iwatch setting - AF history or AF alert?

[Rainfern]

Prior to my ablation last October I had persistent Afib. Since then I have been in NSR. I have kept my iwatch monitor set to record “AF history” and it has consistently shown AF load to be 2% or under on the weekly notifications. Should I stay on this setting or should I now set it to show alerts the moment there’s an arrhythmia present? I do still have the occasional, brief run of ectopics that remind me how AF can still be lurking around the corner - would these show up on the alert setting as AF?

I haven’t used the ECG function for months because I haven’t felt the need and haven’t wanted to think about it too much. But if AF did creep back in silently I’d want to know about it right away as they will offer a second ablation and statistics show the sooner the better with persistent AF.

Thank you in advance for your knowledge and wisdom on this topic.

[Buzby62]

Hi, I still have AF history since my ablation December. I remember you saying your HRV (heart rate variability) was immediately much lower after ablation and I had the same and that is still the case almost six months on.

As you know the watch won’t capture all AF in either mode, so I’m not changing mine. I prefer now to look at HRV history to see if anything might have been happening as the HRV will always be up if you have an episode and is more reliable than either AF alert or History. Be aware though that it does throw an anomaly on one or two readings when you look at all data, I’m guessing when doing something with your arms to upset a reading that has started while still.

Best wishes

[En85 in reply to Buzby62]

I did the same. I had a CV in November and ablation in January. My last episode was the one in November. I had at the time reset the watch and it took a bit to it for flagging the afib (2 or 3 h?) this might be because mine was slowish rate. I decided this time to keep on afib mode, as this mode checks more often for afib and I get more HRV records I can look at.

[Buzby62 in reply to En85]

I think we may have discussed before, it’s the HRV that triggers the the AF alert or the AF history to record but not always, my first alert took over 5 hours and 5 checks with records of irregularities. Apart from a couple of episodes during blanking, my HRV is much lower since ablation and feel that is a good thing 🤞

[Rainfern in reply to En85]

I think maybe how and what we record depends on the type of AF we have, or had. To my knowledge I never had paroxysmal AF. My heart went straight to persistent. So that’s what I’m likely to see again if AF returns. I’ve got to explore this HRV thing because I seem to have forgotten what it means!

[Rainfern in reply to Buzby62]

Thank you Buzby. I must get back to the drawing board to explore the HRV thing! Sometimes I’m quite nervous of looking too closely in case I find any there 🤣

[mjames1]

Depends what you want to capture, but remember the Watch isn't going to alert you to afib in real time (or even high heart rate) in either mode. I left mine to show afib history, FWIW.

Jim

[Rainfern in reply to mjames1]

Thank you, makes me feel I’m doing the right thing 😊

[OzJames]

I have mine on AF alert, it’s been spot on albeit a couple of times it notifies me an hour or so after. It takes measurements every now and then and when a pattern is consistent over a period of time it notifies you. If you have an AF episode once for a few minutes then you won’t get notified. My notice shows the times of checking eg. 1pm 1.15 1.35 and 1.45 I then get a notification. As my resting HR is around 55-60 I notice if I’m in AF when it jumps to 85-90

[Rainfern in reply to OzJames]

Thanks OzJames. Was your AF paroxysmal or persistent?

[OzJames in reply to Rainfern]

Hi Rainfern mine is paroxysmal I’ve had the watch since 2022 and it’s picked up all 3 of my episodes. I’ve always sensed when I’m in AF…. anyway so for me it’s a quick way of confirming and then I check with ECG. I’ve had Cardioversion each time. Prior to that my paroxysmal episodes have been on average once every 5 years since 1993

[KentAndrew]

I have my Apple Watch set to AF alert and also perform a ECG every morning.

It keeps track of my AF episodes.

[Rainfern in reply to KentAndrew]

Thanks KentAndrew. I had persistent so alert would have been useless for me. My understanding is that if the AF returns it’s likely to follow a similar pattern.