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An expert’s take on wearable heart devices

Heart Health
Written by Marie Sanderson

Millions of Canadians experience irregular heart rhythms, known as arrhythmias. The most common type of arrhythmia is atrial fibrillation, or A-Fib.

A-Fib affects approximately 200,000 Canadians. If treated, most people with atrial fibrillation lead active, normal lives. But left untreated, the disorder can lead to stroke and heart failure, not to mention interfere with your daily quality of life.

Dr. Christopher Cheung is a cardiac electrophysiologist with the Schulich Heart Program at Sunnybrook. At our most recent Speaker Series, he shared his insights on A-Fib and the role of new technologies, smartwatches, and other wearable devices in helping to detect and manage the condition.

What are some common symptoms of atrial fibrillation?

Dr. Cheung: Some common warning signs of atrial fibrillation include a fast, almost fluttering, heartbeat. You may also have chest pain, feel weak, dizzy or tired, lightheaded, and be short of breath.

If atrial fibrillation is suspected, you will have a comprehensive cardiac evaluation, which means we take a medical history, perform a physical examination, and run a series of tests including an electrocardiogram (ECG or EKG) and/or a cardiac ultrasound (echocardiogram).

A critical part of diagnosing an arrhythmia is monitoring the abnormal heart rhythm. We have many ways to formally monitor you, including wearing a Holter or patch monitor for several days, to continuous monitoring devices like implantable loop recorders.

What role can wearables play in detecting hearth rhythm disorders like A-Fib?

Dr. Cheung: With the rise in effective wearables, like smartwatches, patients want to learn more about monitoring their hearts in a non-invasive and convenient way.

Wearable devices will change how we deliver healthcare. While these devices do not provide continuous monitoring at this time, they increase the likelihood of detecting an arrhythmia. If you detect something, you can bring that information to your doctor for interpretation. Wearable devices really give us an opportunity to diagnose and identify more people who may have arrhythmias that would have previously been missed.

What are some other benefits to using a wearable?

Dr. Cheung: In addition to allowing us to potentially detect atrial fibrillation earlier, they allow us to personalize your care, meaning tailoring your treatments and medications based on the symptoms and triggers of your abnormal heart rhythm. How often are you having atrial fibrillation, and how much atrial fibrillation are you having? What are your triggers? Wearable devices may be able to provide us with this information in the future, improving health outcomes for patients.

Wearables may also help us to improve or support healthy behaviors to facilitate lifestyle modification. Many wearables have built-in features like activity trackers which can help improve lifestyle in general.

How do these devices work?

Dr. Cheung: Most use a technology called photoplethysmography. Light from the device is emitted into the skin and reflected back to the detector on the device. It’s similar to technology used in oxygen monitors in the hospital. A lot of these devices also have something called an accelerometer or gyroscope which detect your physical activity and can pair that heart rate data with your activity level. This tells you whether your heart rate may be abnormally high, or low, during a period of physical activity or inactivity.

Any words of caution about using smartwatches or other wearable devices to monitor heart rhythm?

Dr. Cheung: It is still important to be very careful when you are using your wearable for heart monitoring. The accuracy of each device can vary. There is also the phenomenon of a false positive or a false negative finding. A false positive finding is when the device tells you something is going on, such as an alert for an irregular heart rhythm, but you actually don’t have an arrhythmia. On the other hand, a false negative is when the device tells you there is nothing going on, but you do have an arrhythmia. False positives can lead to unnecessary investigations and anxiety, and false negatives can provide false reassurance when treatment may be beneficial.

What is the future of wearables?

Dr. Cheung: As we look forward, wearable devices will have more functions and will come in all shapes and sizes. We already have them in smartwatches, and we are starting to see more devices as chest straps and ECG shirts becoming available.

We will also have studies that will incorporate wearables into your routine care. Wearables will really increase the monitoring options that you have available and ultimately help shape how we deliver cardiac and arrhythmia care.

That being said, it is always important to know that there are limitations and risks with some of these devices, such as incidental findings that may not have any significant meaning. Wearable device users should be aware of these risks when using these technologies.

About the author

Marie Sanderson

Marie Sanderson is a Senior Communications Advisor at Sunnybrook.

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