• Wearable device such as smartwatch helps diagnose asymptomatic atrial fibrillation.
• It does not guarantee accuracy due to Signal noise…Medical staff reading required
• It is Expected to improve accuracy by connecting with artificial intelligence technology
Even amid social distancing due to COVID-19, the world is working together intensely regarding health care. Health Kyunghyang, as the first media company to operate a multilingual edition, quickly delivers domestic health and medical news overseas. Meanwhile, we introduce the latest knowledge in the world's medical world to our readers.
This year, Health Kyunghyang continues to publish a 'Medical Discussion with World Scholar.' The eighth topic is 'effectiveness of wearable devices in arrhythmia diagnosis.' Please check the various opinions of researchers from different countries at a glance. < Editor's Note>
The risk of arrhythmias increased with the aging of the population. There are various types of arrhythmias. When not treated in a timely manner, the heart function gradually deteriorates, which has a fatal effect on life.Since atrial fibrillation is a malignant arrhythmia that causes stroke, early diagnosis and treatment are critical.
The problem is that most of the arrhythmias appear intermittently, making it difficult to diagnose with only an electrocardiogram accurately.For this reason, wearable devices attached to our bodies at all times (devices connected to or inserted into clothes, watches, or skin) are drawing attention as valuable diagnostic tools.
Participants in this discussion included ▲Junbeom Park, Director of the Arrhythmia Center at Ewha Woman's University Mokdong Hospital (Associate Professor of Cardiology) ▲John Day, Cardiac Arrhythmia Specialist, Intermountain Heart Research Center, USA ▲Marcellus Francis L. Ramirez, Santo, Philippines Cardiac Arrhythmia Specialist, Thomas University ▲Konstantinos Siontis, Cardiologist, Mayo Clinic, USA ▲ Chi-Keong Ching, Professor of Cardiology, Department of Cardiology, Duke-NUS Medical School, Singapore.
■Discussion Main Issues
Wearable devices that are attracting attention in the diagnosis of arrhythmias include: A wrist watch-type electrocardiogram device, A smartwatch equipped with an electrocardiogram function, An electrocardiogram patch that constantly records electrocardiograms by attaching them to the chest. These devices connected to the body record a patient's ECG anytime, anywhere, so they can be beneficial for diagnosing atrial fibrillation that has no specific symptoms and intermittent arrhythmias. However, it is not 100% precise, so an expert's reading of the measurement result is a must.
- Among wearable devices, the use of smartwatches is increased. Is it conducive to diagnosing atrial fibrillation?
Professor Jun-Beom Park of Korea (hereafter, Jun-Beom Park): As stated in the newly revised guidelines of the European Heart Association, the role of smartwatches in atrial fibrillation diagnosis is vital. They have the advantage of measuring anywhere, anytime. And it turned out that the diagnosis rate by using smartwatches in daily life was higher than that of 12-guided ECGs in hospitals, as stated in the previous study. However, even when measuring with a smartwatch, the users must maintain the electrocardiogram for 30 seconds. Moreover, the experts' readings are fundamental.
American John Day Specialist (John Day): Of course. Currently, I recommend that all patients with atrial fibrillation use smartwatches.
Philippine Malcellus Francis L. Lamarez Specialist (hereinafter referred to as Malcellus): Yes. Smartwatches are particularly helpful in detecting malignant arrhythmias, such as atrial fibrillation.
Prof. Constantinos Ziontis, USA (hereafter, Constantinos): Although accuracy relies on the type of smartwatches, the latest version of the smartwatches accurately detects atrial fibrillation. A wearable smartwatch can be practical since most atrial fibrillation is asymptomatic or occurs during sleep.
- Can we decide the treatment only with the ECG records from the wearable devices?
Park Jun-beom: Even in the recently revised guidelines of the European Heart Association, atrial fibrillation diagnosis by using single-lead ECG is recommended. Unlike the existing 12-lead ECG that can obtain 12 ECGs by attaching multiple electrodes, wearable devices such as smartwatches can record only one ECG through single induction. As the incidence rate of atrial fibrillation increases due to an aging population, active use is recommended in Korea.
