I saw my cardiologist yesterday and we have agree although no AF yet (maybe A flutter) on 24hr ECG getting a watch and maybe a kardia is a good idea.
I am planning to buy the watch and the local apple shop ( Edinburgh UK) and wanted to ask a few questions before hand.
Ive read some on what the watch will and wont do, it seems it will check for AF every so often but wont notify during AF but notify later, is that correct, surely what is needed is to notify during AF?
I note it wont notify premature ventricular contractions PVC or others such as A flutter but those can be seen on the ECG I can take, is that correct.?
As I am not on meds the plan is to go with pill (beta blocker) in pocket approach. My plan is to try and set the phone to alert AF but also to display BPB all the time and set some alarm if beats go over say 120 , I have seen 150 on oximeter during attacks and rarely goes over 120 on exercise. The plan then is to do a ECG when alarmed?. I dont know if I need to set a lower reading , with the premature ventriclar contaractions it can go down to 28bpm on the oximeter but thats not real , the real bpm on a ecg is around 62 when oximeter was say 30.
I assume the watch needs to be a tight fit hence wonder which is the best strap, I see they come plastic or some kind of canvas material, I wonder which gives best fit? I see the watches are different sizes, is big or small better.?
Being a techno phobe I plan to ask the person in the apple shop to set it up for me, Any views on what settings I should request in view of the above or any advice would be most welcome.
Lastly, if the watch does ECG is thee any benefit to also having a Kardia !? or 6? lead as presumably I can view ECG on watch and save and send the ECG to the doc via my iphone 11? . Or is the Kardia more accurate for ECG and give more info on the report?, although I read on here its not always accurate.?
Thank you to everyone who replied to my other two posts, I plan to reply to them this pm.
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ainslie
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I saw my cardiologist yesterday and we have agree although no AF yet (maybe A flutter) on 24hr ECG getting a watch and maybe a kardia is a good idea.
I have both and they can be complimentary. If you get the Kardia, get the Kardia 6L.
I am planning to buy the watch and the local apple shop ( Edinburgh UK) and wanted to ask a few questions before hand.
Remember, your watch will need charging and during charging, you will not get any monitoring or feedback. If your budget allows, get the Ultra 2. Can run for days and charges in a few hours. Also big screen.
Ive read some on what the watch will and wont do, it seems it will check for AF every so often but wont notify during AF but notify later, is that correct, surely what is needed is to notify during AF?
Correct. Checks occasionally for afib with no real time notifications. I haven't found any device with real time afib notifications other than some advanced Holter devices that notify your doctor,not that they are monitoring their screens 24/7 lol
I note it wont notify premature ventricular contractions PVC or others such as A flutter but those can be seen on the ECG I can take, is that correct.?
Correct. Won't analyze those arrhythmia's, but they would be in the ekg that your doctor can analyze or with time, you can maybe analyze. Kardia, on the other hand, will analyze more arrythmia's with the paid monthly Premium Plan, but not aflutter. But again, everything is in the ekg. Note that all of Kardia's (and Apple Watch's ) analysis is imperfect compared to a trained ep.
As I am not on meds the plan is to go with pill (beta blocker) in pocket approach. My plan is to try and set the phone to alert AF but also to display BPB all the time and set some alarm if beats go over say 120 ,
Are you symptomatic or asymptomatic when you go into afib. In my case, I always know when I go into afib or aflutter and then look at the Watch or take a Kardia to confirm which. If you're asymptomatic, then more difficult.
Watch will not alert real time to afib, nor are high heart rate notifications real time. In order to get a high heart rate notification, you have to be inactive for ten minutes and then only get notified if your heart stays high for another ten minutes. So you can miss shorter episodes. Also, in order to get high heart rate notifications, you have to turn off "afib history". You have to choose one or the other. I know it sounds confusing and it is and documentation is spotty. So don't obsess over it. Just get the Watch and/or Kardia and know that you will have more information than before but no way to get the 24/7 monitoring that you can get from a 7 or 14 day ekg patch. However, the Patch will not notify you either, only your doctor and not necessarily in real time.
