Many doctors asking atrial fibrillation patients to get an Apple watch

Stocks A to Z
1

‘Many doctors are telling their patients to go out and buy an Apple Watch to alert them to episodes of atrial fibrillation, despite the fact that the watch is not approved for performing this function in patients who already have a history of the disorder.’

(Apple Watch is FDA approved for alerting people with no history of atrial fibrillation that they are having an episode of it, but before you can turn on that function, you must answer “no” when the watch asks if you have a history of the issue.)

However…
'One major challenge of the potential flood of data from the Apple Watch is false positives. In a world in which tens of millions of wearables might be alerting people to potential health issues, record numbers of people might head for the hospital for unnecessary and expensive tests, says cardiologist Dr. Ruud Koster ’
https://www.wsj.com/tech/personal-tech/apple-watch-is-becoming-doctors-favorite-medical-device-af3719ec?mod=itp_wsj,djemITP_h

5 Likes
2

My DW’s Apple Watch alerted her to afib, let her & her Dr take a look, get the meds going pretty early… Waiting to see what other features come along next & we’ll both move up a bit, mine’s a 5, her’s 6, so we’re due…

2 Likes
3

LOL… and the market moves on while bureaucracy contemplates it’s collective navel.

Yeah, false positives. Probably some false negatives as well (not alerting when it should). I’d rather pay a bit for something where it turns out I didn’t need it… than to have a heart attack. But I guess I’m being selfish from the point of view of some in our society who would prefer that older people die and free up money and other resources for them. Sounds like a sick joke, but they’re serious.

Rob
He is no fool who gives what he cannot keep to gain what he cannot lose.

1 Like
4

My wife has an apple watch and last fall in the middle of the night she woke me up because her watch was alarming and woke her up in Afib. We went to the cardiologist the next day and he diagnosed that her thyroid meds were too high. Decreasing the dosage put her back in sinus rhythm. Then last Feb this year, I was at the in laws doing some work and my apple watch alarmed that i was in a fib during a moment when I was feeling light headed. I sat down and used the EKG function on the watch and sure enough I was in A fib. I started a medication for afib that day and the next day I converted back to sinus rhythm. I scheduled an appointment with my wifes cardiologist and he did a complete workup on me. Everything was good and I now take that a fib medicine atenolol. Any watch that monitors your heart rhythm could save your life in my opinion, especially if you are a senior citizen like me…doc

5 Likes
5

I don’t want to minimize the significance of A-Fib and its consequences. However, A-Fib has nothing to do with “heart attack”. Furthermore, A-Fib in itself is not life-threatening. The only exception to this is in the rare case of patients with an antegrade pathway or WPW syndrome in conjunction with A-Fib.
You might be confusing A-Fib with Ventricular Fibrillation. Ventricular Fibrillation is the most common cause of a sudden cardiac arrest and is fatal if not immediately treated. A-Fib and Ventricular Fibrillation are completely unrelated, there is no cause and effect factor either. If a patient has the notification on their watch that they are in A-Fib, they don’t need to be rushed to the Emergency Dept.
Having said that, A-Fib should be treated. I am of the school that A-Fib ablation should be a first line intervention, of course depending on the burden of A-Fib that can be quantified with the best continuous monitoring devise and interpreted by a cardiologist.

7 Likes
6

It’s not true to say that Afib has nothing to do with a heart attack. It can absolutely be one symptom. Most episodes aren’t due to that, I guess…but you can’t be sure unless you rule it out, or wait long enough to tell. Either way.

Likewise ablation as the first line response to Afib. Even electrophysiologists with a particular interest and expertise in ablation don’t appear to thonk that these days. Afib is oftentimes a symptom of underlying causes that can be modified to control or eliminate it…alcohol (hence the monikers Holiday Heart Syndrome and Saturday Night Arrhythmia) thyroid dysfunction, long term overtraining in athletes for just a few.

7

Arrhythmias are certainly one of the common symptoms we see with a myocardial infarction. They are also seen with coronary artery disease. Both of these are good reasons to seek medical attention if one experiences atrial fibrillation…doc

1 Like
8

This discussion is unclear due to the use of the term “heart attack.” So, let’s define our terms. If by “heart attack” you mean myocardial infarction (MI) then “in theory” there may be an association; maybe. If by “heart attack” you mean sudden cardiac arrest, which is what I was referring to, then there is no association. As I said, in itself.
However, A-Fib has many presentations and I was reading the thread to understand the discussion of A-Fib as a occasional occurrence in people who have seen it occasionally on their smart watch. This type of A-Fib is known as paroxysmal a-fib, or new onset a-fib. Therefore, in this case, a-fib that occurs once in awhile will not cause sudden cardiac arrest, and is not the underlying cause of a myocardial infarction.
I really didn’t want to go into all of this discussion, but you brought it up:

So, let’s go back to the many presentations of a-fib. There is A-Fib with a fast heart rate, we call that RVR, rapid ventricular response. This can cause many problems, or “multimorbidity”. This is one side of a-fib and one side of treatment called “rate control therapy”. The other side is rhythm control, preferable restoring sinus node function (SN), and even better complete SN restoration. These type of cases are most commonly referred to as persistent a-fib, and/or chronic a-fib. A-Fib ablation in the setting of persistent a-fib is not clear cut depending underlying heart disease.

