An adaptive organization index to characterize atrial fibrillation using wrist-type photoplethysmographic signals

The performance of photoplethysmography (PPG)based wearable monitors to diagnose atrial fibrillation (AF) remains unknown to date. This study aims at assessing the performance of new indices quantifying the level of organization in PPG signals to diagnose AF. A database made of 18 adult patients undergoing catheter ablation of various cardiac arrhythmias was used. PPG signals were recorded using a wrist-type sensor. A 12-lead ECG was used as gold standard. ECGs were annotated by experts and selected segments were divided into 4 categories: sinus rhythm (SR), regularly paced rhythm (RPR), irregularly paced rhythm (IPR) and AF. The level of organization of the various PPG signals was measured using an adaptive organization index (AOI), defined as the ratio of the power of the fundamental frequency and the first harmonic to the total power of the PPG signal, computed with adaptive band-pass filters. A total of 2806/803/852/287 10-second epochs were considered for AF/SR/RPR/IPR classes. The following mean AOI values were measured: 0.45 ± 0.11 for AF, 0.73 ± 0.19 for SR, 0.78 ±0.20 for RPR and 0.61 ± 0.19 for IPR classes. Importantly, the AF AOI was significantly smaller than that of the other categories (p<;0.001), indicating a higher degree of disorganization.