My relation to the flutter is complicated

[Mercurius]

First of all I could not figure out, that this my post will fit to the forum policy? If not, then I ask the admin to delete it.

Shortly my case: I have flutter and I'm the medical adviser of a very small company. The company develops a personal ECG. I never had any clinical symptom and the flutter was found by chance when I tested the device. Of course I vent to my cardiologist friend so I'm under control.

But not my case is important, rather the lessons what I learned.

We developed the device according to the stroke guideline that suggested a cheap comfortable one channel ECG for screening of aFib in risk groups. Basically that device is similar to an implantable loop recorder, but cheap and not requires surgery.

That's great but finally came up that now I became an expert of my case (flutter of veteran athlet), but my case is not so typical (the flutters represents only about 10% of all fibrillation cases and vagally mediated flutters are even more rare). So what I need lot of interaction with aFib patients and expert colleagues what they really need to help the patients.

Therefore everybody (patients and colleagues) is welcomed here for discussion on the topic whether a specific fibrillation problem needs a personal ECG or not?

[Goldfish_]

It sounds like this is a commercial comment as you are looking to develop a product.

Many use the AliveCor which is presumably the market you are aiming at.

[BobD Volunteer]

There is already Alivecor/Kardia which is an i phone compatible device which delivers a one lead ECG capable of showing AF. They also have a diagnostic line which provides expert analysis of traces. In addition there is Cardiocity which is a lap top style hands on machine currently under trial at various GP surgeries throughout UK. Methinks you have missed the bus.

[Buffafly]

Am I right in thinking this device take a continuous recording over hours or days? Also that it shows Flutter as well as Afib? Would it give a diagnosis from the device or would the recording be sent to a professional?

Several people here have expressed a wish to buy a device that records more than 5 minutes at a time and would work overnight for example. But there is no such thing yet so if one could be made I am sure it would be popular. The disadvantage with Alivecor and similar is that you cannot record well unless you are sitting still and have a good contact with the device, as my cardiologist mentioned that anyone with shaky hands can't get a good trace! Even the new Kardia band needs you to actively press on it to record.

More info please!

[Mercurius in reply to Buffafly]

Dear Buffafly,

thank for your questions they really relevant.

Concerning the answers all of them is yes, except the last one, where we will restrict the usage of the device for patients who will get the recording and evaluation from her/his cardiologist. I have a good reason for this. Passively I followed several aFib web forum and I see that patient without expert control may have sever fears and misunderstandings. Therefore the device is connected via bluetooth to an android smartphone where it is displayed on the screen and collected. At the end of the observation it is transmitted actually to our company server under a coded ID, and downloaded and analized. Now it is only model since I'm the only patient and only expert in the company. The controls are my engineer colleagues (all of them healthy).

My story is itself is informative so I summarize it shortly.

When I arrived to the company the engineer team worked on a mobile ECG what they called as improved AliveCore. The improvement was that they replaced the microphone connection with bluetooth connection. This resulted in an improvement in the record quality.

At that phase I added my competencies to the story. I told that we must forget about the stupid tales that mobile ECG will help you to avoid sudden cardiac death or myocardial infarct. One channel ECG is suitable exclusively for arrhythmia detection. The most frequent arrhythmia type is the aFib so we have to focus on the atrial fibrillation. The 30 mp measuring time is clearly not enough, I need at least 20 minutes. The team redesigned the device. Ok but who can sit for 20 minutes with thumbs on the device? We must find out an other way of the connection. I took my belt from my trousers and fitted the device by means of the belt on the chest of my son. It worked and even the record quality is further improved. The team inserted the device into a cyclist chest belt. It worked fine and the quality is further improved.

Somewhere here came up, that unexpectedly I have flutter (I don't have symptoms, so it was really a surprise.) My flutter had a strange characteristics. I like mountain biking. If I had flutter before cycling then after cycling I didn't had. I found two case studies in the literature, with similar experience. OK, the phenomenon exist, but what happened? I need 4 hours recording to understand it. The team redesigned the device and I could record my ECG during cycling. It worked fine, I was able to record my aFib termination.

Having the 4 hours recording option I found new rules. I have PACs as well. Two types: one is easily suppressed by walking up and down, the other one is resistant. The resistant PACs developed from the reversible and aFib always displayed after resistant PAC segments. This observation helped me to prevent or at least postpone the aFib onset.

I not continue with further personal experience. Of course we realized, that overnight monitoring is also important (sleeping disturbances may also lead to aFib). We have extensive analysis of Heart Rate Variance (HRV) etc. All this episodes are really fascinating but most of them is only about me. One lesson was what I learned that it is really different something know or see it day after day. The literature and text books are not enough. That is way I think that patient experiment is important.

Best regards:

Mercurius

[expences in reply to Mercurius]

Interesting.

[Buffafly in reply to Mercurius]

Thank you, fascinating! You are so right about the anxiety caused by trying to interpret your own ECG. My Alivecor was very useful because I was able to demonstrate that I was having 5 second pauses caused by the medication intended to control my flutter but that was pure luck because I was sitting in bed with my Alivecor handy. So it took nearly a year to find this out even though I told my GP I felt my HR was too slow.

When your invention is refined will you be looking for people to test it? And by the way what country are you in?

[Mercurius in reply to Buffafly]

You are right. The second top priority is the monitoring of drug effects. My personal experience was similar to yours. I’m on Cordarone. Basically I don’t have any clinical. symptoms except two occasions when serious dyspnea. We retrieved the records and it came up, that in the first occasion i had normal sinus rhythm but the frequency below 40 bpm and second occasion was flutter on 50 bpm. Clearly it was a drug induced bradycardia so we changed the dose and now everything is OK.

Testing: Yes for the certification we must present clinical tets where we proof, that our device measures equivalent result with a certified device. We are in Hungary, so it is EU and we contacted the TÜV. Likely they will be the notified body which will supervise the tests,

[Buffafly in reply to Mercurius]

Thanks and best wishes!