Ectopics and AF

[Pommerania78]

I have just bought the Kardia and may soon get a Smart Watch, but in the meantime with just a cuff BP machine, how does one tell the differerence between an AF arrythmia and an Ectopic? Yesterday (after having taken Flecinaide twenty minutes prior) my cuff machine said I had a brief arrythmia that went away after a minute then came back a few minutes later and then went away in a minute or so. Now, was that perhaps an Ectopic? The cuff machine only says that it is an arrythmia. It does not tell what kind. Thanks.

[AAJJTt]

Hi, I don’t think there is an easy answer to that, the presentation of symptoms vary widely between individuals. For me, it was a bit of trial & error to work out what was going on, using a combination of self awareness and technology (Kardiamobile). I really rate my Kardia but I do try not to fixate too much on the data & devices. It can become obsessive, and often breeds anxiety.

I have usually found the determination of Kardiamobile (I have a 6L) to be accurate where Afib is concerned. That said, my episodes have had very distinct symptoms too - high, irregular HR with RVR causing the familiar chest flutterings and trembling; no other symptoms; usually last for a couple of hours before spontaneously reverting to NSR. I really don’t need a Kardia reading to know I am having an episode.

With a bit of research about ECGs, it is possible to identify an ectopic on the Kardia trace. If there are a number of them too within a 30 sec trace, the device might determine a false positive - possible Afib or an unclassified determination. I can also recognise an ectopic myself when they occur. It feels like a skip or missed beat with a thud and then a sudden increase in rate (a few beats) as my heart catches up. This only occurs now if I am in a ‘sensitive state’ and, a lot of the time I am not aware of them (thankfully). It feels different to Afib, so I can distinguish between them.

I haven’t had an Afib episode for a number of years now. However, I still use the Kardiamobile occasionally as control, just to check, especially if I feel any different.

Sorry, there is not a simple answer.

[Myflowers2 in reply to AAJJTt]

What do you do if the Kardiomobile shows you are in Afib ?

[AAJJTt in reply to Myflowers2]

Hi, I am on a daily dose of Flecainide with an additional PiP plan in place, agreed with my cardiologist. If I determine I’m having a sustained episode, which is ‘easy’ for me to do, then I follow the plan. Basically take an extra 100mg of Flecainide and 2.5mg of Bisoprolol to try and nudge me back into NSR. My Afib has a ‘vagal tone’ and previously has occurred late night/early morning, so use the PiP, and if I’ve not reverted by ‘the morning’ then present at A&E. In the past 3.5 years since my last episode and the introduction of the PiP, I’ve never had to take the extra medication.

This has actually changed today too, after my latest review. Since I’ve been stable for while, the next course of action is to try to wean me off the Flecainide to see if I can maintain NSR without it. The PiP being extended as well, and I can take upto 300mg of Flecainide, in total.

[Pommerania78 in reply to AAJJTt]

Thanks for your comments.

[wilsond]

I think I'd put away your equipment. It's easy to get obsessed/ too focused on readings. The anxiety we may cause ourselves adds to the party. From experience!We cannot really determine the interpretation of the readings ourselves.

Useful for compiling feedback to EPs,Cardiologist etc

Try to limit use. Its easy to ,at first,become fixed on 'fixing' AF once and for all. X

[bean_counter27 in reply to wilsond]

We're all different though...... I have PAF and want to know frequency and duration of AF episodes so I can try and identify triggers and to let my cardiologist know what's been happening since the last time I saw him (which he wants to know). So I use the technology (Kardia 6L, Withings Scanwatch or Wellue ECG Recorder with AI Analysis) to monitor my condition and aid in informed decision-making. I can understand why some wouldn't want to be focused on it like I am but I suspect there are others like me who want to know what's happening to them.

[OzJames]

I only have the Apple Watch which will alert me if I am in AF. In the past I’ve known when I am in AF so just have the watch for confirmation. I set the HR alert at 140 as another form of alert but again I’ve exercised my entire life and am very aware of anything unusual. Otherwise I don’t look at it as it can lead to anxiety which isn’t great for AF people. At first I was using BP machine studying the watch, doing ECG’s etc.. and it was making me more anxious. I am so much better since I stopped looking at machines!

[BenHall1]

I have some diagnostic stuff but don't rate them very highly. I have a BP monitor, ( which I rate highly ) approved by NICE which tells me BP, HR and an icon pops up if I'm in AF. It will then be recorded on the appropriate cell phone APP for that device I'm using. I certainly wouldn't bother with smart watches. Not every BP monitor that records this sort of data is approved by NICE.

[bean_counter27 in reply to BenHall1]

Where do I find the list of NICE approved devices? Which BPM do you have? Does it specifically identify AFIB or just arrythmia? Thanks

[BenHall1 in reply to bean_counter27]

The NICE website would be a good start. Omron Evolve Wireless Upper Arm BPM. TBH, I can't remember, haven't used it for ages ( 18 months to 4 years since my last AF event ) It works by wireless sending a reading to an App on my smartphone. I am sure it does, also records a false reading like if you move your arm when taking your BP. So at the moment if I took my BP now, it would just give a reading with no icon indicating anything, because my BP is in normal range. It would then show up on my smartphone. This particular model above suits my personal needs best.

