Monitoring AFIB episodes

Is anyone here using Fitbit (or similar) heartrate to monitor Afib episodes.
Is this a reasonable method to track the history of episodes?

Any pitfalls to be aware of?

Quote
Searching9
Is anyone here using Fitbit (or similar) heartrate to monitor Afib episodes.
Is this a reasonable method to track the history of episodes?

Any pitfalls to be aware of?

I have a Fitbit and it started trying to track arrhythmias some months ago. It did catch a couple that were verified by my pacemaker, but it also missed some. My experience is that it isn’t very accurate. I find that its graph showing resting heart rates over a chosen period to be more useful. A Kardia will be more accurate for arrhythmias but of course it doesn’t track continuously.

In my opinion, no. I've never seen a fitness app yet that can reliably measure an irregular heart rhythm. Sure, you might deduce that you're in afib from the wildly varying heart rate it shows, but you can do the same thing for free by simply feeling your pulse.

Quote
Searching9
Is anyone here using Fitbit (or similar) heart rate to monitor Afib episodes.
Is this a reasonable method to track the history of episodes?

Any pitfalls to be aware of?

I've used a Polar H10 strap and an app (initially a Polar watch) to record the data for nearly 18 years. I've posted about this a number of times.

If you have a device that will record beat to beat (i.e. R to R), in other words the length of every beat, afib is pretty obvious. You can see this in the link above. The main issue is that many devices report or record a moving average, not beat to beat. In this post, the first graphs are from a recording SpO2 ring, below that are from the Polar (recorded data exported to a PC and graphed there). The SpO2 ring records every 4 seconds, the Polar setup I use, beat to beat. Years ago (15?), an afibber optometrist from the UK, Mark, sent me this set of recordings of different arrhythmias, recorded with a Polar strap & watch (data exported to a PC and graphed there). [www.afibbers.org] So my thought is to find a device that will record and display beat to beat data.

George or anybody else - any experience with this device? Seems more comfortable than the Polar H10 but is it equally useful for showing irregularities - meaning is it clear and detailed to see a P wave?
Cheers
[getwellue.com]

Quote
Joe
George or anybody else - any experience with this device? Seems more comfortable than the Polar H10 but is it equally useful for showing irregularities - meaning is it clear and detailed to see a P wave?
Cheers
[getwellue.com]

Joe, a couple of people have posted on using Wellue devices. Here is a search for their posts: [www.afibbers.org]

So the sleep doc wants to know if most of my episodes occur during "sleeping hours".
The PCP wants to know if the episodes are more frequent during high-pollen periods of the year.
The cardiologist wants to know "how often", how many hours per month.

To attempt to provide some information, I have recorded the "episodes" by reviewing the fitbit daily record of heartrate.
For example:


I've collected each of these daily records for the past 18 months, to try to see any patterns.

I am making the ASSUMPTION that the wild increase in heart rate between 2:25 am and 5:45 am are potential AFIB episodes (as I have no other explanation for the heartrate during that period.

(I understand that each point on the graph is the average of the previous 5 minutes. So the rate could be steady at 120 bpm, but more likely a spectrum of rates that happen to average to 120)

The point is that I'm wondering if this a worthwhile approach to see the frequency (and duration) of episodes varies over a long term.

(BTW, I am very skeptical of consumer devices attempting to "evaluate" arrhythmias - )

What about your nocturnal cardiac behaviour would make it 'worthwhile' to have a five-minute averaged assessment over a reading with a more discrete view, say taken every five seconds or ten seconds, or once every 30 seconds? The answer to this will be the answer to your question, Searching9.

Answering for myself, I don't need to know a beat-by-beat count. For me, it's good enough that I awaken in NSR and with an HR below 60 BPM each morning, even if the rest of the day is rather hellish. My Samsung Galaxy watch will provide the Samsung Health App, to which it is linked on my phone, with the lows and highs of both SPO2 and HR during sleep. It also records the various stages of sleep, their onset and release, and the total time spent in each.

If your health app or recording wearable device will break it down discretely, you can tell in graphical form when you are likely to be in REM stage, and if your commensurate HR spikes, it might be just the heavy duty events in the dream, or it might actually just be AF. It could also be both.

As for duration of episodes, it might be useful to find that episodic frequency and duration are both climbing, although I don't know what an EP or a cardiologist would make of that information, or what you should take from it. Many of us have episodes that come and go, some worse than others, and then we can go weeks with none at all. I think we worry when they take longer than 24 hours to revert. That places a great burden on the heart and may be an indication that there's a trend toward persistent AF. Perhaps some of the others can share some views on that.

thank you

I just went through looking at systems to monitor. I had a Fitbit, sense 2. On my first consult with the EP he informed me he didn’t like it for monitoring and that he recommended I purchase either the Apple Watch or Kardia Mobile. His nurse told me before he came in the room that he will want you to get a monitoring device. The purchase of the device is in the discharge notes from the visit.

