In today’s episode I’m joined by my friend Carlo Piscitello to discuss the AppleWatch and atrial fibrillation. Carlo is a process engineer and athlete who was in his normal state of health with no past cardiac history when he was notified by his AppleWatch that he was in atrial fibrillation.
As you know, I am an electrophysiology nurse practitioner. I specialize in cardiac arrhythmia. In my clinical practice I encourage my patients to wear FDA approved ECG capable smart watches for at least 12 hours a day, making sure it is comfortably snug on the wrist, and attenpt to maximize the battery life to avoid lapse in wearability. Smart watches help guide my clinical decisions, make medication adjustments, and expedite care without the patient having to come in or make a follow up appointment that could take months to get in with a provider.
Please note that all links are italicized for easy identification.
Visit Carlo’s podcast here: Fran and Carlo get OCR adjacent
How to take an ECG with the AppleWatch: https://support.apple.com/en-us/120278
In a clinical study using a 12-lead ECG as a reference device, the ECG app demonstrated 99.3% specificity in classifying sinus rhythm and 98.5% sensitivity in classifying AFib for the classifiable results.
Specificity: Those who don't have Afib, don't have Afib on the watch. True negative is high; false positive is low.
Sensitivity: Detects the presence of Afib. Everyone who has Afib is identified as having Afib. True positive is high; false negative is low.
A helpful video explaining sensitivity and specificity:
Apple Watch articles:
Seshadri, D. R., Bittel, B., Browsky, D., Houghtaling, P., Drummond, C. K., Desai, M. Y., & Gillinov, A. M. (2020). Accuracy of Apple watch for detection of atrial fibrillation. Circulation, 141(8), https://doi.org/10.1161/CIRCULATIONAHA.119.044126
Wasserlauf, J., Vogel, K., Whisler, C., Benjamin, E., Helm, R., Steinhaus, D. A., Yousuf, O., & Passman, R. S. (2023). Accuracy of the Apple watch for detection of AF: A multicenter experience. Journal of Cardiovascular Electrophysiology, 34(5). https://doi.org/10.1111/jce.15892
Aortic aneurysm info:
https://my.clevelandclinic.org/health/diseases/16742-aorta-aortic-aneurysm
https://www.cdc.gov/heart-disease/about/aortic-aneurysm.html
Blood pressure parameters:
Normal: Less than 120/less than 80
Elevated: 120-129/ <70-79
Stage I Hypertension (HTN): 130-139/80-89
Stage II HTN: 140-179/90-120
Severe HTN : > 180/ > 120
Blood pressure cuffs I recommend:
Blood pressure monitors:
Pill in pocket is a medication that can be taken as needed. If someone has an episode of atrial fibrillation they can take a medication to help slow the heart rate and/or help convert them back to normal rhythm.
Relationship between sleep apnea and Atrial Fibrillation:
https://www.sciencedirect.com/science/article/pii/S1547527123021811
CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk
Atrial arrhythmia and coffee:
https://www.ucsf.edu/news/2021/07/421086/coffee-doesnt-raise-your-risk-heart-rhythm-problems
Atrial arrhythmia alcohol/coffee:
Energy drinks have been shown in case reports to be the cause of atrial fibrillation.
Levy, S., Santini, L., Capucci, A., Oto, A., Sanotmauro, M., Riganti, C., Raviele, A., & Riccardo, C. (2019). European Cardiac Arrhythmia Society Statement on the cardiovascular events associated with the use or abuse of energy drinks. Journal of Cardiac Electrophysiology, 56. https://doi.org/10.1007/s10840-019-00610-2
LAA and stroke risk:
Atrial arrhythmia and alcohol:
https://www.ucsf.edu/news/2021/08/421341/alcohol-can-cause-immediate-risk-atrial-fibrillation
Holiday Heart:
https://www.ncbi.nlm.nih.gov/books/NBK537185/
Exercise/Atrial fibrillation men vs women
Physical activity in moderation decreases the risk of AF in men and women; however, men should be advised of the potentially increased risk of AF with long-term, high-intensity endurance training.
https://www.washingtonpost.com/wellness/2023/05/17/heart-afib-too-much-exercise/
Findings from a recent study suggest that after controlling for height and/or body size, women without CVD at baseline were at higher risk for AF than men, suggesting that sex differences in body size account for much of the protective association between female sex and AF.
Siddiqi, H. K., Vinayagamoorthy, M., Gencer, B., et al. (2022). Sex difference in atrial fibrillation risk The VITAL rhythm study. JAMA Cardiology, 7(10), doi:10.1001/jamacardio.2022.2825
https://www.cedars-sinai.org/newsroom/sex-differences-and-afib-new-study-flips-conventional-wisdom/
Society Guidelines for the Management of Atrial Fibrillation: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
Electrophysiology study/Catheter ablation:
https://www.ucsfhealth.org/treatments/catheter-ablation
https://my.clevelandclinic.org/health/treatments/17401-pulmonary-vein-isolation-ablation
AppleWatch information:
You can enable notification for high and low heart rate notifications.
*If your heart rate remains above or below a chosen beats per minute (BPM), your Apple Watch can notify you. These notifications are available only on Apple Watch Series 1 or later for ages 13 and up.https://support.apple.com/en-us/HT208931
You can turn on heart rate notifications when you first open the Heart Rate app on your Apple Watch, or at any time later from your iPhone:
* On your iPhone, open the Apple Watch app.
* Tap the My Watch tab, then tap Heart.
* Tap High Heart Rate, then choose a BPM.
* Tap Low Heart Rate, then choose a BPM.
If you have been diagnosed with atrial fibrillation, you have two choices:
* You can turn on irregular rhythm notification (see link provided above), which will notify you every time you may have an irregular rhythm.
* You can turn on Afib History (https://support.apple.com/en-us/HT212214). This will automatically turn off irregular rhythm notification. Every Monday, you will receive an estimate of how much time the previous week that you were in atrial fibrillation. This estimate will NEVER be lower than < 2%. If you have zero AF, you will still receive < 2% afib burden (we know this, and it is expected). You need to wear your watch for at least 12 hours everyday for this to be accurate. You can also track lifestyle factors that may contribute to AF.
If you have NOT been diagnosed with atrial fibrillation, turn on irregular rhythm notifications (see link provided above), which will notify you may have an irregular rhythm.
Do NOT turn on Afib history.
How to take an ECG using your AppleWatch (only available on Series 4 and up-NOT available on AppleWatch SE):
https://support.apple.com/en-us/HT208955
FDA approved ECG capable smart watches: AppleWatch, Withings, Samsung Galaxy, Google Pixel, Garmin and FitBits with ECG capability (Fitbit Sense 2 Watch and Fitbit Charge 5.
Music: Andrew Couch
Produced by Andrew Couch
