Hello everyone, although I have replied to other people’s posts, this is the first question I’ve asked for myself. Knowing that many of you use Kardia’s, I’m hoping you can help me to make up my mind over a possible upgrade to the 6L version.
First a bit of background; I was diagnosed with AF in late 2018, confirmed in March 2019 and started on the usual mix of 2.5mg of bisoprolol and warfarin daily. I was also taking amlodipine and allopurinol together with atorvastatin.
At the time of diagnosis, I was totally asymptomatic and have remained so apart from a brief period when my meds were changed to diltiazem and amiodarone and no bisoprolol. I am convinced that the symptoms I experienced were the result of being on 2 different calcium channel blockers based on my more recent experience.
Since diagnosis, I’ve used a Viatom Heartmate to self-monitor and, for those of you who are unfamiliar with this device, it has three contacts on the right for the thumb and first two fingers of the right hand plus a single contact on the left-hand side. It can be used in two ways, firstly using the right-hand contacts and pressing the left-hand contact against the palm of your left hand or holing it against the inside of your left-hand knee. These options are simply described as “Easiest” for the two-handed option and “Clearest” for the hand-knee option.
Ok so here’s the crux of the matter; the Heartmate can diagnose 9 different heart rhythms (including NSR) at least whereas, as I understand it, the Kardia only does 4 unless you pay extra for in-depth analysis. So, the Heartmate seems to have the edge in terms of versatility and economy. I also understand the ease of being able to E-mail a copy of an ECG from a Kardia to your GP, Cardiologist or EP. With the heart mate I download the ECGs to my computer, save them as a PDF and can attach them to an E-mail if needed. Not quite as convenient perhaps but, the above only takes a couple of minutes so the Kardia has a marginal advantage. I have to say though that whenever I’ve supplied any of the above medics with copies of my ECGs, they’ve totally ignored them, and one GP denounced all such devices as “worthless”. For me then, the E-mailing feature is of dubious benefit.
So, why am I considering a change? Well, the Heartmate usually gives a different diagnosis depending on the mode of measurement even when two traces are run immediately after each other. For example, these days I usually see “Irregular Heartbeat” and “QRS too wide” from the hand-to-hand method and “No abnormal Rhythm Detected” from the hand-to-knee measurement and don’t understand why the two diagnoses should be so different.
Also, I was started on Amiodarone in March last year in preparation for my second Cardioversion, w3hich was carried out successfully in October last year. The plan was for me to have an ECG done at my GP’s surgery in February this year and, if all was well, come off the Amiodarone. Unfortunately, it showed that I was in AFib so I’m still on the Amiodarone. Again, I was totally asymptomatic and remain so at the present time. Since October last year, I’ve used the Heartmate once a week on the advice of the ward sister when my cardioversion was done and have not detected AFib despite being able to do so previously. I feel great and cycle up yo 30 miles a week with no apparent ill effects. I was doing up to 50 miles a week last year.
So, does the Kardia 6L offer me any benefits? I’d be really interested in your views on the above.
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Not personally familiar with your device, but based on what you said, I'd definitely get the Kardia 6L. If for some reason, it didn't work for you, they have a 30-day trial, at least in the US. I find mine indispensable.
The fact that the Kardia has fewer determinations should not concern you, especially the way you describe conflicting readings. All these devices, including the Apple Watch, have limitations with the automatic determinations. The important thing is the quality of the ecg and the Kardia's quality is excellent for a single or six lead tracing. Once you have the ecg, you either interpret it yourself if comfortable, email it to your doctor, or pay a fee and have someone at Kardia give an interpretation.
Not sure who these medics are, but Kardia is accepted and respected by most well versed cardiologists and ep's. Also, you might want to try the monthly subscription for at least a couple of months to see if it adds value.
Thanks for that Jim, interesting observations. The medics in question are at my GP surgery in Kettering , cardiologists at Kettering General Hospital an EP at Leicester Royal Infirmary. Unlike them, I am aware of Kardia's approval for the NHS.
Automatic determination usually means an algorithm gives a diagnosis rather than a human. Kardia is pretty accurate though, in my experience, iWatch less so but good enough for monitoring HR.
I don’t think the Apple Watch can determine AF during sleep - my iWatch6 will show heart rate and alerts if it is set which show high HR - mine set to anything over 130 - but you need to hold the crown on the watch to take an ECG which is the only way of determining AF. In which case - Kardia gives a clearer trace and is more versatile.
iWatch will take pulse every 4-5 mins and gives a fair estimation of HR during sleep but it can also show spikes low and high which usually indicate the contact between skin and watch moved so be prepared for the odd spike and ignore those readings unless they are sustained.