In order to display heart rate all the time, you either have to run the workout app or the Cardiogram App. Both take battery power which is another reason to get the Ultra
I assume the watch needs to be a tight fit hence wonder which is the best strap, I see they come plastic or some kind of canvas material, I wonder which gives best fit? I see the watches are different sizes, is big or small better.?
Best to try them on in the store and see what fits well and feels comfortable. Lots of selections. Again, the Ultra 2 is the biggest and easiest to read but the functions are the same as with the smaller watches.
Being a techno phobe I plan to ask the person in the apple shop to set it up for me, Any views on what settings I should request in view of the above or any advice would be most welcome.
I would wait till you get home before fiddling to much with the settings at the store.
Lastly, if the watch does ECG is thee any benefit to also having a Kardia !? or 6? lead as presumably I can view ECG on watch and save and send the ECG to the doc via my iphone 11? . Or is the Kardia more accurate for ECG and give more info on the report?, although I read on here its not always accurate.?
Kardia 6L gives more information because it is a six lead not a single lead. I have both the 6L and Watch and find them both useful and complementary. The term "accurate" is often misused. People tend to say that the Kardia (or Watch) is inaccurate when for example it says you're in afib, but it turns out that it was just a run of PACs. What was inaccurate was the device's interpretation, not the ekg itself. If you know how to read the ekg, or if you send it to your ep, you will get an accurate determination with both. Keep in mind that even the automatic algorithm on your doctor's 12 lead ekg machine is also "inaccurate" in that sense and that's why a good ep ignores them.
Thanks very much for taking time to write detailed replies, when my heart is going at 150 I can really feel it and maybe hear it so I suppose the value of the watch for me is likely that I can check the heart rate and do a ecg, its a pity it doesnt alert to AF. Ive seen one on you tube where it displays a clock as in time of day and in the bottom it has bpm, that would work for me.
When you say it gobbles battery in Workout ap or Cardiogram ap, any idea how fast it gobbles, I think its poor it only lasts a day in normal mode considering what it costs, I am not sure I am comfortable with the Ultra 2 cost at this stage, Im not really in to gadgets although I cant live without my ipad :-), I might be come a fan of apple watches though.
My old Watch never lasted a day, esp when using workout mode. My Ultra 2 lasts 2-3 days, but I find that if I charge it each day for about an hour, that's all it needs. So I have 23 hour coverage if I want it.
PAC is premature atrial contraction, often called ectopic beats. We all have them but if too many, the Kardia can mistake them for afib.
If you feel the episode, with Apple Watch, push the crown and take an ekg. With Kardia, open the app and put your fingers on device and take an ekg. Optionally with the Kardia 6L, you can take a six lead ekg as well a single lead. For the six lead, you use two fingers and either knee or ankle. For the single lead, just two fingers.
on the Apple site it offers Series 9 starting at £400 and the ultra at £800, I note we only need series 4 and up to get the ECG, the series 4 is offered by others but not apple , seems its ios 9 as opposed to ios 10?, Series 4 is less than half price it seems of series 9, is it wise buying a older model or better to splash the cash on series 9 or at a stretch the ultra,when I had my old iphone I think it became obsolete because they couldnt update the ios or something, maybe false economy.
Problem with Series 4 is that it may stop getting updates in the next couple of years which will render it obsolete, not to mention IOS version issues. As far as Series 9 vs Ultra 2, I had the same reservations regarding price, but decided to try the Ultra 2, cellular version, with Apple's no-risk 30 day return policy, or whatever they offered. But I warn you, once you get the Ultra 2 on your wrist for a wee or so, you will never take it off! I just love the big screen, added durability for sports and water and amazing battery life. That said, I also loved my previous Watch, so if the Ultra 2 didn't exist, I would still be happy. BTW the Ultra and Ultra 2 are two different Watches with the Ultra 2 the latest. Not sure of the differences, but they seem similar.
Two quick points. You can get the cellular version for a little more, but you don't have to register for the cellular service to save you the monthly. But it's then there in the Watch, should you want to activate cellular in the future for some reason. Also, if you get the Ultra or Ultra 2, get the fast charger versus the conventional charger. They may even have a fast charger for the 9, not sure.
