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However, the accuracy of an rPPG-based machine learning model to monitor the pulse rate during sinus rhythm and arrhythmias is unknown. We conducted a prospective, observational diagnostic study in a cohort with a high prevalence of arrhythmias (patients undergoing elective electrical cardioversion). Pulse rate was assessed with rPPG via a visible light camera and ECG as reference, before and after cardioversion. A cardiologist categorized ECGs into normal sinus rhythm or arrhythmias requiring further investigation. A supervised machine learning model (support vector machine with Gaussian kernel) was trained using rPPG signal features from 60-s intervals and validated via leave-one-subject-out. Pulse rate measurement performance was evaluated with Bland\u2013Altman analysis. Of 72 patients screened, 51 patients were included in the analyses, including 444 60-s intervals with normal sinus rhythm and 1130 60-s intervals of clinically relevant arrhythmias. The model showed robust discrimination (AUC 0.95 [0.93\u20130.96]) and good calibration. For pulse rate measurement, the bias and limits of agreement for sinus rhythm were 1.21 [\u2212\u20098.60 to 11.02], while for arrhythmia, they were\u2009\u2212\u20097.45 [\u2212\u200935.75 to 20.86]. The machine learning model accurately identified sinus rhythm and arrhythmias using rPPG in real-world conditions. Heart rate underestimation during arrhythmias highlights the need for optimization.<\/jats:p>","DOI":"10.1007\/s10877-025-01263-5","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T19:28:11Z","timestamp":1738178891000},"page":"821-829","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Accuracy of remote, video-based supraventricular tachycardia detection in patients undergoing elective electrical cardioversion: a prospective cohort"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9781-8475","authenticated-orcid":false,"given":"Iris","family":"Cramer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rik","family":"van Esch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Verstappen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Kloeze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas","family":"van Bussel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"Stuijk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Bergmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"van \u2019t Veer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svitlana","family":"Zinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"Montenij","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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Bouwman and L. Montenij act as clinical consultants for Philips Research in Eindhoven, the Netherlands. The other authors have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interests"}},{"value":"During the preparation of this work the authors used GPT-4, an AI language model developed by OpenAI, in order to improve readability and language of the manuscript. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declaration of generative AI and AI-assisted technologies in the writing process"}},{"value":"This study was conducted in accordance with ethical guidelines and received approval from the Medical Ethical Committee of M\u00e1xima Medical Centre, Eindhoven, the Netherlands (File No. N21.039).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical statement"}},{"value":"Written informed consent was obtained from all participants prior to the commencement of any research procedures.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}