Sinus rhythm with supraventricular ectopy.

[richard_jw]

Last December my Kardia mobile saw AFIB when I was sitting on a plane coming back from Egypt. It is not the first time, in fact there have been dozens of times when I have seen it.

I went to the GP and he sent the kardia output to the cardiologist.

Several cardiologists disagreed about the kardia diagnosis, but nevertheless "they" wanted to put me on Warfarin. Warfarin because DOACs are incompatible with taking phenytoin which I do.

Some time later the cardiologists changed their mind and prescribed apixaban (a DOAC).

They initially prescribed Rivaroxaban but changed it to apixaban because after a month of 20mg rivaroxaban I was haveing severe gastric problems. The apixaban was supposed to be better on the digestion. It was not.

So I get 3 hours sleep.

Royal Brompton did a 7 day Holter which showed an average 16% burden of mostly SVEs. increasing to 40% for short intervals, but NO sign of AFIB. The cardiologist changed my meds slightly (from 2.5mg bisoprolol to nebivolol) and is repeating the holter. If it shows afib to be absent he will discontinue the apixaban in the hopes that this will fix my digestive problems and allow me to get a good nights sleep. Then he might contemplate an ablation if the ectopics are still troubling me.

My question is "has anyone else found the Kardia Mobile to diagnose AFIB when there is none present?"

I have to say that this cardiologist is not the first to make such a diagnosis. In fact he is the third in a year. Does this call into question the accuracy of a Kardia diagnosis?

[dedeottie]

Hi. It is very frustrating but if you have paroxysmal AF which many do, you will sometimes be in AF and sometimes in a completely normal rhythm so if the cardiologist has monitored you during a normal period he won’t see anything abnormal. My Kardia is usually accurate but often picks up on short runs of AF that my consultant has classed as insignificant. Hope that helps. X

[Jalia]

Hi Richard. Interesting to read your post as I'm particularly troubled with SVEs as you mention. I've never found my Kardia to diagnose AF when it wasn't present . I've found many P waves missing in my SVE diagnoses though and this was remarked on by hospital medic also.

My GP has just referred me to cardiology and enclosed printouts from my Kardia as my ectopics are unrelenting and very troublesome. I can't take beta blockers.

[richard_jw in reply to Jalia]

Thanks for the post Jalia. I see missing P waves, and one GP who had been on a course (because the local hospital won't interpret these things for her) said the hallmark of AFIB is missing P waves. I thought that in an ECG strip, the main thing was irregularly irregular QRS complexes. It seems that cardiologists can look at an ECG and say immediately if it's AFIB. I assume they look at the distance between the RR intervals as well as the missing P waves. I'm prepared to accept the good cardiologist's diagnosis about what is or is not AFIB.

BTW I don't think Beta Blockers actually do much as antiarrhythmic agents. I think they just slow the heart. I changed from Bisoprolol to Nebivolol recently because it's more selective

I

[Jalia in reply to richard_jw]

Yes betablockers slow the whole body down. Sometimes slowing the rate will allow sinus rhythm to return. I'm already taking an anti arrhythmia drug which is probably why I get a bad reaction with BBs

[Auntielala]

Hi Richard, yes this happened with me, got lots of AFib on Kardia but none on ECG's that I know of. Cardiologist went through Kardia printouts and said he can see short runs of Afib but as they're not sustained we don't need to worry about them yet, but said permanent Afib is probably "on the cards" in the future. I'm on Bisoprolol for SVT and ectopics and getting less Afib readings now.

[GranmaWendy]

that is intresting, my cardiologist only recomended the Kardia in order that we could " catch episodes when having symptoms" because if you are not in AF all the time, of course nothing shows up on your ecg. my Cardio said, rather than drag myself into A&E when I had symptoms, catch a reading on Kardia and email it to her. this seems like the most prudent use of this little devise, which only gives a 2 lead reading

[Electricblu]

Hi Richard, Other respondents have covered paroxysmal AF, which may in part answer your question, so I will just focus on my own experience of the accuracy of Kardia diagnosis. I have absolutely no faith in it whatsoever, including those where I have paid for an interpretation. I have multiple complex arrhythmias - AF, bigeminy, atypical atrial flutter, atrial tachycardia, sinus tachycardia, bradycardia and occasional varying block. The Kardia interpretation for almost all of my arrhythmias (even sinus tachycardia) is 'possible AF' and recently AF has been classed as 'normal sinus rhythm' so as far as I'm concerned it's a bit of a joke. I'm very symptomatic and for me its usage is limited to catching an arrhythmia to show my cardiologist that there are other things present which may not have been caught on a Holter monitor, so in that respect it's useful for recording paroxysmal arrhythmias, but not the diagnosis of what they are. I hope you get sorted - I also had severe gastric problems when taking Apixaban and was changed to Edoxaban which helped. All the best.