Hi ainslie. Jim is right. I’ve had the same experience. My Watch and Kardia misinterpret PAC doublets regularly. Knowing how to read your own tracing is helpful. It avoids getting alarmed when the device says AFIB and you can look at the tracing and see one or two widely spaced PAC doublets, which everyone has—“My heart skipped a beat “—and are not dangerous in terms of stoke or heart attack.
I didnt know that it could report AFIB when its not afib? , now thats important , I need to learn how to read the ECG's , who needs to be told its afib when its not, is that defo corrrect ie it can report afib when its not. How would you know it wasnt afib if you got the report later saying it was and you hadnt done a ecg to see it wasnt? Stress!
Not really, but since none of these devices are 100% accurate, at least in the beginning you would want to email the ekg to your ep for confirmation. But down the road, you will probably sooner than later learn what is afib and what isn't.
With the Kardia, if you subscribe to their paid premium service, you can actually have a cardiologist review your EKG for a reasonable fee in a matter of hours which can add peace of mind. I used this service several times for the first month I had the Kardia until I more or less figured out what was what.
Quite useful in the middle of the night. or on weekends where you cannot contact your cardiologist and are looking for an immediate answer.
And frankly, if you know when you're having an episode, the Kardia 6L may be all you need, and will certainly cost you less than the watch. I have both and I find them complementary.
Now thats also very helpful, I may add the Kardia to get my ECG analysed with the premium service, presumably they offer that when you buy one?
The three 150 beats per minute sessions were on sundays , two late at night, my Cardiologist is at Spire privately and he only gave me the Spire e-mail address so 9-5 Mon to Friday at best probably. Is the Kardia premium service 24/7 in terms of getting a response., can you remember the cost by any chance.
Their premium service is called "KardiaCare" and it costs 99 pounds a year. With it you get the advanced determinations which diagnoses more arrhythmia's than just afib; icloud storage of your ekg's and four free clinician reviews of your ekg's should you want the xtra security of a cardiologist reviewing an ekg. I assume you can pay for additional clinician reviews as needed like in the US.
In the US, you can actually speak to a cardiologist via zoom for $69, but I didn't see it on the UK website. We also can pay monthly instead of yearly, which may or may not be an option in the UK, but with four free clinician reviews, I'd just take the yearly plan.
In the US, the clinician review is 24/7 and they guarantee 24 hour turnaround, but I never had to wait more than 3 hours. If you go this way, the Kardia mobile is fine, but the 6L can be useful if you need to take a six lead, plus I find the connectivity a little better.
While I love my Watch, if I had to pick one strictly for ekg's, I'd get the Kardia. If I wanted passive monitoring, albeit imperfect, then the Watch. If you want both, then get both.
Thanks. I think this was meant for the OP, but I'll take a shot.
I appreciate you've taken the time to understand EKGs to a certain extent. However, I don't want the original poster or others to think this is at all necessary. to get benefits from either of the Kardia or Apple Watch, as this step of knowledge may turn many people away if they think it's needed.
I found the Kardia and Apple Watch's automatic algorithms very accurate for the most part, but in the beginning, I always ran them by my doctor or Kardia's cardiologist when in doubt, or if I got something new or an unexpected. I think that's all most people need.
Much later I did learn how to read EKGs, but again, it's not necessary.
I agree. It’s not necessary. I find it helpful. That’s all. Just sharing my experience. I’m glad you brought up that deep dives into how to read ecg’s are definitely not necessary; that’s your provider’s job, and Watch and Kardia do good jobs at telling you what’s up with your ticker.
I understand the stress part. That’s why I learn everything I can, so I can, to the best of my ability as an layperson, understand what’s going on. I’ve learned when to be alarmed and when not, when to contact my EP and when not, when to go to the ER and when not, and a bit about how to read an ECG tracing and reported results, which involves learning about the PQRST sequence of a heartbeat. Learning that allows you to interpret medical test results yourself to see if you’re in normal range or in trouble as you peruse the figures for your QT interval, for example. It’s a fairly steep learning curve as Dealing With Afib is not on the school curriculum. (-: Just keep informing yourself and stay proactive. That reduces stress. Good luck!
I tried to paste a diagram, but it didn’t work. Type into your browser “PQRST cycle images.”
P is the beginning of the cycle, a small bump before Q, which is where the spike begins. R is the top of the spike. S is the bottom of the spike. T is the bump and line following the spike. Whether the differentials in the intervals between these points on an ECG are normal or abnormal gives a lot of information.