What I found is you must really take the time and investigate each one thoroughly. I liked the Fitbit ease of use as well as the watch dial always displays the bpm. Also liked the exercise part of it. However, if you look into this further Fitbit informs you that it does not identify afib in real time. It actually delays before there is a notification that you are in afib.

There are pros and cons to the devices. It came down to what I wanted the device to do as well as the ease of use. I got the impression from the EP he leaned toward the Apple. I ended up purchasing Apple Watch, Series 8. It took a lot of time and several days of research before I made the decision.

Once I started to use it, I understood why he appeared to lean toward it. The watch, through your cell phone, tracks the time you are in afib and it is displayed in the phone on a graph. It identifies the percentage of time you are in afib based on the percentage of time you wear the watch. The problem w the Apple is the battery charge does not last as long as the Fitbit. Fitbit has really good batteries. If you do an ekg w the Apple Watch, it will indicate quickly you are in afib and the phone stores the strip. You can simply swipe left or right to see the entire strip. There are some comparison studies you can read Apple Watch series 4 to Kardia. Kardia was more accurate in identifying afib. However, since Apple developed the Series 8 and they claim after testing they have improved the ekg recognition. I have not seen any independent comparisons for the series 8.

What I liked about the Fitbit was having my pulse always displayed. You can put the pulse rate on the Apple watch dial in one of the corners. However, you have to tap to open it then wait while it gets your pulse. It will display a graph like the Fitbit, but the Fitbit's graph is much easier to read because the entire dial displays a 2 hour segment. Apple divides it into multiple 6 hour segments of 6:00 12:00 6:00 12:00.

One of the issues w Kardia I didn’t want was having to always have the finger pad with you. Also, you don’t see this on the commercials and this is why you need to research, Kardia requires a monthly subscription to store your ekg strips. It only stores your last one taken. And from what I read online the software does not allow you to take a screen shot of the strip.

There are a lot of videos on you tube that shows you all the features the systems do as well as reviews.

I don't get why one would hope any "personal" HR monitor (or app) being able to display things like "it's AFib", knowing that professional grade 12-lead machines are not even able to diagnose anything reliably.

@Pompon,
I'm not aware of any "personal" devices that declare: "it's AFIB". The personal devices I'm aware of may say "suspected" or "possible" AFIB.
I could be wrong about this next statement, but I believe that the diagnosis of AFIB is actually made by a physician, rather than an algorithm.

My Samsung Galaxy 4 watch is capable of real-time monitoring, or it will do an assessment every ten minutes WHILE THE WEARER IS INACTIVE. Since I am not hugely active, and don't really want my battery getting run down over six or eight hours, I use the inactive setting and cue myself to look at my watch-face every 15-30 minutes.

And yes, my Galaxy watch will actually display "Atrial fibrillation detected. See your physician."

The Galaxy can't distinguish between flutter and AF. Flutter was detected for the first time in me earlier this month. The watch says, "Indeterminate arrhythmia. If you are unwell, consult a physician."

My EP didn't question an ECG that I downloaded from my Galaxy three months ago and sent to his nurse. She took one look at it and said it's AF, and he agreed. He has since called me to talk about a second attempt at ablation. Seven weeks later, still no date. In fact, my GP has given them until today, and if we don't hear he will contact my EP's office himself on my behalf.

I suppose that I failed to make it clear, that I am interested in long(ish) history of Afib.

For example, I (and my doctors) are interested in seeing if any of the therapy efforts are effective in suppressing episodes (frequency & duration).

I've had paroxysmal Afib for 10+ years, following a cardiac cath. I have been on Multaq for 10+years. Recently (18 months) my cardiologist-EP recommended CPAP therapy. A four hour sleep study recorded an AHI of 11. My AHI, with CPAP, now averages 3-6. So, we are both interested in the effectiveness of CPAP for me in treating AFIB.

That's what I'm trying to track.... has the frequency and duration of AFIB episodes changed over the past 18 months.
Obviously I can't wear a Holter monitor for weeks on end, so I'm trying to find some objective way of monitoring the frequency and duration of my episodes.

One question that I suppose I should have previously asked the experts here is this: Does AFIB reliably cause erratic (beat-to-beat) ventricular contractions?
Said another way, can one have an AFIB episode that does not reveal itself in erratic ventricular pulses?

Quote
Searching9
@Pompon,
I'm not aware of any "personal" devices that declare: "it's AFIB". The personal devices I'm aware of may say "suspected" or "possible" AFIB.
I could be wrong about this next statement, but I believe that the diagnosis of AFIB is actually made by a physician, rather than an algorithm.

If you have Kardia’s Advanced Determination (many of us were grandfathered into it) it will tag an ECG Atrial Fibrillation rather than suspected. Also, I am able to take a screen shot of the strip.

@Daisy,
That's interesting, I purchased a Kardia 6 lead about 2 years ago. When I use it during a AFIB episode, the Kardi determination is "Possible Atrial Fibrillation. BTW, contrary to what Jake was saying (above) I can print out the strips (4 pages for all 30 seconds), and the all strips are on my phone for the past 18 months (and all can be printed for a physician to review).

