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Kardia Report

Hi, may I ask a question regarding a Kardia report? I have previously been diagnosed with SVT and given Bisoprolol, which I have only used as PIP. I do get ectopics, but the last year or so they have felt worse. I bought a Kardia last week and most of the ecg's have been unclassified, but as each time my bpm was over 100 so I assumed it was because of the tachy. None of the ecg's have said possible AF. This morning's ECG was unclassified, over 100 bpm, but looked very erratic, so I sent it off for a paid report. The result came back this afternoon saying Tachycardia, Atrial Fibrillation. So my question is, could the report be wrong? I am going to take my print outs to the GP next week, but hoping some of you good experienced folk here can advise? Does this mean I have AF, or could it be a mistake?

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Your GP should be able to tell from the readings whether AF had been recorded and take it from there. The evidence is there for him if you are in AF ! I have always found my Kardia very reliable.

Sandra

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Thanks Sandra, I keep telling myself they've made a mistake - even though the reason I took the reading in the first place was because I could feel the hob nailed boots dancing in my chest and felt a bit off, and I could see the graph was all over the place. It confused me because I thought if it was AF the result would have said "Possible AF", but it said Unclassified and then the paid for result said AF. Looking forward to the GP hopefully being able to straighten this out for me. Thank you for taking the trouble to reply.

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Hello Auntie :-) as I understand it 'unclassified ' does not rule out AF, it could still be AF it is just that the recording didn't achieve a definitive result for some reason as described here....

alivecor.zendesk.com/hc/en-...

I have never paid for a report but would assume they are accurate.

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Thank you so much for the link.

I think maybe I have confused them - I know I've confused myself for sure ☺

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Hello Auntielala, as Yatsura suggests, Kardia’s are generally accurate but obviously they are not as effective as the conventional ECG. It’s my understanding that many GP’s are not qualified to read normal 12 lead ECG’s and if that’s the case, I suspect many may not be familiar with the Kardia monitor, let alone the readings. Clearly there is some conflict between what the machine is telling you and what has come back in the report you have purchased and I suspect that is because of the high pulse rate and the ectopics possibly confusing things. Of course, take the Kardia with you when you see your GP, but I suspect he may want you to have a 12 lead ECG. In the meantime, try feeling your pulse, if it’s fast but regular, it’s unlikely you have AF. Rapid (or slow) and totally irregular then I’m afraid it is more likely to be AF. As I’m sure you know, if it’s regular, but contains occasional missed or additional beats, then they are ectopics and you do not have AF.

If I were you, I would lock the Kardia in the shed and give Unclelala the key, but maybe try it again the day before you see your GP. They are a bit like blood pressure monitors, it’s so easy for them to become obsessive which often is unhelpful......I know, because I’ve been there and the suggestion about hiding stuff in the shed was given to me once by one of the volunteers who will remain nameless, but we call him Beancounter!

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Lol, I will definitely be calling hubby Unclelala from now on, why haven't I thought of that before? The pulse when I took the reading was irregular and fast, I don't think I felt any missed beats, which I normally recognise fairly easily, and the report said no ectopics, but did say atrial fibrillation. I will be showing the report to my GP, who I think will likely refer me back to the cardiologist. It's just that I'm new to Kardia, and it might be wishful thinking, but I keep hoping it's a mistake. Thanks very much for your reply - and for the new name for hubby :)

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Actually ( no offence Flapjack!😁)....i would take a reading on your Kardia whenever you feel something unusual until you get this sorted out. After all this is why you bought the device. You will be reassured if AF does not show up but if it does you have more evidence for the medics.

I think most of us are over enthusiastic when we first get our Kardia..i know it was my new toy! I find it invaluable and very reassuring.

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Thanks Sandra :) You are all so helpful and lovely here, it's much appreciated!

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None taken......😀

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I have found Kardia analysis reports to be accurate and the apparent difference in the Kardia reading and the analysis is depth of accuracy. When your unclassified reading was examined in more depth, runs of AF were identified - hence the double diagnosis of tachycardia (probably SVT and regular beat?) and AF breaking in with its irregular rhythm.

I’ve had a few reports back from an unclassified reading - one of them containing NSR, tachycardia, single atrial ectopics, multiple atrial ectopics and a single ventricular ectopic, all in one trace (but no AF!!) Quite a mess.

