Wearable ECG monitoring (personal "holter monitor")

monitoring your heart

by new to pace.... - 2023-08-03 06:27:24

Save your money and let your heart do what it does best with your pacemmaker ..  No need to see how it is beating all the time.  Take this time to enjoy life.

new to pace

My use case

by John_Locke - 2023-08-03 06:53:15

Thank you new to pace, I am of two minds myself here and can certainly see the potential for obsessing too much about your heart.

For a bit more context - I currently have quite a few "data points" that I track regarding my own overall health, from smart scales (sadly I've had to disable the body composition analysis), sleep tracker, heart rate monitor when exercising, smart thermometer, smart blood pressure monitor, periodic private blood tests on cholesterole etc. I was naively hoping that I would get some meaningful ongoing access to data from the pacemaker itself with a home monitoring station, but even if I could, it wouldn't tell me much. It seems that my device, even though internally it must have an exact count, only reports the pacing load as "< 1%" and it's likely to stay like that for me for a long time. I have an intermittent AV block and don't need it much but have had some long recorded pauses in the past so when I need it I do need it...

What I'd love to get from this is a view of how my AV block develops over time, or more specifically, if there are any triggers for it that I could understand (sleep, caffeine, exercise, etc). I understand that the ECG would no longer show the pauses or skipped beats, nor the pacing signal itself, but I imagine in theory I should be able to see a delay between the P and Q on the ECG when this happens as the pacemaker needs to wait for my natural ventricular response to not happen, then trigger a pulse.

I'm not sure whether this is practical and whether the accuracy of consumer grade devices would be enough, but I'm in technology and would love to see if I could piece this all together on an automated basis.

Self-monitoring

by piglet22 - 2023-08-03 07:36:32

Hello

I see you are a UK, presumably NHS patient.

I've no doubt you've seen a lot in the press about the troubled NHS and it affects cardiology just the same as any other part of the NHS.

I had my first PM in 2005 and the post diagnostic and treatment service has slowly been whittled away with face-to-face physical clinics closing and general access to cardiac specialists getting much harder.

I think that some degree of self-monitoring and record keeping is invaluable. GPs aren't specialists and are more receptive of patient generated data than maybe 50-years ago. It still has to filter through to hospital consultants.

I would be wary of too many devices and maybe use one or two. My own condition has deteriorated this year to the point where ectopics are causing daily episodes of low blood pressure, low oxygen, dizziness and collapses.

Gathering evidence has been essential as most of the problems happen outside of office hours.

I would suggest a decent BP recording monitor with arrythmia detection (Omron M10-IT for example) and an oximeter.

Most of the problems I would like to monitor happen in the evening and probably during sleep. I am actively looking for a recording oximeter to give me a record of BPM and SpO2.

I still need to get to the bottom of why a PM set to 70-BPM allows a waking BPM of less than 40 and SpO2s less than 80%. An insight into what happens during sleep would be fascinating.

There are a lot of devices on the market and there is little point in getting something cheap that doesn't work well.

Ask your GP. Mine was quite helpful and recommended a chest strap BPM monitor rather than a FitBit type.

There are arguments for not spending a lot of time, maybe worrying about the fine details, but I would say that no-one knows your body better than you and some well-presented records will get the attention of even the loftiest consultant or GP. Sometimes you must take matters into your own hands, especially when things go wrong.

Self monitoring is here to stay in the UK

by Gemita - 2023-08-03 07:43:18

John, without obsessing I believe it is good to monitor ourselves today, when self monitoring is indeed encouraged by doctors (blood pressure, blood glucose, heart rate, oxygen level monitoring for example).  I cannot help you with a monitor although I did consider the Frontier X2 and other chest or wrist monitors.  My cardiologist recommended Kardia for heart rhythm monitoring.  I also felt the Kardia monitor would best suit my requirements and now have a 6 lead Kardia monitor.  We also have blood glucose and blood pressure monitors.

I am not an athlete and I always go by how I feel to assess how much to push myself physically and it has always helped me to stay safe.  I can understand you want the freedom to do this with a good combined heart rate, ECG, oxygen monitor and so on.  There are plenty of individual monitors out there but not sure that there is one that would give excellent results to cover all our monitoring requirements?  

As we age, sick sinus node dysfunction or different types of block usually progress or most definitely change because of many factors like meds, other health conditions, pacing changes, lifestyle and exercise.  I would suggest by listening to your body and understanding your symptoms, you will be able to let your doctors know immediately when something doesn’t feel right and then hopefully get any necessary changes to settings to keep up with your changing needs. 

If you find home monitoring helpful, then I see no harm in it.  We all do it, afterall.  You could also work with your cardiac technician while you are on a treadmill to optimise your settings and learn more about a safe level of pacing for you.  

Good luck and enjoy your activities and your monitoring but don't get obsessed by those numbers!