What you want to see is a small bump, then a spike, up and down, followed by a smooth but slightly larger bump leading to the next cycle, with this sequence totally regular, one after another after another. Looking at your own Watch or Kardia tracing (though Kardia ones are more herky-jerky), you can see for yourself if your heartbeat is smooth and regular or all over the place (afib)—irregular irregularities in intervals. Aflutter shows up, at least mine does, as regular spikes during tachycardia followed by a T tracing that looks like a line of squiggles, meaning my heart is indeed fluttering (spasming).
On test result reports I kept seeing things like “QT interval” and a number. What does that mean, I wondered. I went online and discovered what numbers were considered normal according to the range given. All I really wanted to know is if my numbers were in the normal range to be reassured. If not, I would query my EP team, but usually they would have already told me what concerns we had from the latest ECG.
I have only a primitive understanding of ECG tracings, but what I do know helps me keep track of what my heart is up to. For me it’s helpful to know if I’m experiencing PAC couplets, or PVT’s, or bursts of afib, or a lengthy episode of aflutter—to help me decide what if any steps I need to take.
I find the explanations of ECG tracings in diagram images online quite interesting. You can also find images of afib and aflutter and PVT’s and PAC’s.
I know: a little bit of knowledge is a dangerous thing, but I like being able to look at an ECG at the clinic and have at least some idea of what I’m looking at. At least I can spot afib in a second. I can spot aflutter prior to a cardioversion as quickly as the provider. And I can spot a normal ECG and go “whew.”
My first alert came at 10:30 pm back in Nov 2020, when I look back at the background readings which triggered the alert there were about 5 background checks over approximately 5 hours, If I had gone to bed 5 minutes earlier then I might not have known about that episode and I was shocked to get the alert.
AF alerts are meant to be disabled if you know you have AF (some prefer to keep them on) by using the alternative setting of AF history which disables alerts. The watch will not capture all your AF in either mode and will miss some, especially if short episodes. (Another anomaly as I mentioned previously)
Probably too much information but what I found was whenever I was in AF then my HRV (heart rate variability) was always sky high and only when I was in AF. So looking back at my HRV data in the two months I had the watch before the alert I can see there were very likely more episodes that I was blissfully unaware of and no alerts.
HR notifications can be set:
High to Off, 100 to 150 in steps of 10.
Low to Off, 40, 45 or 50.
As for size, it’s just a personal choice, same functionality. Mine came with a large and small strap but I think I’ve seen since you now have to choose one or the other.
Personally I didn’t feel the need for another device like Kardia as the watch did all I wanted and was able to share good quality PDFs of my ECGs with GP and Cardiologist. As I’ve said previously 40+ episodes captured on my watch and only once confirmed on a medical grade machine at my GP surgery in over 3 years and never captured on any investigations.
Oh, and without an iPhone you can’t use an Apple Watch.
AF alerts are meant to be disabled if you know you have AF (some prefer to keep them on) by using the alternative setting of AF history which disables alerts.
Apple suggests a fib alerts off probably for liability, reasons, but as you say, it's really up to the User which way they want to go. But if you do enable a fib history, you do not get the irregular heart rhythm alerts and I don't think you will get the high heart rate alerts either but not 100% sure. I've had it set up both ways at various times for different reasons. I find the alerts for a spotty, so currently I just have a fib history set up.Which is not perfect but could conceivably catch in a fib episode I'm unaware of
Thanks Buzby for al the info and links and your time, I think its time now to go the shop and interrogate the poor Apple rep and ask them to demonstrate to see if it works on my wrist, I hope they know their stuff, nothing worse than sales person who doesnt know about the products, I think you are right , the watch maybe not perfect but its more than I have now and I note decent cardiologists seem to think they are a good idea. Decision made 👍
Mine is a series 6 which was the first one to come with ECG pre-installed, later the series 4 and 5 were allowed an update to download the ECG app. My series 6 is 3.5 years old now and the 4 and 5 will be older. The thing to be aware of buying an old model is battery life as they do go off and can’t be changed as far as I’m aware. Also as you say the OS updates stop at a certain age and become obsolete sooner.