However, in the case of paroxysmal a-fib there is plenty of agreement among electrophysiologists that ablation is the first line therapy.

Our meta-analysis including all 6 RCTs with relatively uniform study design and strict inclusion and exclusion criteria suggests that early rhythm control using AF ablation as first-line therapy is more effective than AADs (antiarrhythmic drugs (AADs) in patients with paroxysmal AF.

JAMA April 2021

You might notice in my previous post that I mentioned a-fib burden as an inclusion criterion. You may also note that I made it clear that I didn’t want to mitigate the medical consequences of a-fib, and that treatment is necessary. I would suggest that early referral to an electrophysiologist and early a-fib ablation is the most effective first-line therapy for rhythm control and longterm sinus node restoration. There are evidence based medical reasons for the success rates in early onset, paroxysmal a-fib. I will be happy to share it with you if you are interested.

1 Like
9

Arrhythmias?? That’s a big boat. Yes, bradycardia, heart block especially with an occluded RCA. Runs of VT with an MI, yes very common. Atrial tachycardia, very common with a low cardiac output state in the setting of an MI. A-Fib, yeah, once in awhile. Of course the most common symptoms are angina, diaphoresis, and SOB.

I made it clear that A-Fib is a consequential medical condition and should be addressed with a physician. In fact, my perspective is that all patients with A-Fib should have a referral to an electrophysiologist, sooner rather than later. In reality, it is not the current medical practice, many (and I say most) physicians treat A-Fib patients for years before a referral to an electrophysiologist.
What I think I was pointing out to the thread where people are watching for occasional A-Fib on a smart watch is that, if you see something that looks like A-Fib, you don’t need to call 911. However, if you feel chest tightness, and you’re sweaty and short of breath, yes, call 911.

10

Well, it seems to me that for those in this thread who’ve mentioned discovery by Apple watch, their diagnosis and subsequent treatment occurred after the very first event they were aware of (they’ll correct me if I’m wrong)…not after experiencing episodes of paroxysmal Afib.

My first episode (with rapid ventricular response) occurred before Apple introduced this feature to their watches so that wasn’t my heads-up. I didn’t need a smart watch or any such device, as the feeling in my chest was so distinctive and obvious, and the “irregularly irregular” radial pulse was, I assumed, pathognomonic of Afib…correctly, as it turned out.

I actually did take myself off to the emergency room…well, my daughter, who’s a veterinary cardiologist, insisted and took me. Not because I thought I was having a heart attack (something that I’d always define as an MI if being pedantic, whether immediately fatal or not)…but primarily because I couldn’t be certain enough that I wasn’t. Apart from that reason, the adage “Afib begets Afib” came to mind. Being aware that the longer I was in Afib, the harder it would be to convert back to and remain stable in sinus rhythm, that seemed to me to be the quickest route to achieve that.

Follow up from that episode was with an electrophysiologist …recognised as one of the more prominent/skillful ablationists locally…and, not having much practical insight into the various treatments for the condition, I assumed it would be a work up prior to ablation. Imagine my suprise when the guy whose primary source of income from this highly lucrative procedure informed me that, contrary to common belief, it wasn’t automatically the first line of treatment following initial diagnosis and that, in many cases where it was a symptom of an underlying condition, was contraindicated as it was unlikely to be of long term success.

This was back in April 2017. On a regimen of fairly low dose Sotolol (lower than my daughter would prescribe for a 65lb Boxer) and Eliquis, I had about half a dozen “breakthroughs” between then and Christmas 2018. Decided to give up alcohol completely for a New Year rezzo and, voila, not an episode since…in spite of tapering off and discontinuing beta blockers, with guarded agreement of my electrophysiologist. Given this experience, the advice/education provided by my various providers and subsequent reading I’ve done, I’m still skeptical of your assertion regarding ablation.

2 Likes
11

There are various reasons that a-fib ablation is not indicated, however, it may not be the case that your diagnosis is early onset atrial fibrillation. I am not going to argue medical opinion here. I have provided you with the most recent scientific research studies that indicate that early onset, paroxysmal atrial fibrillation is best treated with ablation rather than antiarrhythmic medication.
Anecdotal evidence is not scientific evidence.

2 Likes
12

Hi bones,

Great information and many thanks for it. Can you give us a definition of paroxysmal AF? Thanks again. Spot

13

https://www.google.com/search?q=paroxysmal+afib

1 Like
14

I knew I could Google it, but Bones was so emphatic about ablation that I wanted to clarify his indication vs AF with RVR.

Your links provided me with something even better, the approval of the newer pulsed field ablation- that looks like a greatly improved procedure.

Thanks RH! I hope you are well-I am always glad to see you posting and to follow along with your life. Leigh ( Spot )