patient with atrial flutter. Upper panel: Timeline presenting the different adaptions to rate control. Lower panel: two examples of photoplethysmography recordings. Left: photoplethysmography recording taken in the morning, before administration of rate control medication. Right: photoplethysmography recording taken in the afternoon, after administration of rate control medication.
See this image and copyright information in PMC

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