EKG-machines and pacemakers

Since I was told I have A-fib, I have looked for a device to tell me. I want to know more about the situations leading up to an A-fib incident, and to know when the incidents stop. I'm not able to pin it down on my own, without some kind of equipment. I've tried to make Medtronic make a device to give me a continous reading from the PM, but they don't seem to be interested.

However, I've found to small EKG monitors: ReadMyHeart and InstantCheck, from DailyCare. They're a poor substitute for a PM reader, but better than nothing. I've found them on Amazon, so I assume they are easily available. The first one is around 200$ and the other one 500$. Prices differ a bit, between the different dealers.

But there's a snag. In the manuals of both of them, there's a warning: "Not suitable for users with pacemakers".

I've asked the dealers to tell me why they are considered not suitable, but there's no answer.

So, do anybody here know why these EKG devices are considered unsuitable for PM users?


13 Comments

EGK Machines

by SMITTY - 2010-02-20 10:02:32

Helloi Otbergo,

I'm no expert on this subject, but Ill try to offer something, as I understand it.

As you know, an EKG is a test that measures the electrical activity of the heart. Since a pacemaker generates and sends an electrical impulse to make the heart beat, telling which electrical impulse is being made by the heart and which is made the pacemaker is difficult. A good cardiologist or electrophysiologist can tell which peak on the EKG strip is made by the heart and which is made by the pacemaker. I would guess that because of the difficulty in distinguishing which is which is the reason for the warning on the devices you looked at.

Another thing is it is not uncommon for a doctor to discourage self-diagnosis. This may go back to the saying "a little knowledge can be a dangerous thing" which could be why you did not get an answer.

When I want to know what my heart beat looks like I use an pulse oximeter. This, or course reads out blood/oxygen level and heart rate. It also gives me an estimate of the duration of the heart beat by the length of the little bar (looks just like the bar on a bar graph) that shows the duration of the heart beat. Using this I can get an estimate of the frequency of PAC/PVC and skip beats. Let me add, I don't know if my interpretation of what I'm looking at is accurate or not, but I like to think it is. I would also guess if I ever went into A-Fib while looking at this thing I might be able to see that, not that I know if I would recognize it.

As for A-Fib, I have that occasionally and it is of such short duration I would never be able to get a machine hooked up in time to record it. The one time I had an episode of A-Fib that was of long enough duration to make me pass out (one or two minutes, I think) I had not idea what was coming off. Even if I had known I would not have been able to tell anyone anything. I was having breakfast and I recall that when I first felt that episode I told my wife that something strange is going on with my heart and the next thing I recall was some sometime later and I was on my way to the ER.

On a couple of my PM checkups I have been told that the PM recorded some episodes of A-Fib and on the last checkup they added two episodes of V-Tach to my list.

You might consider asking the doctor if your PM will records A-Fib, V-
Fib/V-Tach and if so what have they seen?

Afib and ECG's

by ElectricFrank - 2010-02-21 01:02:56

Afib is very difficult to detect on an external ECG, even with very sophisticated machines. They are usually deduced from the lack of a P wave on the ECG or a noisy looking trace between the larger ventricular waves. However, either on of these can be caused by other problems as well. The difficulty is that the atrial muscles are nowhere as powerful as the ventricular ones so even the normal atrial signals are small in amplitude.

I recently read an article questioning how often patients are being medicated for afib when it doesn't exist.

One advantage we have with a pacemaker is having a lead in the atrium. This gives direct access to atrial signals so the pacemaker can determine afib much more accurately, but since the information is only used to control pacing and/or is stored in the pacer for later interrogation it doesn't help as a real time monitor.

As Smitty mentioned, the spikes generated by the pacemaker tend to overwhelm the natural signals so the ECG is confounded. Actually, I don't trust those automated diagnosis that are printed on the ECG under any circumstances.

frank

Dear Smitty and Frank

by otbergo - 2010-02-21 05:02:06

Thank you for your comments.

I have both long and short A-fib episodes. At my hospital check this week, the PM recording showed 4 episodes that lasted for more than 96 hours, since 13th January. 3 more episodes lasted less than one hour. I'm not really able to feel when they start and stop, so I need some equipment to help me discover the episodes.

It's quite easy to see the fibrillation at the EKG equipment at the hospital, it shows up like a seesaw instead of the normal P bump on the graph.