Self-monitoring

by AgentX86 - 2023-08-03 11:06:20

My answer to these things has always been and always will be, "Don't do it. You'll drive yourself crazy, even if it does work, which it likely won't."

A Holter monitor is a full twelve lead EKG.  Watches can only be single lead and that lead isn't one of the twelve (one lead in the arm, not across the heart), so who knows what it's really showing.  Sure, it'll see Afib but it doesn't take a geneous to tell Afib from a normal pulse.  You could tell when you went into Afib but that information isn't all that useful. It cannot even see flutter or differentiate more complicated arrhythmias.

Going by what Gemita said about your NHS, it may be useful to check your vitals, maybe once a day and when you feel unwell. A Kardia 6L would be the tool for that.  It will give a cardiologist some real information to go by.  I have a 6L and it was useful to show my device tech and cardiologist to get answers.  No resolution, but answers, and a little information about my pacemaker/settings.

I have a feeling that you're too close to  obsessive/compusive behavior, here, and constant monitoring of your heart will become a real problem in your life.  Don't give in to that temptation.  Have a life.  Your pacemaker will be just fine. If you don't feel well, then check it with a real, tested, device.

Aside: a 200Hz sample seems odd for a European device. It would make perfect sense for the US.  I have a feeling that you folks are getting leftovers.

Got the Frontier X2

by John_Locke - 2023-08-03 15:01:01

FWIW, I'm now the proud(?) owner of a Frontier X2 - thank you Amazon Prime.

If anyone would like more information about the device, please let me know.

I’m also a “data geek”

by Aintgotrhythm - 2023-08-04 11:25:19

Hi John,

I also monitor various aspects of my health closely and always have done. This has proven invaluable to me in getting treated. When I had my first "event" 6 weeks ago (HR dropped to 40 while cycling), had I gone into my PCP and just said "I don't feel good" it's likely I would have gotten the "take 2 aspirins and see if it gets better" reply.

Instead, I went in with HR data while riding going back 10 years, information on hi/low HR's during exercise, Apple Watch ECG's, etc. No, I didn't have a stack of charts but I *did* have 3 that I created that showed what was going on and how it had changed over time.

This made all the difference. I went from urgent care to a variety of tests to implant in less than 4 weeks with most of that delay being scheduling for the different tests and to get into an EP.

I've sent Gemita a PM about the Kardia unit as I'm very interested in that as well. I see on their web site that the Kardia "is not tested or approved for pacemakers or ICD devices" but it apparently works for her so I'm a bit confused about that. 

As an aside, I'm also a technologist (joint PhD in Math/Computer science) so I think it's part of my personality profile to want more details and data. Some people are in the "it's working so don't fret" school and that's totally fine since it works for them. I, on the other hand, want to know more details and am actually more relaxed when I do.

Good luck with your Frontier!

On medical devices and pacemakers

by John_Locke - 2023-08-04 11:34:43

When it comes to medical devices that "work" with pacemakers, there appear to be two broad categories: Devices that concievably could interfere with the pacemaker operating normally, and devices that might possibly be confused by the operation of a pacemaker.

For example, I have a set of smart scales that do not only measure weight but also body composition by sending a small electric current through the body (that gives a different response for fat vs muscle). It's marked as not pacemaker compatible and I can see why as the current could potentially interfere with the sensing part of a pacemaker.

On the other hand, there are plenty of passive measuring devices such as heart rate monitors, consumer ECGs, etc where it's hard to imagine any actual interaction with the pacemaker. These often state for regulatory/liability reasons that they have not been tested for use with pacemaker, but this simply means that the company didn't think it was worth the investment of performing a study, not that they won't work or might be dangerous to use.

As the ECG curve / electrical profile of a pacemaker triggered heartbeat looks different from a regular one, it's possible that things like HRV measurements, automatic arrythmia detection etc get confused and show the wrong thing, but I cannot see a way in which a device like Kardia would "not work" when it comes to sensing and plotting an ECG curve.

Device “not working” with a PM

by Aintgotrhythm - 2023-08-04 12:34:22

I should perhaps clarify what I meant by "not working with a PM". The device will of course take measurements but the measurements would be meaningless/not useful when you're being paced.

Pre-implant I used the ECG capability on the Apple Watch whenever I wasn't feeling well to see and record what was going on. Now, post-implant, many times when I use it I get "inconclusive result" so the PM is interfering with its ability to take readings.

So although I expect the Kardia would "work", it might not provide useful data if used when you're being paced.

It depends on the use case

by John_Locke - 2023-08-04 13:29:42

For me specifically, I have an intermittent AV block meaning that, for the most part, an ECG will show a normal sinus rythm and will be unaffected by the pacemaker entirely (as the PM doesn't actually do anything other than watch). I can however see when the PM kicks in from the shape of the QRS as this is quite distinct.

You should be able to recognise say afib from the ECG even if being paced in the ventricle.

But yes, automated detection of these things is probably likely to be confused in the presence of (an active) pacemaker.