My preferred method of printing strips is to "download to pdf", then send that PDF to my printer.

Now, I'd like to get back to the use of heartrate monitoring over a period of months to suggest the frequency and duration of Afib over a long term.

Quote
Searching9
When I use it during a AFIB episode, the Kardi determination is "Possible Atrial Fibrillation.

If you subscribe to Advanced Determinations your ECG will be analyzed and tagged with one of the following:

Atrial Fibrillation
Bradycardia
Tachycardia
Normal Sinus Rhythm
Sinus Rhythm with Premature Ventricular Contractions (PVCs)
Sinus Rhythm with Supraventricular Ectopy (SVE)
Sinus Rhythm with Wide QRS

It is too bad that it is now a subscription rather than being included with your purchase.

Quote
Searching9
..

One question that I suppose I should have previously asked the experts here is this: Does AFIB reliably cause erratic (beat-to-beat) ventricular contractions?
Said another way, can one have an AFIB episode that does not reveal itself in erratic ventricular pulses?

Yes....sometimes...for both questions. There is a syndrome known as 'rapid ventricular response syndrome' where the ventricle is compelled to beat in concert with a fibrillating atrium - [www.healthline.com]

Quote
gloaming
Yes....sometimes...for both questions. There is a syndrome known as 'rapid ventricular response syndrome' where the ventricle is compelled to beat in concert with a fibrillating atrium - [www.healthline.com]

RVR is anything over 100 BPM (or 110, depending on the source) at rest. A person can have afib with RVR and still have erratic (beat-to-beat) ventricular contractions. The exception would be where the atrioventricular (AV) node is not blocking any signals and there is 1:1 conduction (ventricles beating at the same rate as the atria). I think this is extremely rare in afib, but more common in atrial flutter. I'm pretty certain you'd know if you were in 1:1 conduction, as you'd likely be extremely asymptomatic. Moderator Shannon told me of his flutter 1:1 conduction experience caused by flecainide. He was in the Netherlands and decided to drive himself to the hospital after this presented. He barely made it to the nearest petrol station before having to stop and call the paramedics. This flecainide risk (atrial flutter with 1:1 conduction) is why a rate control med is commonly prescribed with flecainide.

In my experience, the erratic signal can be harder to see when the rate is slow because someone is in afib and on a rate control med.

Quote
gloaming

There is a syndrome known as 'rapid ventricular response syndrome' where the ventricle is compelled to beat in concert with a fibrillating atrium - [www.healthline.com]

So what I'm likely observing is RVR in response to atrial fib. (see the example fitbit graphic above).

I think I understand that this RVR has the capacity to do more damage to the heart then Afib without RVR. (I don't mean to suggest that Afib without out RVR should be ignored, just that the RVR may "raise the stakes")

So, for the home user, the frequency and duration of these periodic and un-prompted episodes of rapid ventricular response SHOULD be discussed with one's physicians.

@ george, I'll have to spend more time digesting what you've just offered.

Thanks to all.

Quote
Searching9
So what I'm likely observing is RVR in response to atrial fib. (see the example fitbit graphic above).

I think I understand that this RVR has the capacity to do more damage to the heart then Afib without RVR. (I don't mean to suggest that Afib without out RVR should be ignored, just that the RVR may "raise the stakes")

So, for the home user, the frequency and duration of these periodic and un-prompted episodes of rapid ventricular response SHOULD be discussed with one's physicians.

Here is the deal. Afib has two big downsides: stroke and cardiomyopathy (heart failure). Anticoagulants are prescribed to mitigate the stroke risk (depending on your CHA₂DS₂-VASc score and situation). If your non-exercising rate in afib is > 100 BPM, and you are in afib for long periods of time (weeks), then a rate control med is usually prescribed to mitigate the cardiomyopathy risk. So it if you go out of rhythm every once in a while for a modest period of time, this is different than if you are in persistent afib with a rate > 100 BPM. I don't know exactly where the cutoff is. If your rate is high for a long time the ventricles will enlarge and their pumping efficiency will decrease (ejection fraction on an echocardiogram). RVR is just a fancy way of saying your resting rate in afib is higher than 100.

What I was describing above is a situation (1:1 conduction) where the ventricular rate is the same as the atrial rate. In afib, the atria are nominally beating at 300 BPM, the ventricles aren't happy at this rate (and you would likely know it!). Your fitbit would be showing a much higher rate than on your graphic. If you are getting 3 or so hours of the ~120 BPM nightly, then have a discussion with your doc as to whether they think you need rate control. Also, a Holter, Zio patch or such, that can determine if these high rates are afib may be warranted for a short period of time (in conjunction with the device you have now). With that info, then you'd know better what your current device is telling you.

Measuring HRV works. When you see you have elite athlete status you're probably in AFIB.

Hint - afib is HRV

Quote
PavanPharter
Measuring HRV works. When you see you have elite athlete status you're probably in AFIB.

Hint - afib is HRV

HRV is the acronym for Heart Rate Variability. Correct?

Is heart rate variability based on beat to beat (R to R) variability?