By "automatic determinations" I was referring to how the Apple Watch determines, for example, whether you are in afib or not, or just have ectopics, etc. Here, you have to push the crown of the Watch to generate an ecg. That's the function I use most often.
The function you are talking about is a passive function using the led's on the watch that works in the background without you having to do anything. I never have used this function to record my heart rate while sleeping, but apparently they have an app called "Cardiogram" that does what you want. Also, for a fee, they have a premium service with it that gives you some bells and whistles like remote monitoring, if you want someone else to see your heart rate.
It sound exactly like what you want but like all these gadgets you never know how good they really work till you try them. If they have a return policy where you live, that should protect you in case it doesn't work as you expect.
As to other devices, at one point I used my Polar Waist Strap to record my HR at night, but sometimes the strap slipped and stopped recording, plus it didn't have any alarms, if that matters.
There are a whole lot of other devices out there, I'm thinking of Fitbit for one, but really haven't kept up on what each of them does as the list keeps expanding and they keep adding new features.
Thanks Buffafly, I don't know what planet they're on either only that it doesn't seem to be this one! The cardiologists seem to have a marked aversion to talking to their patients are are very much the "do what I say" types who don'[y seem to think you need an explanation of your condition or their treatment recommendations.
My cardioguy also likes my 1 lead Kardia ecg's-it was the determining factor in my definitive afib diagnosis. I also have a FitBit Sense, but the Kardi gives a much cleaner graph. I can also use the Kardia output to "estimate" my QT interval to check for any QT elongation-which fortunately there is not!
Hello I'd like to know how to estimate my QT interval. I'm changing drugs from diltiazem to Sotalol and need an ECG after a week. As I have the Kardia it would be good to know what to look for. Can you help please?
I have the Kardia "one lead" device, so the best I can do is a pretty good "estimate" of the QT-which a real ecg confirms as being pretty close: The Q wave is not visible, but we know it occurs just before the big R wave-so I just estimate where the Q wave should be, and count the number of small squares (you'll probably have to expand the graph on your phone app) forward until the end of the T wave, when the graph returns to baseline. Each small square = 40mseconds, and you'll have a good idea of your QT interval. QTC (the gold standard!) is a function of heart rate and QT interval-go on the internet to find QT to QTC conversion, and if you plug in QT and HR, you'll get a good idea of QTC. I've read that is should be BELOW 440msec, and if over 500msec, could be a precursor to Torsades de Pointe (sp?). Hope this helps-my QTC is generally about 360msec, and I take an antiarrhythmic, so I'm happy!
Many years ago, after being in hospital for almost a week, a cardiologist brought a Kardia to my bed and sang it's praises suggesting I get one as they were so good. I never did, the main reason was it wasn't compatible with my phone at that time. If I was having severe attacks of AF now I would get one, but I'm in constant AF at a low rate of something like 70-90bpm (I rarely check it now) and am happy I didn't buy one. Checking your heart rate with gadgets and making yourself anxious with the results is not a good idea and that's exactly what I would be doing. I do have a cuff heart rate monitor and a stethoscope.
Once I was lying with a calm heart in bed and I thought how good it felt, I wondered what my heart rate was and got out of bed to get my cuff monitor off a chest of drawers which were out of reach. You've guessed it - by the time I got back into bed my heart was thumping madly. Never will I do that again!!
Thanks Jean, I agree with everything you say. One of the reasons why I'm considering a change is that I've just got my first Smartphone - yes, I know all about dinosaurs etc! So the option of using a Kardia wasn't available to me. I do wonder at the value of knowing what's happening with my AFib when I can't do anything about it and it's not causing me any problems or symptoms. I have been caught out by the device I have a couple of times when I've run an ACG feeling on top of the world only to get the diagnosis of "QTc prolongation" which has worried me and depressed me greatly. As an aside, I reported this to my cardiologist who's initial response was that it was due to the two calcium channel blockers that I was taking and it should disappear soon. It didn't, and when I again informed him that I was still seeing it, I got no response at all. I haven't seen it for a while though.
I doo wonder if in my case, ignorance is bliss but reconsider using an ECG device if I ever get symptomatic.
I saw my cardio a couple of days ago and he suggested I get an Apple Watch. ( he said Apple, Samsung & another which I can’t remember) are approved by the NHS. I’ve been having what may be ectopics as lots of normal beats in between runs of faster beats and ‘twiddly’ beats inbetweeen. Like you I said I’d be constantly looking at it and worrying although I can see the benefits of being able to send the report direct to the cardio. I’m still in a quandary as to what to do. He didn’t rate the Kardia one as high as the Apple etc.
