Evidence map›Paper›PMID 38941497›Full record

ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2024

Reliability of single-lead electrocardiogram interpretation to detect atrial fibrillation: insights from the SAFER feasibility study.

Katie Hibbitt, James Brimicombe, Martin R Cowie, Andrew Dymond, Ben Freedman, Simon J Griffin, F D R Ichard Hobbs, Hannah Clair Lindén, Gregory Y H Lip, Jonathan Mant and 4 more

Abstract read
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In one paragraph

Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Digital recruitment and prevalence of screen-detected atrial fibrillation in nationwide patch-based ECG screening: the NORSCREEN randomized clinical trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Trial
  2. Interrater agreement in atrial fibrillation diagnosis using one-week single-lead patch ECG monitoring: findings from the NORSCREEN trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
    Article
  3. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Katie HibbittDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.ORCID 0009-0008-7040-7881
James BrimicombeDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.ORCID 0000-0002-3443-3256
Martin R CowieRoyal Brompton Hospital, Faculty of Medicine & Lifesciences, Kings College London, London SW3 6NP, UK.
Andrew DymondDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.ORCID 0000-0003-0764-3095
Ben FreedmanHeart Research Institute, University of Sydney, Sydney 2006, Australia.ORCID 0000-0002-3809-2911
Simon J GriffinDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.ORCID 0000-0002-2157-4797
F D R Ichard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.ORCID 0000-0001-7976-7172
Hannah Clair LindénZenicor Medical Systems AB, 113 59 Stockholm, Sweden.
Gregory Y H LipLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.ORCID 0000-0002-7566-1626
Jonathan MantDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.ORCID 0000-0002-9531-0268
Richard J McManusNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.ORCID 0000-0003-3638-028X
Madhumitha PandiarajaDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.
Kate WilliamsDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.ORCID 0000-0002-6188-9363
Peter H CharltonDepartment of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.ORCID 0000-0003-3836-8655

Funding

British Heart Foundation FS/20/20/34626Department of Health and Social CareMedical Research Council G9900264National Institute for Health Care ResearchNIHR School for Primary Care Research SPCR-2014-10043
6 · The paper itself

Abstract

aimsSingle-lead electrocardiograms (ECGs) can be recorded using widely available devices such as smartwatches and handheld ECG recorders. Such devices have been approved for atrial fibrillation (AF) detection. However, little evidence exists on the reliability of single-lead ECG interpretation. We aimed to assess the level of agreement on detection of AF by independent cardiologists interpreting single-lead ECGs and to identify factors influencing agreement. METHODS AND

resultsIn a population-based AF screening study, adults aged ≥65 years old recorded four single-lead ECGs per day for 1-4 weeks using a handheld ECG recorder. Electrocardiograms showing signs of possible AF were identified by a nurse, aided by an automated algorithm. These were reviewed by two independent cardiologists who assigned participant- and ECG-level diagnoses. Inter-rater reliability of AF diagnosis was calculated using linear weighted Cohen's kappa (κw). Out of 2141 participants and 162 515 ECGs, only 1843 ECGs from 185 participants were reviewed by both cardiologists. Agreement was moderate: κw = 0.48 (95% confidence interval, 0.37-0.58) at participant level and κw = 0.58 (0.53-0.62) at ECG level. At participant level, agreement was associated with the number of adequate-quality ECGs recorded, with higher agreement in participants who recorded at least 67 adequate-quality ECGs. At ECG level, agreement was associated with ECG quality and whether ECGs exhibited algorithm-identified possible AF.

conclusionInter-rater reliability of AF diagnosis from single-lead ECGs was found to be moderate in older adults. Strategies to improve reliability might include participant and cardiologist training and designing AF detection programmes to obtain sufficient ECGs for reliable diagnoses.

Indexed as

AlgorithmsAtrial FibrillationElectrocardiographyFeasibility StudiesObserver VariationAgedAged, 80 and overFemaleHeart RateHumansMalePredictive Value of TestsReproducibility of ResultsSignal Processing, Computer-AssistedAtrial fibrillationDiagnosisElectrocardiogramInter-rater agreementScreening

Identifiers

PMID38941497
PMCPMC11249076

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.