If I feel well enough, I file the printout and show my cardiologist only the interesting ones.

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Wow, that's a lot going on for you there Finvola! All in one trace too. Thank you so much for your reply, it has certainly helped me to make a bit more sense of it. I hope you feel well at the moment :)

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Should have said it was a 3 minute trace, which I do with short runs of anything suspicious and I felt awful. Thanks, now feel great - my cardio thought that particular series of arrhythmias was caused by a virus.

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Glad to hear you feel better now :)

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Hi Auntie

Be careful you don't become obsessed with the Kardia; many people do 😏.

It takes a trained eye to decipher an ECG and the algorithms built into the Kardia are quite limited. My cardiologist is happy to look at my Kardia graphs but he wouldn't take a second look at the automatic diagnosis. It's rather like my Fitbit telling me I have excellent cardio fitness for a man of my age. If I had I wouldn't be in this forum 🤣

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Thanks Ian , I know what you mean ;) This is a lovely forum, so many nice people being so helpful and friendly, when you all have problems of your own to deal with. Makes me feel better already ☺. If it does turn out that I do have AF I shall look forward to being a "regular" here and hopefully I will be able to give something back in turn ☺

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Actually I don't have AF; I have another arrhythmia. They haven't thrown me out yet though 🤗

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😀 Aww, I'm sure they wouldn't do that 😀 Keep well!

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nor would we Ian.

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Hi Auntie

The Kardia is taking a ‘lead 1’ reading which is like having 3electrodes places around the heart. A 12 lead reading gives a much more detailed report of the heart from various configurations of the electrodes. I have found the diagnostic reports of the Kardia to be somewhat inconsistent especially with ectopics which it often called normal on mine. However when seen by a trained eye (although I’m a nurse, ecg is not my speciality) the readout is invaluable in giving the cardiologist a record of your events.

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Hi Jes, yes I took a reading this morning and was pleased to see normal although I did feel a couple of ectopics. I believe that the paid for report does say if there are ectopics, although my paid report said af but no ectopics. Thank you so much for the info :)

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Did you do the $10 or $20 paid report? The first is read by a Kardia technician and the second by a board certified cardiologist.

Yes, there is always a chance that they read it wrong but unlikely that a board certified cardiologist read it wrong. In any event, you do want to take it to your doctor to confirm but not your GP. Even cardiologists make mistakes reading ECGs, especially single lead ECGs like the Kardia. You want it to be read by an EP. If Kardia's board certified cardioloigst said it was afib and your GP said it wasn't, I would go with Kardia. On the other hand, if an EP said it wasn't afib, then I would go with the EP. And yes, if your HR is over 100, most of the time you will get "unclassified".

Lastly, I would not lock it up in a drawer as has been suggested, but continue to take ECGs at appropriate times and either email them or save them for your EP. That doesn't mean you have to compulsively take ECGs but the more data points the better. When I was having SVT attacks some days I took a half dozen ECGs or more. Lately, things have calmed down and I haven't taken a Kardia ECG in a week.

Jim

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Just want to make a general statement about Kardia.

The ECG's it generates are excellent and one EP told me they are of better quality than the event monitors they send patients home with to wear.

That said, the automatic algorithm isn't perfect although when it says "normal sinus rhythm" chances are excellent you are not in afib. That can be very reassuring.

I also found when it says "possible afib" that is also very accurate but not 100%. Any reading of "possible afib" should be sent ideally to an EP, not to most cardiologists and almost never to a GP.

Sending it to Kardia's cardiologist (the $20 service) is another option, but again not a good as an EP, but very useful like over the weekend, when you don't want to wait for your EP, or for a second opinion.

So even though Kardia's automatic reads aren't perfect, the ECG it generates are of professional quality that a good EP can read. That said, as has been pointed out, Kardia is a single lead ECG (usually lead 1) and has that limitation, so for example some of the finer distinctions (flutter vs SVT (AVNRT) might be hard to distinguish and the diagnosis may then have to be made by context.

On the other hand, unlike a 12 lead ECG, you can take the Kardia ECG any time you want, not being confined to the sixty second window at your doctor's office.