Juust want to add that when you get the watch, you can get it with her without cellular. As far as afib detection goes, it will work the same way, whether you have cellular or not.
However, I chose the cellular option because with it the watch can double as a back up phone if you leave it at home or run out of batteries. I look at it as a safety feature.
yes, the Apple Watch needs to be a snug fit. I personally had an allergic reaction to the strap that came with my Series 5 and I was unable to use it but I managed to find a stainless steel strap on Amazon which, I think, is far better than the one the Watch originally came with and fits perfectly and snugly with a magnetic clasp. Was quite cheap too.
If you have afib history set, It will only notify once a week of percentage of time in afib I had a series six that died in December, and I now have a series 9 and the battery life is much better and I charge it when I am showering only. I have slender wrists and the Ultra 2 was too big otherwise that would have been the one I would have chosen. I bought the 44 mm series 9 cellular and I love it. You really only need the ultra 2 if you hike in the mountains or scuba or need the gps for sports, or if you prefer the larger screen. Watch straps can be changed. The silicone strap makes me a bit itchy but fits well. I subscribe to an app that reads the ekgs when I send them. I also send them to my EP. My watch first diagnosed my afib, and my friend's watch diagnosed his...
thanks for info, very helpful, can I ask you how long the battery lasts on the 9 with you and what setting/app do you use as I understand battery time can vary depending on which apps are on.? When you say you subscribe to a APP that reads the EKG , can I ask you what sort of report they give you that the phone doesnt, and lastly how long can you do a EKG/ECG on the 9 is it 30 secs only?
I don't wear my watch until it runs flat, but I charge it for 20-30 mins every morning while I am showering and getting ready for the day. I have the afib checker running in the background, I use phone/text apps. I use the activity app most days for work out and walking the dogs which amounts to two or three hours running time as I usually forget to turn it off. The battery power is much much more than my last two watches. I don't have to compromise on any app I want running in the background.
I use Qaly app, the apple ekgs are automatically waiting to upload should I take one and wish to send it to have it checked. A real human analyzes it, but a 'tech', not a doctor. They will report the arrhythmias and any other thing they find on the 30 second trace. For an annual or a monthly fee you can submit as many a day as you would like but only one can be analyzed at a time. Turn around time is quick, 5-10 minutes usually, and they personalize it. you can also submit a little write up with the EKG if you'd like.
I bought an Apple Watch after my ablation in Dec 2020 It has improved my quality of life because despite being an IT slow learner I could work it myself and with no guidance easily. I can recode ECG and send to my cardiologist to check, the Apple Watch tells me if there is an AF episode. It is useful because I sometimes get fast heart beats and ectopic with no AF again the readings go off to the cardiologist to check. Being able to do this helps with my physical care and emotionally which for my Af is important, knowing I can get reassurance or advice reduces stress which for me reduces AF episodes.
I recently asked my cardiologist if I should look at another device as my watch is now 4 years old I was told that what I have is fine. It gives all the data needed added to this it is easy and quick to use with reliable Wifi.
I have tried a BP monitor combined, none of them have worked with WiFi properly I had 4 of one well know brand which had a hit and miss wifi worse still was the hopeless helpline. Touch wood the Apple WiFi connection has never failed me. The Apple helpline for me has worked perfectly helping me get more than the basics out of the Watch and software.
The health date is easy to read keeping a good log.
I can’t speak for other watches they may be equally as good but for me my Apple Watch has been a life changer. I have the rubber strap with a buckle, I don’t wear it particularly tight.
thank you for very helpful info, can I just clarify, your phone can say its AF when its not, is that right, then you check this by sending the ECG to your doc. that sounds a bit stressful until you know its not one. can aI also ask you what do you mean when you say you recode the ECG and send to your doc ,plse.
Glad to hear its poss to set it up if your a slow IT learner , like me 🙂
The phone reliably tell you if it is AF when you do the ECG which is easy. You can also set the phone up to give you an AF warning that you are in AF
For me I hear the heart beat in my ears so I know after 12 years what my heart is doing. When my heart goes into AF if is like a very fast car revving up do I feel it.
Some time I just have faster beat or ectopics which I send to the cardiologist just in case. Usually if I am in AF I will be in A and E.