No, it won't. What you have will show you as good a trace of heart activity as the Kardia, even though the latter can be used (at £10.00 a go) to get a more detailed explanation. If you were to buy a beginner's guide to ECG analysis, then I think you'd be able to do the same. The PDF facility is neither here nor there. The base model and the 6L are very similar but the latter uses a better connectivity using Bluetooth radio.
You've found a GP who dislikes these, well, in some ways he might have a point. My own GP and cardiologist seem to like them, but the Kardia has twice flagged AF and my cardiologist has assured my it was NSR with multiple ectopics. My Apple Watch hasn't yet got it wrong, interestingly!
The "wide QRS" might be temporary and down to the drugs, or to something like right- or left branch bundle block, I guess. I have LBBB, showing as Wide QRS on many of the Kardia 6L's readings. I think a wide QRS can confound these devices a little, but I am not sure.
Thanks Steve that's very useful information on the Kardia. The wide QRS has been a feature of many of the ECG's I've run since buying the device but I don't know if it also appears on any ECG's run at the hospital, they don't tell me the results of such tests. I do have a left branch bundle block as told to me by the ambulance technician that I had to call out during my short period on two calcium channel blockers. I also have an enlarged left atrium, diagnosed some 3 years ago but no follow up to see if it has shrunk whilst I've been under treatment and have spent significant amounts of time in NSR.
My main concern about my Heartmate is that it gives very different readings with the two methods of measurement whereas I would expect the same from both. There is a temptation to dwell on the Hand-to-knee measurement as it is described as giving the clearest results and usually r3eturns NSR at the present time.
I suspect the use of fingers and thumbs is always going to be a severe compromise when compared with the electrodes of a 12-lead medical machine.
The Kardia 6L uses the ankle (not that easy) or knee (again, not easy wearing trousers). From what I can tell, the “Lead 1” trace is what is used for all “determinations“, “advanced” or not. That’s a limited set of data input from which to analyse heart problems which is why there are severe limits on what it can diagnose (AF, PVC, bradycardia, tachycardia, wide QRS).
I don’t get different readings on Lead 1 whether I use two or three points of contact. Maybe you could post an example for me to look at?
On your traces, I imagine you could yourself determine much of what mattered? The LBBB will be what creates the Wide QRS.
Two ECG's that I ran yesterday, one after the other. Mode 1 is the hand-to-hand and Mode 2 is the hand-to-knee. Mode one is classified as "Irregular heartbeat" and "QRS too wide",
Those are very different - far less well defined and smaller - from my own Kardia and Apple Watch traces, but both clearly show an irregular heartbeat. The definition is poor so it’s hard to find the P wave but there are some that look like AF to me.
I’ll post one when I’m on my laptop rather than from my phone - it’s easier.
Yes, I agree that the image is much better quality but it isn't as clear as my originals. Nethertheless, thanks for your help, it gives me a lot to think about and, maybe, things will be clearer for me after my consultation next Friday and I get a better idea as to why the cardiologists around here have such a low opinion of all such devices.
I think they are perhaps at their most useful for when a mix of arrhythmias exists and when AF is unusual, which is my case. I feel much the same with tachycardia caused by runs of ectopics as I do when it is caused by AF, so differentiating the two is important and it's something my cardiologist is keen on. For people with a single and known arrhythmia, it seems much less useful as it doesn't need a device to tell what is happening.
On the image I posted, I'm not sure what isn't clear, but I think the definition on all the handheld devices will be poor compared to the 12-lead ones.
I was looking at a different one on Amazon yesterday - a Holter device that works for 24-hours by a company called Wellue. It's currently just under £300 which seems a lot, but it seems to work exceptionally well.
Different algorithms, Apple Watch and Kardia. Apple Watch seems to have a higher threshold before it makes an afib call. This can result in fewer mistakes but it can also result in some missed calls. All the auto determinations have limitations and never should be relied on by themselves. It's all in the ecg. This even holds for 12-leads at your doctor's office. A good ep ignores what the machine diagnosis is and goes strictly by the ecg.
Can I add that I brought a Kardia a couple of years ago and I pay for the advanced readings.For months it said atrial fibrillation but after my recent ablation they only found flutter.Not once did the kardia pick up flutter even for a clinical review.Good for atrial or ventricular ectopics tho and normal rythmn.
Kardia is not supposed to report flutter. It will probably need FDA approval and/or an updated algorithm to do that. Flutter will probably be reported as "unclassified". But again, you never want to depend on the automatic determinations alone. What's key are the generated ekg tracings. From that you, or your ep, can make the aflutter determination versus afib, etc.