Something positive...Thanks Smitty and Frank

by ted - 2010-02-21 08:02:28

What a joy to read a posts from Smitty and Frank. Their responses are always measured, well thought out, and based on true facts and knowledge. Their answers to questions by folks who might be scared to death and who dont know who to believe, are never off the wall, or misleading, or based on mumbo jumbo, or psuedo science, or just to hear themselves talk. Thank you Smitty and Frank. I wish that everyone here could follow your example and not confuse folks by acting like they know what they are talking about just because they read something on the internet. You guys are for real and I always learn from you. Ted

But what to do?

by otbergo - 2010-02-23 02:02:08

But what should I do? I didn't find any EKG portable device, with good enough registering to tell me when I have a A-fib episodes, and the PM producer do not want to develop any device for patient use. They only develop equipment for the physicians.

I use a sports/pulse watch to keep track of my pulse. But I'm not able to pinpoint the start and stop of A-fib episodes.

Thanks, Ted

by ElectricFrank - 2010-02-23 12:02:32

While I appreciate your confidence and am also dependent on others to keep me on track. The thing I have to offer is a fresh look at the questions and issues. We have a few doctors and nurses who are up on the common wisdom of the medical community who can provide that information.

best,

frank

Example

by ElectricFrank - 2010-02-24 02:02:26

I just posted a screen capture of my ECG showing pacemaker spikes (ventricle only), and a PVC. It may not come out too good at the small resolution of the gallery.

This is my ECG unit. The time and heart rate boxes only show data when I click my mouse on an area of interest and lets me make measurements down to the millisecond.
frank

Use with pacemaker

by ElectricFrank - 2010-02-24 02:02:56

The waring about not being suitable with a pacemaker is a standard warning to give them legal cover. The device will not interfere with the pacemaker as it only picks up and amplifies signals.

There are two issues that you would have to deal with. The first is that the actual heart waveform of a paced heart is different than one without a pacemaker. This makes the waveform examples in the manual less useful. However, with some experience you can learn what your normal and afib look like.

The second problem is that the pacemaker spikes are of higher amplitude and shorter length than the waveforms of a normal ECG. This can cause the amplifiers to distort the reading if they aren't well designed.

There is a trick that can help. First avoid the thumb electrodes and use the regular stickon type to allow you to experiment with placement. If you place the two electrodes over the upper part of your chest on the left side it will emphasis the atrial signals and reduce the large ventricular ones.

In my case I modified a biofeedback instrument to accept the ECG signals modified by the pacemaker. I am able to see the pacer spikes from both chambers and a good heart signal as well. In fact my signals are much better than the ECG in the cardio's office or hospital.

The only thing I can suggest is to look for an opportunity to try several of the portable units on the market to see what they provide.

frank

What equipment do you recommend?

by otbergo - 2010-02-24 04:02:32

Frank,

I have looked at:

ReadMyHeart
InstantCheck

Both are simple devices for personal use, with readings for 30 seconds from the thumbs or 2 electrodes. The first one is around 200 and the second arond 500 US dollars. Both are by a Taiwan producer and sold by several agents in Asia, USA and Europe. The producer is Daily Care, with web address www.dcbiomed.com.

ECG???

by ElectricFrank - 2010-02-26 01:02:34

The only way to be sure how either of these will react to a pacemaker is to try them. I see that Amazon handles them. If I remember right they have a pretty liberal return policy. You might be able to order one and if it doesn't do the job just return it. If you do be sure to not mention the pacemaker. Just give the reason as "it doesn't meet my needs.

Hopefully one of them will give usable results.

frank

Thanks a lot

by otbergo - 2010-02-26 04:02:00

I'll try one of them, then! Thanks a lot.

Not to easy to see a-fib on ECG

by ted - 2010-02-26 07:02:48

My Cardiologist tells me that it is not so easy to determine a-fib from reading the ECG in a person with a pacemaker. He says that the absence or presence (I forget which) of the "P" wave will have him then interrogate the pacer which should provide accurate info re a-fib.

Easy to see afib on a good ECG

by otbergo - 2010-02-27 03:02:55

I's quite easy to identify, at least my kind of afib, on the ECG equipment in my cardiologist's office. Afib - extremely high pulse in the atrium - shows up as a zigzag line, instead of a small bump on the graph.

What I don't know, if it will be possible to see it on a much simpler (and cheaper) ECG for personal use, with just 2 electrodes, sold by Amazon and others. If anyone has experience with such equipment, pls let me know!

You know you're wired when...

Your electric tooth brush interferes with your device.

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