Wellue users and True Afib

[MeganMN]

I am using a 24 hour Wellue device. I am an ER Nurse and well versed in ECG readings. My Wellue is interpreting Atrial Fibrillation, but I am skeptical. I have frequent PACs, Atrial Tachycardia in 2-7 beat runs, and blocked PACs. Have any of you had this experience? Being educated in reading them, do you have any tips for discerning the subtle difference? Not looking for medical advice. I am forwarding the readings to my EP. Just curious.

[Responsable]

I strongly believe that you are right.

Since a long time, I suspect that people are often wrongly diagnosed with AF, not only because of the use of these small devices but also in contact with EPs. What is especially dangerous, is that, if a patient has had AF confirmed one time, he will consider any other future arrhythmia to possibly be AF. I am afraid that it is similar with the MDs. And it is not like this - arrhythmias come and go, without any regularity in type and duration. It is possible to have, in the same day, two arrhythmias from the opposite sides of arrhythmia spectrum. The rule is, of course, that there are no rules.

Here an interesting thought - whenever contemplating the percentage of the people who have arrhythmias, do not remain at the low percentage. The truth is, 100% of the population suffer on arrhythmias - differently, of course. The best example are PVCs. The doctors have stated since a long time - "Everybody has them!" - and it is a damned truth. Biological system, like the one for the activation and control of the heart, is not perfect and has its faults, which get more frequent and more expressed with the time. It is a good thing that the symptoms remain mild and unnoticed in the majority of people. I remember having my first arrhythmia at a very young age. Nearly everybody I know suffers on them. We had a case at the forum, with a little girl 9 years old.

So, brothers and sisters, all of us, the people, are arrhythmia sufferers. So fair, ain't it!?

[Ewloe]

it depends if you have a p wave

[babs1234]

I would like to see a picture of your readings. I sometimes feel like I’m definitely in AF only to take a reading and I’m in SR. I think I have Ectopic beats too which gives me the same symptoms

[MeganMN in reply to babs1234]

Here is one of my 'normal' abnormal readings with PACs, SVT. I'll have to upload the one that says 'Afib'.

PACS, SVT

[Quest4NSR in reply to MeganMN]

I'm a massive Wellue user and I couldn't do without it, I wouldn't get too tied up with what it tries to tell you, just screen shot the page and let your EP determine what they are. However looking at the PACs the P waves are almost non existing

[Cookie24 in reply to babs1234]

Same here

[Ennasti]

PACs, blocked PACs and atrial tachy all have p waves as you’d likely know. I have no idea how these home ECGs read but I guess they’d need to read more than a single lead. How many leads is your Wellue? Although I’m pretty certain they still only read lead 1 anyway.

[MeganMN in reply to Ennasti]

Yes, they are one lead. I have a 6 lead, and it reads it as possible afib, but I can see that it clearly ISNT Afib. With the new device, I poured over the tracings and can't tell, there is a bit of artifact. I am trying another recording tonight to see if it gets any more clear.

[Ennasti in reply to MeganMN]

So what do you see in the other 5 leads? This is the only way you’ll even get close to an educated guess. A single lead is a waste of time. The p wave might look very different and without the extra leads (preferably 12) it doesn’t matter how much or hard you look, you won’t be able to accurately tell what you’re looking at (as you would already know).

My EP and cardio would never use my home traces as gospel. They use them to add to their knowledge on the diagnostics they have undertaken and, playing on the safe side, take my low rate AF diagnoses on my 6L Kardia and single lead iWatch as extra info based on what they know already.

We had a member here (who was banned for stupid reasons) who actually ordered a 12 lead device and taught himself to read ECGs. His knowledge is a great loss to the forum. With your professional knowledge and experience, you would have enjoyed talking through these things with him I’m sure!

[mjames1 in reply to Ennasti]

A single lead is a waste of time.

My Kardia single lesd tracings have been accepted by top ep's in three countries to confirm afib.

Jim

[Alemo27 in reply to Ennasti]

Agree with your comments. I came to the conclusion , that all AI only good for confirmation of AFIB, If person isn’t feeling it,, that might oversight heart failure, if don’t take the actions. Still all of the AI devices can’t substitute the professional knowledge. I have contacted 5 cardiologist, and none of them was agreed to have my KardiaMobile or Apple-watch ECG reading be shifted to them. Their protocols are-Holter monitors , and medical offices standard ECG, Echogram,etc.

To us “arrhytmikers” the problems are, that with the time overall health and heart conditions are deteriorating and we need the EP and cardiologist to have more close look to more frequent the arrhytmia onsets , taking into consideration all related health issue and med.side effects.

The reasons for not Symptomatic AFIB hasn’t been defined yet!

The only in 100% can be diagnosed for sure is the age!!🤨

I

[ozziebob in reply to MeganMN]

My understanding is that a P wave is easier to detect on Lead II of the 6L trace.

[Ennasti in reply to ozziebob]

Precisely. You need more than 1 lead especially for things like blocked PACs and even atrial tachy. The p wave is often not very discernible on a single lead. As much as it gets up someone’s got when I say it, I’ll say it again anyway - a single lead is a waste of time especially for anything more complex than the obvious I also has Ashmans phenomena and what looks like a very obvious PVC in a single lead is not when you view the rest.

