What Device Can Be Worn to Show Afib
J Thorac Dis. 2018 Nov; 10(Suppl 33): S3824–S3827.
Smart devices for a smart detection of atrial fibrillation
Received 2018 Aug i; Accustomed 2018 Aug 28.
Atrial fibrillation (AF) is the most frequent sustained cardiac arrhythmia and is associated with significant clinical events and costs. A higher and increasing prevalence of AF has been reported, more often than not due to advances in diagnosis methods (1). AF morbidity and mortality reports are based primarily on symptomatic AF. However, in at least one tertiary of patients, AF is neither clearly symptomatic nor noticeable due to degradation of functional course. This silent class of AF is incidentally diagnosed during routine physical examinations, pre-operative assessments or population surveys. Regrettably, in some other cases, silent AF is revealed subsequently complications such as stroke or congestive heart failure have occurred as first manifestation (ii). Therefore, lack of symptoms from AF does not mean lack of risk of complications, which are probably present in the same magnitude every bit in symptomatic AF.
Assessment of the existent prevalence of paroxysmal AF is challenging, since the arrhythmia may be cursory, completely asymptomatic and hard to detect. Today's cardiac implantable electronic devices (pacemakers, defibrillators…) can accurately find asymptomatic cardiac arrhythmias equally atrial high charge per unit episodes (AHREs) when the atrial charge per unit exceeds the programmed detection rate during a programmable number of beats (3). The presence of brusque duration AHREs (>5–6 minutes) has been related to a higher risk of stroke and systemic embolism (4-6). On the other mitt, in most of the patients with AHREs and embolic events, the mechanism of stroke may non be related to the AHREs itself. Nevertheless, these episodes seem to be a consequent risk marker for thromboembolic events whatever the ultimate machinery is (7). AHREs represent a "grey zone" where management recommendations are defective. Nowadays, the employ of anticoagulation in this scenario is unclear in the absence of randomized studies. In any example, information technology is consequent in all the studies that the longer nosotros see the eye rhythm in patients with AF chance factors the more than AF we detect and these episodes are related to a higher hazard for embolic events. In the following years, results from ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation; {"blazon":"clinical-trial","attrs":{"text":"NCT01938248","term_id":"NCT01938248"}}NCT01938248) and NOAH (Not-Vitamin Grand Antagonist Oral Anticoagulants in Patients With Atrial Loftier Charge per unit Episodes; {"type":"clinical-trial","attrs":{"text":"NCT02618577","term_id":"NCT02618577"}}NCT02618577) will provide evidences about the best treatment for this curt episodes of AF. Today, management of these patients should be adapted attention to their private risk factors and CHAtwoDS2VASc score.
Technological advances in all fields are exciting, particularly in the medical field. New electronic devices (smart phones, smart watches…) tin can also perform other tasks for the states such equally assessing our daily steps, walked distance, sleeping hours, calories burned or even tell our heart rate… (8). However, the true expectation for these technological advances is that they may help us to diagnose diseases or discover abnormalities and then we can treat them quickly and forestall complications. This is specially necessary in AF, a highly prevalent entity with potentially devastating complications. The about important limitation is that AF usually requires a prolonged monitoring for its diagnosis. On the other paw, smart devices with accurate monitoring capabilities might resolve this limitation. Nigh every i of united states of america has a jail cell telephone, smart telephone or other electronic device that we carry with u.s.a. every day.
The development of smart phones applications which tape a high-quality single lead ECG makes heart rhythm assessment viable (9) ( Effigy i ). The Kardia Mobile (Alivecor, Inc., U.s.) device is a portable smart telephone compatible accessory which contains two electrodes. The Kardia Mobile device transmits the signal to the Kardia Mobile app, a downloadable mobile application for smart phones. Recording starts with finger placement of right and left hands on the two electrodes. Finger contact activates ECG recording of bipolar lead I (right hand to left hand) and is transmitted from the device to the phone. The ECG is instantly shown on the smart telephone screen. An automated algorithm on the Kardia Mobile app checks the rhythm based on RR wave regularity and it provides a diagnosis citing either "no abnormalities detected", "possible atrial fibrillation" or "this ECG could not be interpreted". It is a FDA-validated algorithm with 97% sensitivity and 98% specificity for AF detection. Recently data supports its clinical use. REHEARSE-AF report is a randomized controlled trial for AF detection using an Alivecor Kardia device (x). It included 1,001 patients with CHA2DS2-VASc score >2 and non-prior history of AF that were randomized to Kardia monitor or routine intendance. Nineteen patients in the Kardia group were diagnosed with AF over the 1-year follow-up versus 5 in the routine care group (Hour =3.9; P=0.007). About of the patients were comfortable using the device, finding it piece of cake to use, non-restrictive and not causing anxiety. Kardia Mobile has been also considered a more feasible alternative for prolonged ECG monitoring in cryptogenic stroke patients (xi). The MOBILE-AF trial has been designed to evaluate the efficacy of the Kardia Mobile device for AF detection in patients with cryptogenic stroke or transient ischemic set on compared to regular follow-up for AF detection using conventional ECG or Holters. This trial may open new clinical scenarios for this promising technology that is already widely used for the remote detection of AF and mutual arrhythmias in routine clinical practice.
