Wide QRS with sinus rhythm

[kalgs]

My Kardia 6L indicated Wide QRS with sinus rhythm . I send it to Alivecor for analysis and it comes back as normal. I have quite an uncomfortable conversation with Alivecor trying to find out why the device was wrong. After 3 weeks they write to me and say the device was right and the “ expert” who provided the analysis was wrong.

[Hidden]

I guess a lot depends on how you are feeling. If your pulse suggests you are still in sinus rhythm then maybe leave well alone. I suppose the only alternative is to ask your GP for an ECG ………

[Ppiman]

I strongly suspect that the Kardia device will be reporting correctly. A wide QRS is a delay beyond an internationally agreed time limit between the electrical conduction leaving the atria and that arriving at the ventricle. It can be normal and without consequence, or it can be a sign of various heart issues. In my case it's a sign of left branch bundle block, itself of no great consequence, I have been assured, unless my AF worsens when it will be an unhelpful thing to have, so I've been given losartan as a cardio-protective just in case.

Steve

[kalgs in reply to Ppiman]

Thanks for reply. It went for analysis where a qualified person looked at the ECG and said it was normal. I asked why the difference. Often a bad reading can cause a false ecg . My point is that after paying for analysis they got it wrong

[Ppiman in reply to kalgs]

Aha - I misread the final part of your post. Sorry. There is a doctor on this forum who helped design the Kardia device, and still works for them, I believe. I've never used their service, even though I pay monthly for the "advance determinations".

I'm not sure that is worthwhile these days, for myself. From what I understand, the Kardia and the Apple Watch "look for” the presence of the P-wave, the blip from the atrium that occurs just before the large ventricle "R" wave, to confirm AF. I tend to get long runs of ectopic beats more often than AF, and a mild tachycardia more often than both, so I think I'm likely able more to self-diagnose from either the Watch or the Kardia. I started paying early for the advanced determinations, but out of interest and anxiety, mostly, I suppose.

Steve

[kalgs in reply to Ppiman]

They are qualified.

[Ppiman in reply to kalgs]

Well, after I wrote that I thought otherwise. I was thinking when I wrote "medically qualified" that they were not cardiologists.

Steve

[Hidden in reply to Ppiman]

Kardia use a company, ECG On Demand, for analysis, I believe. I recently returned a 72 Holter device too them -they forwarded the result to Barts. Its likely that the Kardia analysis is performed by computer, as is, effectively, an ECG in a hospital.

[Ppiman in reply to Hidden]

That’s good to know. I had my suspicions that the company took things very seriously. I’ve decided to edit my first post!

Steve

[mjames1 in reply to Ppiman]

Like yourself, at this point I trust myself more than Kardia's determinations to interpret my ecg's. When I'm not sure, I will send it to my ep. The only reason I still pay for the monthly fee is because "wide qrs" is part of the advanced determinations. I'm on flecainide so I'm watching out for that and don't feel comfortable yet to make that determination myself. When I do, I'll cancel the monthly fee.

That said, I think the monthly fee is a good idea when you're starting out. But you have to keep in mind that machine interpretations of ecg's are not as good as a trained person. My ep says he doesn't even look at the machine interpretation of a 12-lead ecg, because they are wrong so often.

Jim

[kalgs in reply to mjames1]

They are looked at by a human. It was in the UK because I actually spoke to someone about a year ago at the company who analysis them. However, I think it’s now in the USA which has caused my issues.

[mjames1 in reply to kalgs]

Sorry, having two conversations at once.

Yes, when you pay a fee to Kardia, they are looked at by a human. But that human is probably not an ep. Either a technician or cardiologist, depending on what you pay. I would always defer to an ep with anything complex.

What I was last talking about was the machine readings of Kardia, Apple Watch and the 12-lead in your doctor's office. Here, probably any trained human can do better.

Jim

[Ppiman in reply to mjames1]

Good information there, Jim - thank you! I think if I were given flecainide I’d be wary.

Steve

[Hidden in reply to kalgs]

I frequently get that message on Kardia 6L and 1L, but it also occurs on ECGs at the doctor's surgery. I agree with Ppiman that the Kardia reading is likely to be correct. It is not generally held to be of great consequence however; it just indicates block. You could probably confirm the Kardia reading by counting the small squares on the Kardia ECG- Kardia might be able to show you how to do that.

[Lilylui in reply to Hidden]

when you say a block do you mean like a blocked artery? Would thry not put a stent in? Sorry just trying to work out all these terms

[Ppiman in reply to Lilylui]

Hi Lily. A heart block refers to either a delay in or stoping completely of electrical signal in the heart muscle. It is a confusing term as it has nothing to do with blocked arteries.

Steve

[mjames1]

Even ep's can disagree on a ecg tracing and the best ep's will often admit they they're not sure, especially when it's a single-lead tracing like the Kardia.

And in all due respect to Kardia (have several and love them) their automatic determinations are not always correct and my understanding is that their paid determinations are either from technicians or cardiologists, not ep's.

So my suggestion is to find a good ep and show them the tracing. Depending on your history, they may want you to come in for a 12-lead.

Curious if you're on Flecainide which can cause a widening of the QRS interval?

In my case, I've only gotten one wide QRS reading from my Kardia and my ep confirmed it. At the time I had just increased my dose of Flecainide.

You mentioned you have the 6L. Could be wrong, but my understanding is that Kardia bases all their advanced determinations only on lead 1. Also, if you're not paying a monthly or yearly fee, you will not get the advanced determination feature which will flag certain arrythmia's like Wide QRS.

Jim

[kalgs in reply to mjames1]

Many thanks. I do pay monthly. But your advice is well received. So kind of you to explain .

[LieselS]

uggghhh! 😬

[kalgs in reply to LieselS]

???