Also there is an added bonus I didn't mention. If one is in AF one can do the reading which automatically store to your mobile. This for me has been hugely helpful in hospital because one has a history to show cardiologist. I think the watch only gives you a 2 lead reading but that is good enough for monitoring the rhythm.
If I have bad patch re heart rhythm or need a check up - have you heard of Zito( I think I have the correct name) it is a patch to stick on the collar bone that gives a 2 week heart reading that is sent off for analysis then returned to cardiologist. This is hugely reassuring and avoids the monitor.
To take the ECG one presses the ECG on a list that is clear on your phone. This bring up the ecg and you will hold your finger for 30 seconds on the side button for 30 secs. This automatically goes to your phone where you can look at it and easily email it where you want it to go.
I have found it easy so far the links between phone and watch have never failed.
To start with I didn't realise one has to close it at the end of one ECG before you can do another.
The ECG's have times on so one has an accurate record.
The watch does not have to be tight but not loose just comfortable.
I think all the right info has already been said. I’ve had my series 8 watch since late 2022. It’s great… you can set up icons on the face, one of mine is HR so I can check quickly if I feel a bit odd. The ECG is great as well and if I’m worried I email to my Cardiologist secretary who gets him to have a quick look and usually comes back and says just a few ectopics. When I’m in AF I notice it anyway my resting HR is around 60 and if it jumping around too much when I’m training I notice it and confirm it on the watch HR
1. The Apple. Watch is ideal for "technophobes" as my wife is one but uses hers and wouldn't be without it. It comes with a charger and we charge ours overnight. It must be linked to your Apple iPhone to work. The app on the phone saves all recording, but you have to put in your personal weight, height, age and health details yourself as the Apple Store will consider these private. Apple is rightly obsessed with personal privacy. With these on the phone, everything else works easily. You can set an "Outdoor Walk" and do your 10000. daily paces and similar! Great fun and very useful.
2. The ECG app and function needs you to gently touch the crown for thirty seconds, It doesn't need the wristband to be tight, just not sweaty or loose (there will be times you get a failed reading because of this. Try later or was and dry the wrist and wipe the back of the watch.
3. The continuous monitoring app checks only for an irregular heartbeat, not for AF directly (which would need the watch crown to be touched); this means it will report something like "possible AF" (I don't use this function as when I did it used up more battery and it didn't tell me anything I didn't know as I can feel my palpitations without the Watch).
4. If you are willing to pay for the Apple storage service called iCloud+ ("iCloud Plus", from £0.99 / month) you get extra storage for your photos and with this comes a uniquely private way to use your phone's internet called "Private Relay". This keeps what you do on the phone and internet entirely private. Many people using Apple iPhone use this service, I would think.
5. It even tells the time and tells you when the egg is boiled!
😂 My wife uses the timer function a lot and my eggs are always perfectly soft yolks and hard whites!!
I think the battery would still see you through the day but it did charge very quickly so, in truth, it’s a non issue. Some see the battery as the weakest point of the phone as it needs charging each day (well - mine is at 50% by bedtime). If you wear it in bed for the heart irregularity and sleep quality functions, or blood oxygen, then you’d have to put it on the charger for an hour or so in the morning.
Don’t forget that the SE model doesn’t have an ECG hardware onboard.
I see there’s some Series 8 on the Apple UK store “refurbished”. This is a good way to buy as with Apple this means a full warranty and new watch face and battery. Essentially it’s a new watch.
For years I had periods of skipped heart beats and palpitations without any ECG or heart monitor showing AF.
I have an Apple Watch and used the ECG function every so often. Only once in 4 years did it show an irregular heart beat. On January 31st of this year I got a warning from my watch that readings suggested that I might have AF. On checking I could also see my HRV had shot up. I did not have any symptoms so without the watch I would have missed it. I immediately went for a checkup with my GP and an ECG/pulse confirmed AF. A visit to hospital for checks again confirmed it as well as well as a slightly enlarged heart and leaking valves. I am now on Apixaban, bisoprolol and amlodipine.
I would have missed my AF without the Apple Watch so am glad I have it. It now seems to suggest I am in AF 100% of the time. I only have slight symptoms so I could still be totally oblivious without my watch.
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