Comparison between electrocardiogram- and photoplethysmogram-derived features for atrial fibrillation detection in free-living conditions
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OBJECTIVE: Atrial fibrillation (AF) is the most commonly experienced arrhythmia and it increases the risk of stroke and heart failure. The challenge in detecting the presence of AF is the occasional and asymptomatic manifestation of the condition. Long-term monitoring can increase the sensitivity of detecting intermittent AF episodes, however it is either cumbersome or invasive and costly with electrocardiography (ECG). Photoplethysmography (PPG) is an unobtrusive measuring modality enabling heart rate monitoring, and promising results have been presented in detecting AF. However, there is still limited knowledge about the applicability of the PPG solutions in free-living conditions. The aim of this study was to compare the inter-beat interval derived features for AF detection between ECG and wrist-worn PPG in daily life. APPROACH: The data consisted of 24 h ECG, PPG, and accelerometer measurements from 27 patients (eight AF, 19 non-AF). In total, seven features (Shannon entropy, root mean square of successive differences (RMSSD), normalized RMSSD, pNN40, pNN70, sample entropy, and coefficient of sample entropy (CosEn)) were compared. Body movement was measured with the accelerometer and used with three different thresholds to exclude PPG segments affected by movement. MAIN RESULTS: CosEn resulted as the best performing feature from ECG with Cohens kappa 0.95. When the strictest movement threshold was applied, the same performance was obtained with PPG (kappa = 0.96). In addition, pNN40 and pNN70 reached similar results with the same threshold (kappa = 0.95 and 0.94), but were more robust with respect to movement artefacts. The coverage of PPG was 24.0%-57.6% depending on the movement threshold compared to 92.1% of ECG. SIGNIFICANCE: The inter-beat interval features derived from PPG are equivalent to the ones from ECG for AF detection. Movement artefacts substantially worsen PPG-based AF monitoring in free-living conditions, therefore monitoring coverage needs to be carefully selected. Wrist-worn PPG still provides a promising technology for long-term AF monitoring.
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The percentage of unanalyzable PPG reached 76.0% by also accounting for the accelerometer-identified movement.
“However, the percentage of unanalyzable PPG reached 76.0% by also accounting for the accelerometer-identified movement.”
From Modeling of artifacts in the wrist photoplethysmogram: Application to the detection of life-threatening arrhythmias (2021) · cites this paper as [13]
The contradiction arises because sensitivity was calculated by including all arrhythmia episodes in our study, whereas only those episodes remaining after exclusion of artifact-corrupted PPG parts were included in [13].
“The contradiction arises since the sensitivity was calculated by including all arrhythmia episodes in our study, whereas only those episodes remaining after the exclusion of the artifact-corrupted PPG parts were included in [13].”
From Modeling of artifacts in the wrist photoplethysmogram: Application to the detection of life-threatening arrhythmias (2021) · cites this paper as [13]
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Tabei, F., Abohelwa, M., Davis, D. P., Sethi, P., NUGENT, K. M., & Chong, J. W. (2022) · IEEE Healthcare Innovations and Point of Care Technologies Conference (HI-POCT) · doi:10.1109/hi-poct54491.2022.9744074
Detection of atrial fibrillation using photoplethysmography signals: a systemic review
Chung, C. T., Roy, V. A. L., Tse, G., & Liu, H. (2024) · Elsevier eBooks · doi:10.1016/b978-0-44-314141-6.00009-8
A photoplethysmogram-based 1D-CNN algorithm for automated atrial fibrillation detection
John, A. (2025) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc58623.2025.11253262
Rantula, O., Lipponen, J. A., Halonen, J., Jäntti, H., Rissanen, T. T., Tarvainen, M. P., Naukkarinen, N. S., Väliaho, E., Santala, O. E., Sedha, J., et al. (2026) · JMIR mhealth and uhealth · doi:10.2196/82475 · Cited by 1 · see citing works
- Authors
- Eerikäinen, L. M., Bonomi, A. G., Schipper, F., Dekker, L. R. C., Vullings, R., de Morree, H. M., & Aarts, R. M.
- Affiliations
- Philips (Netherlands) (NL)
- Catharina Ziekenhuis (NL)
- Eindhoven University of Technology (NL)
- Philips Research
- Corresponding author
- Eerikäinen, Linda M
- Vullings, Rik
- ORCID
- Venue
- Physiological Measurement
- Publisher
- IOP Publishing
- Published
- 2018-08-01
- Volume
- 39
- Issue
- 8
- Pages
- 084001
- ISSN
- 0967-3334 (ISSN-L)
- 1361-6579
- OpenAlex
- W2847349893
- Cited by
- 61
- References
- 30
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 7 · 2022: 13 · 2021: 12 · 2020: 10 · 2019: 9
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Physiological Measurement (publishedVersion)
- PubMed (publishedVersion)
- TU/e Research Portal (submittedVersion, other-oa)
- TU/e Research Portal (submittedVersion)
- Funders
- Technische Universiteit Eindhoven
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- atrial fibrillation detection, photoplethysmography, electrocardiogram, sample entropy, RMSSD, motion artifacts, wearable sensors, free-living conditions
- MeSH terms
- Activities of Daily Living, Adult, Aged, Atrial Fibrillation, Electrocardiography, Female, Heart Rate, Humans, Male, Middle Aged, Movement, ROC Curve, Signal Processing, Computer-Assisted, Photoplethysmography
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