I was told that atrial flutter is often very hard to determine, especially when there are other events happening alongside such as tachycardia and AF.
In my case, the doctor had to stop my heart briefly to be sure., using an injection of adenosine (I think). To determineSF, the Kardia likely looks for pulse variability and the lack of a P wave (both AF and AFl will stop that wave forming).
The advanced determinations do not include flutter, which will probably be reported as "unclassified". Also, it's very hard to always distinguish flutter from afib based only on a single lead ecg. This is not a limitation of Kardia, it's a limitation of ekg's in general, versus doing an electrologist study in the ep lab during an ablation. In any event, never rely blindly on any automatic determination, Kardia or otherwise, always send the ecg to an ep. I don't think Kardia uses ep's for their clinical reviews, just cardiologists, but I could be wrong here.
Question -- did they end up doing a PVI ablation or did they only do an afib ablation? It's not uncommon that they cannot stimulate afib in during the procedure, but they often do the PVI anyway as long as there is a history of afib. That might be what is going on in your case.
Hi if you are referring to my ablation I was convinced I was in a fib and flutter also ectopics in the atrium.Throw in tacky and you can see I had the full whammy.Flutter was all they abated in the right atrium.Aperently they called my ep halfway through the ablation to ask what to do re a fib.Was so surprised they they didn't do the a fib.Flutter rate is regular and fast .My rate was fast and irregular most of the time.Im mystified.I will ask the ep at my 3 month I guess phone call.Have no date for that yet.Hope I get some sort of notification.
So if I understand you correctly, they did a flutter ablation only, and now the flutter is gone but you have afib? Sometimes they don't do an afib PVI when flutter and afib is present, if they think the flutter is dominant and/or may be triggering the afib. Then if afib remains a burden you don't want to manage, they will do a PVI in a second procedure.
Yes I guess.Wouldnt it have been better if the health person would have told me this but I had nothing just basic discharge notes.Thankyou for your answer .Thank goodness for this forum.
The ablation treatment scenario I outline was only an educated guess by a non professional. You should really contact your medical team and get from them a detailed synopsis of what they actually did during the ablation. And if they propose another ablation, you will also want to know in advance exactly what their plan is.
Jim
I would recommend getting the 6L Kardia. It's approved by the British Heart Foundation and my GP has one which he uses with patients. I regularly send ECGs taken with it to St Barts; on one occasion they advised a visit to A and E based on a reading. I would say that your GP is not up to speed on this issue.The main advantage is that you can take a reading when any sort of suspect event actually occurs and email/show it to a medical professional- by the time you get to see such a professional the event may have passed and won't show on a full 12L ECG which they might carry out. . Using this device I have picked up things like bigeminy and ST segment elevation which would not otherwise have been detected.
Thank you for that, I agree that my medics are not up to speed but it's not only my GP, my consultant cardiologist and his minions together with my EP all are totally uninterested in seeing the traces from my current device. Since that's the case, why would they be interested in an ECG from a Kardia? I do understand that a reading can be taken at any time but, I can do that with my device too and have nowhere to send it too. My device also picked up ST wave elevation once but, there was nothing I could do with it.
I would point out to them that cardiology departments in leading hospitals like St Barts accept Kardia ECGs for evaluation and ask them to explain why they think these departments are in error.
Maybe it’s the device itself that is the problem? My GP was very dismissive of my Kardia recordings but luckily referred me to a cardiologist with a sniffy comment about ‘recordings from a phone app’. My recordings got me an ablation and the promise of a pacemaker if that didn’t work. My EP is highly respected EP at Royal Brompton and Harefield. Where is yours based?
In all due respect to GP's, many GP's cannot read an ekg if they were standing on it, and rely on what their 12-lead generates as a diagnosis. Ep's on the other hand, generally ignore the auto generated diagnosis on the 12 lead and simply read it. One knows what they are doing regarding arrhythmia, the other (the gp) often doesn't have a clue. I have never had an ep be dismissive of any Kardia tracing.
I can understand that GP's are not specialists so can't properly interpret one but that's not to say that they should be dismissive of them. I also found them to be useless when it came to helping me with serious side effects from Bisopralol and warfarin. I got the impression that, as they'd passed me on to a cardiologist they just wanted to wash their hands of me.
My then GP told me straight out she knew nothing about heart problems/ecgs - that took me back a bit as I had hoped she might know the basics as even I can recognise bigeminy when I see it 🤔
I don't think it is the device as they all seem to be dismissive of all patient determined ECG's. I was aware that the Heartmate wasn't officially approved but, at the time I was diagnosed and bought it, I didn't have a smartphone so a Kardia wasn't an option. Now it is.