John Day: We are currently asking patients to upload their documented atrial fibrillation file as a medical record. In other words, the file taken from the wearable device becomes a part of the medical record.
Malcellus: We are still utilizing the standard 12-lead electrocardiogram to scan arrhythmias. However, with more research and technologies being developed, wearable devices will be used as a basis for treatment decisions shortly.
Constantinos: They can be used but require great care. For example, the ECG signal may be disturbed by unnecessary signal noise in a smartwatch. It is also possible to record only fragmentary signs of arrhythmias. Therefore, when analyzing the electrocardiogram of a smartwatch, experts should be meticulous in distinguishing whether it is an actual arrhythmia or not. Moreover, treatment for transient and asymptomatic atrial fibrillation should be arranged according to each patient's condition. Therefore, technical supplementation is necessary to supplement.
John Day: When the ECG is recorded while the patient is in the correct position, there is no problem for the medical staff to interpret the signals. However, we cannot say that automatic reading is always accurate. For example, frequent premature atrial contractions (PAC) and premature ventricular contractions (PAC) are often misclassified as atrial fibrillation.
Malcellus: It is relatively accurate, but there is still the possibility of false positives and negatives. Also, unnecessary signal noise can lead to errors in interpreting the results, so it is not perfect. However, it can be employed to detect irregular rhythms such as atrial fibrillation or specific ventricular arrhythmias.
Constantinos: It varies depending on the wearable device, but most exhibit more than 85% sensitivity and specificity for atrial fibrillation. Recently, as artificial intelligence technology is actively used in the ECG analysis process, accuracy increases. Furthermore, the accuracy is increasing as wearable devices, including a more significant number of ECG leads, such as six leads other than a single-lead, are released.
Ki-Kyung Ching: Although there are distinctions between wearable devices, smartwatches approved by the FDA provide moderately accurate results.
- Is the smartwatch practical in diagnosing arrhythmias other than atrial fibrillation?
John Day: Personally, I do not use the smartwatches for arrhythmias other than for atrial fibrillation and atrial flutter (the state in which the heart contracts rapidly at about 250 to 400 beats per minute). But, I have once diagnosed supraventricular tachycardia (SVT) with this device.
Malcellus: In my experience, it was effective in diagnosing early ventricular systole and ventricular tachycardia in two patients. Therefore, it will be sufficiently valuable in diagnosing other arrhythmias.
Constantinos: At this point, I think other arrhythmia diagnoses are at a rudimentary level. In addition, there have not been systematic studies on the accurate diagnosis of arrhythmias by quantifying cardiac contractions and the classification of other types of arrhythmias.
- What are the future development prospects for wearable devices?
Jun-Beom Park: Single-lead electrocardiography has limitations in the early diagnosis of diseases such as myocardial infarction. However, as a predictive model for chest induction using artificial intelligence has recently been reported, I expect that myocardial infarction will be diagnosed early with a wearable device sooner or later.
Constantinos: Typically, smartwatches tend to operate artificial intelligence technology actively for accurate signal analysis. And technology to minimize the effect of unnecessary signal noise on electrocardiogram analysis is still being developed. In the future, wearable devices will make a more outstanding contribution to clinical practice. We notice the arrhythmia predictability of smartwatches, not just detecting and diagnosing arrhythmias. For example, suppose a smartwatch detects a subtle abnormality in a patient's electrocardiogram and sends a notification a few days before the onset of atrial fibrillation. In that case, we are more likely to intervene appropriately to provide stroke prevention treatment.
Ki-Kyung Ching: Wearable devices and related apps should continue to be developed. Specifically, it is necessary to integrate the electrocardiogram results with other variables such as age, gender, drug intake, lifestyle, and blood test results. This Integrated Management will enable more precise arrhythmias prediction.