[mjames1 in reply to MeganMN]

I have a 6 lead, and it reads it as possible afib

Kardia only uses lead 1 to make its determinations, even if you have a six lead.

Again ignore the determinations and focus on the ekg itself. AI is still not better here than a trained human.

Jim

[ozziebob in reply to mjames1]

Yes, I accept your considerable experience and conclusions in this matter, but I was simply suggesting that if you do have a 6L trace, it does seem to be easier to see the p wave on lead II. Yes/no?

[MeganMN in reply to ozziebob]

Thanks! The Afib was in the night, so I wouldn't be able to catch it on Kardia. I will look closer later, but my strong suspicion is that my frequent ectopy and artifact that threw off the AI .

[mjames1 in reply to ozziebob]

if you do have a 6L trace, it does seem to be easier to see the p wave on lead II. Yes/no?

Yes. Good point! But since these devices, including the Kardia 6L, only make their determinations on lead 1, tracings from additional leads would need to be read by a human.

Jim

[ozziebob in reply to mjames1]

Well, last time I looked, I was a human, and if I was confused about a 6L Kardia determination, I would certainly look at the Lead II trace, if only out of interest, before I called on the "experts" which I don't have access to. I wish I did, although I'm still grateful I don't have the need at the moment.

After some recent nighttime starting AF, I would like to monitor my sleep for potential AF (or other), but am not really convinced by suitability of the single lead devices currently available.

[mjames1 in reply to ozziebob]

Well, last time I looked, I was a human.

Was that when you looked at Mirror 1 or Mirror 2

Jim

[baba in reply to mjames1]

"Kardia only uses lead 1 to make its determinations,"

Also only analyses the first 30 seconds of the trace.

[CyclingRunner]

My Wellue appears to diagnose AF when my P wave is missing. For me this works - I can clearly tell when I am in AF and when I drop back into NSR (physically as well as though the device).

It also gets interference when you move around, hence I always make sure I’m still when looking at it on my phone.

Depending on where i place the two chest electrodes also has an influence on the signal. I find it’s more reliable than an Apple Watch but I only use it when I’ve had an episode, but it’s only a home use device and can provide more useful info to your EP but is no substitute for a real ECG. For example last time when I was in AF (and the Wellue agreed) then I got a proper ECG done and they said I had fluttter with a 5.1 / variable block - never going to pick that up on a device like I’ve got.

[Ppiman]

My cardiologist seems not interested in whether my atrial misconduction arrhythmias are AF or other (i.e. atrial tachycardia, atrial flutter, or multiple ectopics). When I have what my devices flag up as AF, I find this tends to be with a faster rate (85-150bpm) than when I have multiple ectopic beats. However I get runs of fast beats, too, which could be other arrhythmias.

For AF the cardinal signifier is the lack of a P wave, but this can easily be obscured in fast ectopic runs.

Steve

[babs1234]

this is SR yet feeling very like I’m in AF 🤦‍♀️

ECG Apple Watch

[babs1234]

this is now saying AF

Now AF

[MeganMN in reply to babs1234]

That is very helpful to see both!! Thank you!

[mjames1]

Best to ignore what Wellue says and just analyze the tracing itself, or have an EP do it if you don't feel qualified. Same advice with Kardia and Apple Watch tracings.

In fact, good EP's ignore AI determinations even on their office 12-leads and only look at the actual tracing.

Jim

[MeganMN in reply to mjames1]

Great advice! Thanks so much! Will have another look tonight. This is a new device to me. I have another Wellue but it was easier to view the tracings on.

[mjames1 in reply to MeganMN]

As long the tracings are clear, it shouldn't matter whether Wellue, Kardia or Apple Watch, although the Kardia 6L will provide additional information which can be useful to your ep with complex arrhythmia's like you have, assuming you can capture the event with it, which you said you couldn't.

One day, AI determinations will no doubt be equal to or probably even surpass the determinations of of even ep's, but we're still a way's off on that, especially with complex arrhythmia's like you have.

This is not to say that these AI generated determinations are useless for more simple arrhythmia's -- they have very good published sensitivity and specificity for Kardia and Apple Watch, just not conclusive. I don't believe Wellue has any published data here, but as their tracings are clear, it shouldn't matter to an ep.

Jim

[MeganMN in reply to mjames1]

Thanks Jim, and everyone, for your input. It is very valuable and appreciated. I did another 15 hour reading and reviewed the tracings. I worked a bit harder to get the stickers on and not be so squirmy 😀. All in all, out of 87,000 beats, 34,700 were ectopic, with some hours having almost a 50% burden. I also had 800 runs of short SVT bursts. I'm still reviewing the tracings to examine the Afib readings, but I believe it to be ectopy with artifact, or PACs that are too frequent and fast to show a 'p' wave. I will send it off to my EP tomorrow. Thanks again for he discussion. It was very helpful and useful.

I didn't mention this, but my EP was the one that actually requested the report and tracings because in my case, it really saves me money and unnecessary monitors when we already know the problem but are trying to determine response to treatments.

[Ppiman]

I don’t find it makes much difference unless the AF is especially fast. The physical result is the much same and the cause not far off, too, i.e. atrial mis-conduction.

AF requires anticoagulant therapy but other than that the symptoms can be similar.

On an ECG, the P wave is the key yo diagnosis and, on a 6- or 12-lead, I gather, lead 2 shows this most clearly.

Steve