Hi there and thank you for your post. If you would like any advice or information regarding the AliveCor Kardia Mobile - please visit AF Association heartrhythmalliance.org/afa... or contact our Patient Services team for further advice.
I have the Kardia 1 lead, I took it to show my consultant cardiologist and he was over the moon. He thought it was brilliant and even bought his father in law one. He said the one lead was perfectly fine, so I didn’t bother upgrading it.A GP I saw was so amazed asked if he could video my taking a reading for training purposes.
I had got enough points to get an Apple Watch but ummed and ahhhed about getting one, but did and got benefits from the apps it links with and I really like that, reminders to take my meds etc, if I’m feeling bit off I can check my heart rate and do a reading.
Some say it’s make them feel panic but for me I find it reassuring.
Thank you for that Lacey lady, it's very helpful. The impression I have from all of the replies is that the value of self-monitoring depends entirely on the attitude of the medics treating you. Most appear to be very happy with patients self-monitoring with a Kardia but there are those who don't trust any such device and, unfortunately, I seem to be saddled with a group of those! To my mind the most important thing about self-monitoring is that you can get something done if your monitor shows a problem, I can't so what's the point? I can't get help because my medics don't except the results and will ignore any message I send to them via their departmental secretaries etc. To get a reading that shows a problem can cause a great deal of anxiety if you know that you can't get anything done about it and, as we know, anxiety isn't good for AFib.
The dilemma for me is; do I self monitor knowing that I can't get anything done about a particular result causing me anxiety. Whilst, on the other hand, knowing that the longer I'm free of AFib, the better it is for my heart and the only way I can know this is by self-monitoring due to the fact that I'm totally asymptomatic.
I also have great difficulty in understanding my medics attitude to self administered ECG's whilst they're very happy to accept my results for blood pressure which I check daily.
You gave the right to change drs and second opinions. I’m a Complementary Therapist of 25 years, have anatomy & physiology in some cases lot more than a nurse. I was more clinical Reflexologist and would send patients to drs for a NHS diagnosis, I have been right in many instances. For me, I get irritated if I get a dr who dismisses my concerns, In some cases I can and will argue my point. I monitor myself and decide what to do. I use complementary therapy where it’s ok. I’ll look at ways to help myself. Life style and diet changes, complementary therapy . I don’t like drugs, often vast list of side effects, sadly I have to accept them but will challenge the medication and doses. Luckily we gave private insurance which I use when I have to, I have a good consultant cardiologist whom I can talk to. Diet, hydration, sleep, stress and exercise all help. Get 2nd opinions, You have the right.
Thanks for reminding me of my rights though it isn't as straightforward as it should be. I've been told that I can't change cardiologists unless my GP agrees and requests a different referral from the hospital. Although our GP's surgery has not yet got to barbed wire and machine gun posts to keep[p it's customers away, they've just about done everything else. I've not spoken to or seen my GP for about 6 years or so and she had nothing to do with my diagnosis as AFib in the first place. The original diagnosis was made by a different GP purely by chance. I have been refused an appointment with a Dr by a receptionist on the grounds that my need "wasn't urgent enough". I hope that that gives you some idea of what I have to deal with and why I'm not a fan of the NHS. It's no use looking for a different GP either as none are accepting new patients in this area.
However, I have decided to see what the cardiologist has to say about self monitoring ECG's, I say "the cardiologist" as it might be the consultant to whom I was referred or it might be one of his minions when I speak to them on Friday. Although it was the consultant who spoke to me at my last telephone appointment, that was the first time since I was diagnosed. I've always assumed that he wasn't speaking to me as I made a formal complaint about him after the very first consultation some 3 yrs ago.
I will decide on whether or not to write to my GP, as that seems to be the only way to get through to her, to request a new referral depending on what happens during Friday's conversation
Sorry 😞 do not believe that you cannot change cardiologists ‘without’ the GP’s say so. I had appalling treatment by one consultant and told my GP I was never having him again. (Female condition) my GP was surprised but said that HE didn’t have to put up with his treatment and gave me another. It is this very reason I think they are fobbing you off.
Thank you LL for the two very interesting links, I've book marked them for future reference. On reading them, I can honestly say that many things have happened that appear to be in conflict with the contents of those documents. For example; I was never offered a choice of consultant or hospital when I was first diagnosed. I have never been given the opportunity to discuss my test results or the reasons why a particular drug is being prescribed. The severe side effects that I've suffered from warfarin and bisoprolol have been dismissed with the statement that "the drug doesn't do that" despite it being listed in the leaflet accompanying the drug.
I could go on but I won't and I will definitely take action after my consultation on Friday. Thanks again.
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