Kardia smart devices for center rhythm monitoring. (A) Showing the Kardia Mobile consisting in a two electrodes detector for finger tips and a smart phone app that receive the ECG bespeak (lead I) and information technology is instantly displayed on the smart phone screen; (B) showing Kardia Band that replaces the original Apple Sentry band with an integrated sensor electrode in which placing the thumb a unmarried lead ECG is recorded and displayed on the smart watch screen.
During the final years, this technology has been extended to smart watches ( Figure 1 ). The Kardia Band was introduced recently as the beginning FDA approved Apple Watch accompaniment that record a rhythm strip equivalent to lead I for 30 seconds, provides an instantaneous and automatic algorithm for rhythm diagnosis of AF and tin can transmit this data to the patient's caring doc instantaneously. This engineering science was tested recently in 100 patients programmed for cardioversion of AF to foreclose unnecessary admissions if the patients have already converted to sinus rhythm (12). Compared to ECG, the Kardia Band interpreted AF with 93% sensitivity, 84% specificity. Dr.'s review of Kardia Band recordings showed 99% sensitivity, 83% specificity. Amid 113 cases where Kardia Ring and physician readings of the same recording were interpretable, agreement was actually high (K coefficient 0.88). Therefore, the Kardia Band algorithm for AF detection, supported by physician'due south interpretation, can accurately differentiate AF from sinus rhythm. A contempo study en rolling 9,750 Health eHeart Study participants and 51 patients undergoing cardioversion at the Academy of California, with an Apple Watch who downloaded the Cardiogram mobile application, capable of detecting heart rate from the photoplethysmography sensor and pedometer information from the accelerometer, showed that these devices can passively identify AF against the standard practice of ECG recordings amid patients at rest when centre rate data are nerveless at a high temporal resolution (98% sensitivity and xc% specificity) (13).
Given the increasing employ of smart watches with multitude of downloadable mobile applications, this approach may ultimately be applied for AF screening in large populations. These new devices nowadays of import advantages in relation to conventional monitoring techniques. They are easy-to-use, noninvasive, prophylactic and tin can exist used on need. There is not run a risk of wound infection related to a surgical implantation procedure, does not take to be carried on the body causing discomfort and is cheaper than an implantable cardiac monitor (nine). These characteristics are especially interesting when used in children and young patients. A recent report in children showed that smart phone-based consequence monitor was superior compared with conventional monitoring with a college diagnostic yield and information technology was as well more adequate to the patient and parents (14).
Just despite the smashing advantages provided for these new devices, they are not e'er as smart equally supposed and in that location are some important limitations. Due to the widespread apply of these devices in the general population and the big number of free apps some of them without proper certification; it may lead to a great amount of misleading information causing anxiety for arrhythmic events reported by the devices but not professionally confirmed, turning a solution into a problem. It is necessary a learning process to ameliorate the technique of ECG acquisition in the smart phone, which requires a comprehensive educational activity, focused on the patient to refine the obtaining of ECG and thus avoid false positives. It is as well important to elaborate recommendations for patients supported past the Professional person Cardiology Associations and Societies regarding the appropriate employ, estimation of the events reported and what to do in case of arrhythmia detection. Ongoing studies will as well aid physicians to provide clinical recommendations in relation to the arrhythmia detected past these devices, specially in AF. Finally, it is estimated that past 2019 almanac sales of smart phones and smart watches will attain 50 billion dollars worldwide. Therefore, although more studies and technical improvements are needed, it seems undeniable that this technology will be office of our medical practice and volition provide great benefits for our patients.
Provenance: This is an invited Editorial commissioned by the Section Editor Fang-Zhou Liu (Guangdong Cardiovascular Institute, Guangzhou, China).
Conflicts of Interest: The authors have no conflicts of involvement to declare.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297460/
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