Jim

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Thank you so much for the info Jim, that is so helpful. Here in the UK there is one option offered for clinician review, which is £5.00 for a report from a qualified cardiac physiologist. I don't know how my GP is on reading ECG's, but I'm confident that he will refer me to a cardiologist, as he did 5 years ago after feeling my pulse manually in his surgery, and I was subsequently diagnosed with SVT, although back then no afib detected, just runs of ectopics and tachycardia.

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I'd like to add to that comment @mjames1 - its a while since I looked this stuff up but it is my understanding that the Kardia has two "recognisers" - one for NSR and one for AF. If the ECG is not recognised as one of these two the result will be "unclassified". The recogniser algorithms are regarded as quite accurate and I believe are approved by the FDA. I believe the threshold for approval is quite high and these algorithms are considerably more sophisticated than what you will see in most fitness HRMs for instance.

It is important to understand that these algorithms have been deliberately defined in a certain way to prevent them being relied on in situations where their results may be questionable. The precautionary principle I guess. So, for instance, a HR of less than 50 or greater than 100 will always unconditionally generate a result of "unclassified" - that is, the result of the algorithm is trumped by the conditions being outside of the range of circumstance the company and the regulators are comfortable with the device providing a result for. I suspect the NSR and AF recognisers work perfectly adequately below 50 and above 100 BPM but the regulators have insisted that the result always be presented as "unclassified" in these two cases. There may be other things that trump the two recognisers but I have not ever seen anything documented along these lines.

The device will also return "unclassified" if the NSR and AF recognisers have not reached their threshold of confidence. This will be the case, for instance, if there are more than a certain number of ectopic beats that reduce certainty for a NSR or AF call, or if the ECG has a form that raises difficulties - in my case I have a bit of LBBB which means that even when my HR is between 50 and 100 BPM I get an "unclassified" result even when I can see from the ECG that I'm in normal rhythm or AF.

I imagine that the company would be perfectly capable of adding recognisers or extending the range of conditions under which the current recognisers would offer a result but this is a question of how fast the medical profession and regulators are willing to move rather than a limitation on what the technology could do.

As you say, the ECGs themselves are of good quality for a single lead device and I have found them a great help when presenting at A&E when I had an attack and even more so when my partner developed AF and we were able to present a clear trace to the triage nurse.

So in @Auntielala 's case you will always get "unclassified" when the HR is more than 100 and you should not take this to suggest either NSR or AF - only by having a professional look at the ECG trace (or, perhaps, by looking at it yourself if you spend a bit of time developing your own skills) will you be able to tell.

"Unclassified" doesn't only mean "don't know" - it can also mean "not telling".

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Good luck and let us know what happens.

JIM

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Thanks Jim, all the very best to you too ☺

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My personal view on kardia:

If you are not formally diagnised with AFib dont rely on kardia to diagnose it for the first time

Go to yourgp/ cardiologist make sure they do aproper ECG and holter monitor

Dont get panic about kardia report. While it is very good but i find quite sensitive to external stimuli around

Good luck

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Thank you falah, I have wondered about interference. All the best to you too ☺

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All above comments are valuable, just another on Kardia, I note a recent news report that the NHS are investing in it by purchasing bulk supplies unless of course that is fake news! whether it is replace existing equipment I know not.

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That is interesting, yes you have to wonder if it's for real. I read the NICE report and they are keen on it, it seems it saves money and I have read somewhere that some doctors are getting them in to lend to patients.

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With an irregular rhythm over 100 bpm it may be difficult for a machine or GP or EP cardiologist to say for sure what the rhythm is. It could be fast sinus rhythm (sinus tachycardia) with frequent ectopic beats, multifocal atrial tachycardia, atrial flutter with variable block or AF.

As Jes59 says the Kardia, as usually held, just records "lead I" of the ECG, which is not the best for seeing P-waves, which are one of the main clues to what is going on in the heart. "Lead II" is usually better and you can record this by holding one pad in your right hand and resting the other on your left knee.

The other thing which may help diagnose the rhythm is a longer recording, as Finvola did. You can choose the duration of the recording under "settings"

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Thank you for the advice Jonathan, that's very helpful. My 7 day cardiomemo 5 years ago showed only sinus tachycardia/multiple SVE's and echo was normal so hopefully maybe that is still the case now.

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