A fib and wearables

Hi there, I'm a 58 y.o male, I've been very active all my life.  Commute one each way by bike when weather permits, run a couple of times each week.  I got an implanted dual lead Medtronic Azure close to two years ago.  It's been a game changer for me.  No more lightheadedness due to a resting pulse of 35.  A couple of weeks ago I got up quickly from the couch, went outside and shovelled the three or four inches of snow from our driveway, then went for a 45 minute walk with my wife.  When I came inside something didn't feel right, fluttering in my chest, hr wouldn't come down.  I went to emerg, by the time they ran an ecg my heart was back in normal rhythm.  I checked in with my p.m clinic who ran a diagnostic and said, 'yup, you were in a fib there'.   I just saw my gp who said, 'don't worry about it, just monitor for now, buy a snowblower'.  I have a long family history with a fib and strokes.  I am trying not to over-react to this (and, my guess is I've had some afib before now).  I was just looking at the Frontier X wearable, since it gives real time ecg's.  Any thoughts or advice would be welcome.  Thanks!


5 Comments

EKG

by AgentX86 - 2021-12-28 16:30:05

If you're looking to monitor your heart rhythm,  there is no better device than the Kardia Mobile 6-lead. They're between $130 and $150, depending on sales. These will take an accurate EKG and tell you if you're in Afib. You can forward the EKG to your EP for further details.

If you're in, or going into and out. Of Afib, it's probably a good idea to  e taking an anticoagulant. You can look up the CHAs2 scorecard and evaluate your risk of stroke. The other important factor is your resting heart rate.  It needs to be below 100bpm. Other than those possible complications   Afib isn't dangerous but it can be debilitating for some. Others are completely asymptomatic.

Afib

by ar_vin - 2021-12-28 17:30:26

What Agent said above is spot on. In addition I'd suggest seeing your EP so your condition is taken seriously and you get a prescription for an anti-coagulant. You need to protect against the risk of stroke!

The Frontier X is pretty good but to me it feels more like a work in progress. I like the idea of a chest strap that can be worn for extended periods of time. I've used a Polar H10 for all my workouts: runs, hikes, bike rides etc In comparison I found the Frontier X a bit fiddly. 

The Kardia Mobile seems like a great product but it requires you to be stationary while it takes a reading: a no go for my use case. I want an "ambulatory EKG".

Something like a simplified Ziopatch for consumers: the technology exists but it needs to be productized. The Frontier X could evolve to be that product but it has a long way to go,

A Fib and wearables

by TAC - 2021-12-28 18:05:14

You didn't say why they implanted a PM on you. Of course, you had bradycardia but, from what? A/V block? Sick Sinus? Then you described an A Fib episode. Do you suffer from paroxystic A Fib? Have you had an ablation? Do you take anticoagulants? Please provide this missing infirmation if you don't mind, so that I can have a better idea of what you're facing. Yes, there are electronic devices that can detect A Fib.  But what good is that going to do? As you know, PM's don't cure A Fib.

Paroxysmal Atrial Fibrillation and stroke risk

by Selwyn - 2021-12-29 08:44:15

Hi BradyJohn,

About 10%+ of  ischaemic strokes are associated with atrial fibrillation (AF).

The more AF you have the greater the risk (though, as noted above, the CHA₂DS₂-VASc should be assessed).

The benefit of having a pacemaker is you have your own built in counter (See AMS function) for knowing the number of events and the duration of AF. This can then be used to determine whether you need anticoagulation when coupled with the CHA₂DS₂-VASc  score.

Paroxysmal AF, that is AF that comes and goes, carries a risk of stroke similar, if not worse, than permanent AF, depending on the AF load.

AF may occur at night in your sleep.  You will never know. Be aware of the limitations of the Kardia® (for which I have a six lead one, personally). It is useful during the day. I would want my pacemaker to monitor the situation carefully ( eg. 3 months). If I was then having frequent  AF that was not detected by me, using the Kardia®, or otherwise,  I would consider anticoagulation. One or two attacks of fairly limited AF may not be a reason to have anticoagulation, as this is not without its own risk, hence the CHA₂DS₂-VASc  calculator. 

My Mother had a pacemaker and paroxysmal AF, as I do. My Mother died of a massive ischaemic stroke in spite of warfarin anticoagulation. I am anticoagulated  and have had 3 ablations for AF and atrial flutter. I last had atrial flutter for a month after Covid this June.  I do not take an anti-arrhythmic medication.

Any strain on the heart can cause attacks of arrhythmia, as can eg. alcohol, caffeine etc.  There are preventative measures eg. beta blockers. There is even, a 'pill in the pocket', for taking a beta blocker for the rare attack of AF. As stroke risk increases with the duration and frequency of AF, limiting these parameters lowers your stroke risk. 

Something to think about!

( See NICE guidelines :
https://www.heartrhythmalliance.org/files/files/NICE%20AF%20guideline%20(NG196)%20-%20Key%20recommendations%20for%20primary%20care.pdf)

 

Thanks!

by BradyJohn - 2022-01-03 17:29:42

Hi all, 

Thanks for your responses.  TAC, I was told by my gp that I had 'heart block', my arrythmia specialist said 'weak electrical signal'.  I am not on any meds of any kind,  my hr with my pacemaker has a base of 60bpm during the day,  drops down to 50bpm at night.  I am aware that the pm doesn't address the afib.  My gp said my risk profile is low enough that anticoagulants are not necessary at this time.  My thought of having a wearable ekg is so that I know what is going on,  ie possible afib episodes at night etc.

Again,  thanks,  the wisdom and knowledge on this site is very helpful. 

Happy new year 

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