Omron produce a wide range of BPM's best to research their website.

NICE = ( nice.org.uk ).

[bean_counter27 in reply to BenHall1]

Yes, I looked on NICE website but could only find referral to British and Irish Hypertension Society website for their list of validated monitors rather than a list of NICE approved devices. Do you have a link? Thanks

[BenHall1 in reply to bean_counter27]

I have checked myself and the website has totally changed since I referred to it a bit over 3 years ago and I just can't see the reference material I used in the first place. I'm afraid its going to be a case of trawling the internet for BP monitors for use in UK.

The one I use mostly ( because it is so easy to carry around ) is the Omron Evolve Intelli Sense and it transfers data to an App on my ( now aging ) smartphone where data is stored.

Sorry about that, but TBH I hardly recognised the 'new' NICE website when I got into it. I would search any recommendations on NHS or BHF websites for types. I have also used Microlife BP monitors in the past.

[bean_counter27 in reply to BenHall1]

No problems. Thanks for your help anyway. In the process I found the Omron HEM 7361T BP monitor which is validated by British and Irish Hypertension Society and can detect AFIB rather than just arrythmia.

[Pommerania78 in reply to BenHall1]

What is NICE? Thanks.

[BenHall1]

NICE = ( nice.org.uk ) which is National Institute for Health and Care Excellence.

[Pommerania78 in reply to BenHall1]

Thanks.

[Ppiman]

Except for a very few at the top of their manufacturer's ranges, a BP monitor only looks for and detects basic rhythm abnormalities, which could be atrial flutter, fibrillation or ectopic beats (most likely this). There are a few other arrhythmias that can cause this, too.

Most convenient are the home ECG devices such as a smart watch (e.g. the excellent Apple Watch), a Kardia or, my preference, a Wellue AI ECG, to diagnose arrhythmias more precisely.

Steve

[Pommerania78 in reply to Ppiman]

Thanks

[bean_counter27 in reply to Ppiman]

The Omron HEM 7361T is a blood pressure monitor which can specifically identify AFIB when checking BP. It has also been validated by British and Irish Hypertension Society for taking BP at home - so it should be reasonably accurate for BP.

[Ppiman in reply to bean_counter27]

I haven't tried that one, only the similar Withings device (I review BP machines for a company). It looks to be an excellent machine, although unless they have come up with something new, BP can never be measured accurately when AF is happening. I really like my trusty Omron Evolv but I'm less happy that, like Kardia, the company is also finding ways to extract a monthly fee from users!

When I tested it, I found the Withings monitor a bit clumsy to use and I felt it was trying to be two things and not doing it too well. I really like my two Wellue devices with their AI readings and one having the potential for up to 24-hours of readings. Kardia 6L is an excellent and convenient device, too, but falls short in the length of time it can measure and the need for £10.00/month payment for any arrhythmia other than ectopics and AF, essentially.

Steve

[bean_counter27 in reply to Ppiman]

I think you are correct re unreliability of BP machines when in AF. I therefore presume it is just to detect AF when taking BP - so (a) you know you're in AF and (b) if in AF, know the BP result is questionable.

I have a range of Withings devices (BP Connect, Scanwatch and scales), which all record and automatically transfer to an app in my phone (HR, ECG, steps, SpO2, sleep data, breathing disturbances, weight). I use Scanwatch for ECG/AF detection when my Kardia 6L isn't close by e.g. when out and about or in bed. I recently bought the Wellue ECG Recorder with AI Analysis to do 24 hour recordings. Still early days but the Wellue seems to be fairly impressive but I'll see what what cardiologist thinks when I see him in a few months for my annual checkup. The Wellue requires a bit more effort but might detect whether I am having "silent" AF episodes or episodes while I am sleeping. Up until now I only do ECG on Scanwatch or Kardia if I suspect I am having an episode.

The Omron HEM 7361T is of interest even though I have the Withings BP Connect. I like to periodically double-check BP with another device to ensure reliable results. Having one with AF detection might alert me to a "silent" event but is probably overkill.

Yes, I like technology - in part because I want to know what's happening so I can better manage my AF and to be able to accurately communicate my condition to my cardiologist, who I currently only see once a year. Before I got any of the above, I'd use my wife's BP monitor (has arrythmia detection and sound for HR) to take readings and write results in a book. Quite labour intensive and crude for monitoring possible AF events compared to what I have now.

[Ppiman in reply to bean_counter27]

You sound rather like me. I enjoy technology and see these devices as helpful. I think for a very few users, they might induce unnecessary anxiety but not for most. I feel that knowledge is always better than ignorance or mythology.

The reason I bought the two Wellue AI devices (I have the smaller Wellue AI device, too, which is very similar to the Kardia) is because I have a "wide QRS" caused by a left bundle branch block which caused my Kardia to return "unclassified" frustratingly often. I also get regular ectopic beats and do like the way the Wellue reports on these.

I suspect that for many people who have only AF as their arrhythmia, any device (or none at all) would be fine.

Steve