[frazeej in reply to Electricblu]

Kardia is admittedly a simple device, 2 lead in my case, that uses algorithms to arrive at a possible afib diagnosis. I think it's a bit much to expect this $79 unit to sort through the very complex issues you have.

[richard_jw in reply to frazeej]

I thought the idea of the device is to detect afib. Either it can or can't. At least my watch says Inconclusive if its not afib or nsr. As I understand it afib is where there is no P wave and there is no pattern in the QRS complexes. That does not seem too much to ask for even in a cheap device

[Electricblu in reply to frazeej]

Hi Frazeej - I don't expect Kardia to sort through my complex issues, far from it, the AI used isn't yet capable of doing so. However, I don't think it's unreasonable to expect it to do what the ads lead us to believe and there is currently a big ad campaign running in the UK . According to Kardia's website 'Kardia can detect Atrial Fibrillation, Bradycardia, and Tachycardia (plus a few more if you upgrade). My rationale is that if it can do so, it should be doing so accurately or giving an unclassified reading and I rarely get unclassified. If I have a sinus tachycardia of 158 I expect to see the result as tachycardia, not possible atrial fibrillation and if I have any other arrhythmia, I do not expect it to be classified as possible atrial fibrillation or normal sinus rhythm - especially not normal sinus rhythm!

I am fortunate in being able to read ECG's so it's not an issue for me. I am able to take myself off to hospital if necessary. My concern is for many others who do not have that ability and are new to this journey and reliant on the accuracy of the report given. I am sure that there are many people for whom the results are accurate, but unfortunately for me that has not been the case.

The cost of a single lead Kardia in the UK purchased direct from Alivecor is £99 ($126 at current exchange rate) and the 6 lead is £149, so significantly more expensive than in the USA, but price aside, profit margins will have been built in to whatever you pay and I think people have every right to expect it to do what it says on the tin. My experience of the USA has been that it is extremely litigious and one day it might come back to bite them. But then even doctors get it wrong don't they 😉

[frazeej in reply to Electricblu]

Hi Electric: I agree with you that Kardia ads are misleading and overpromising, and I think it is not right that their algorithm is such that you would get an incorrect reading (such as "inconclusive") when in an obvious afib episode........as has happened to me when afib HR was too high. Fortunately, as with you, I can read the ecg "between the lines" and see the obvious afib, but "Joe", up the street can't, so he's stuck with an incorrect or otherwise worthless conclusion.

JimF

[browng]

Richard,

I have very similar problems with the Karida advising that I have SVEs while my Apple watch diagnoses AFIB. It was for that reason that I purchased the Wellue monitor getwellue.com/products/hear... which I wear overnight from time to time.

Following an increase in AFIB warnings from the watch I have sent a set of ECGs from the watch and Wellue to my EP. I await his repose which is normally within a couple of weeks. I will update the Forum when I hear from him.

I have also gone back onto Apixaban because of the more regular occurrence of arrythmia. As Bob says you don't want a stroke so minimise the risk by taking NOACs.

Gordon

[Kevin2331]

Hello, there are times when I have some extra/skipped beats and my kardia will show possible afib or unclassified. In February, I had this show up and sent the reading to my cardiologist at Mayo Clinic and he said it was NOT afib. So yes, the kardia can be wrong.

[AussieHeart]

Would your cardiologist consider referring you to a cardiac electrophysiologist (EP) to discuss a non-invasive procedure to insert an ILR (implantable loop recorder) which monitors your heart 24/7. I had intermittent aFIB and symptoms dismissed until the ILR revealed aFIB and the severity of my heart rate. After a couple of months into being monitored it gave my EP detailed information to prescribe right BetaBlockers for me and eventually lead to ablation. The personalised monitoring provided peace of mind.

[richard_jw in reply to AussieHeart]

Thanks for that. In fact the cardiologist actually suggested an ILR ages ago when things were not so bad. Thinking back I think he was really selling a kardia. Less work for him and less cost to the NHS. I went with the kardia. With hindsight I think the kardia has just confused the issue. It has got at least 3 cardiologists disagreeing with each other.Currently I'm paying so within reason I can have what I pay for. Current plan is to run another holter and have the cardiologist look at it and if he says there is no afib to stop the anticoagulation

I will suggest that he considers an ILR in view of your experience with it

[AussieHeart in reply to richard_jw]

Yes the ILR will leave no doubt as to what’s really going on. These 24-48 hour monitors are useless if you suffer intermittent aFIB. I’ve heard of something called a Zio patch as an alternative to ILR but I’d rather be monitored for three years not two to three weeks when it comes to EPs administering powerful drugs such as BBs / considering if ablation an option. My three years is coming to an end and I’m going to ask whether I can be monitored for another three years. That is, instead of removing the ILR insert a new one! I’m that happy with the surveillance