Hi all,I have been back in AF now since end of June.
How do people get an accurate HR reading when in persisten AF? I have tried a few times on my Kardia mobile device and it always seems high (just now it read 127) when I try taking my pulse normally (count pulse for 15 seconds and times by 4) it always comes out a lot lower, I have also taken it on my blood pressure monitor and it reads 85.
I recently had a 24hour monitor fitted and was told my average HR was around 94.
Any advice appreciated
Take a default 30 second ecg with the Kardia. Count the number of "R" waves (peaks) and then multiplied by two. This should be more accurate than the number Kardia generates, although I've often found them the same. Blood pressure monitors are often very inaccurate when you're in atrial fibrillation. If the rate is slow enough, taking pulse old school at wrist or neck should also be very accurate.
Jim
OK I will give that a try.Thank you
Radial pulse in AF can be wildly inaccurate. BP monitor useless in AF. Holster is by definition giving an average. Kardia best.
You need an ECG asap. Assume you are on a thinner. Sounds like you need DCCV in near future. Not a doctor.
I am waiting to see an EP with a view to either a cardio version or ablation.I am just about to start taking Apixaban and digoxin.
Thanks
When you are in AF it’s very difficult to count the heart rate manually. The Kardia should be accurate and it will produce a wave for each beat on the ECG trace. Unless counting these individual waves yields a different number to the total count (which would seem very unlikely) you can be fairly confident in the Kardia result.
OK thanks, I will take another ECG and see if I can read the patterns
According to the monitor your average HR is in normal range, though high and uncomfortable not likely to damage your heart. So a cardioversion wouldn’t be considered necessary unfortunately.
it always seems high (just now it read 127
The key is does it stay at 127. afib will cause the heart rate to spike. From your post, I would trust the holter reading of an avg of 94.
We afibbers sometimes forget other events can cause a spike in heart rate, stress, exertion, etc.
Whatever medication you are on should do better controlling your heart rate. Would consult your doctor soonest. Ideally, average should be 80 or below.
I think the way these devices measure HR during AF is the reason for this. I have switched to a new device from Contec, and that struggles, too. My Apple Watch seems the best of all.
I would use your own manual method, which is bound to be as accurate as needs be (although the wrist pulse sometimes and for some odd reason, I have read, can occasionally be slower than the AF generated ventricular pulse).
Steve
When in Afib with tachycardia, my Garmin (measuring the radial pulse) can read 50 bpm slower than the ventricular rate. I just learned this after my new cardiologist ordered a 30 day heart monitor.
That's interesting. This is a phenomenon that I can recall reading about some time ago.
Steve
In theory, I knew this. In practice, I somehow did not apply it to myself, so I was shocked to learn how high my heart rate was actually going.
I wonder how much it matters to the health and can’t find much online about that. Logically, what matters most of all must be the blood pressure during AF as this is what ensures the required perfusion in the organs. BP seems likely to be a better measure of the heart’s efficiency and is likely what can lead to the most unwanted symptoms. That said, tachycardia is said not to be good for the ventricles and valves, when sustained; but again, it’s hard to find out what “sustained“ means.
Steve
Kardia counts electrical impulses which do not always translate to a detectable pulse. Manual and oximeter and BP machines count pulse, hence the discrepancy.
I've had that recently when using my Kardia (I'm also in persistent AF, having my first ablation one week from tomorrow!) -- typically at bedtime, my first reading is very high (115+), then if I wait a minute or two and do it again, it drops back down to "normal" (normal for me in AF), which is 70--90. A cardiac nurse told me to go by how I feel, and if I'm not dizzy/breathless, I assume the lower second reading is closer to accurate.
No, see my general answer.
Simple answer to this : your pulse and your heart beat are NOT the same when in AF. The Kardia mobile is reading the electrical activity of the heart beating, and will be accurate. If your heart beats when it has not yet filled with blood, (because it happens at random at the 'wrong' time) there will be a beat with no resulting pulse in increased blood pressure.
Thank you what you say about the difference between the electrical activity recorded by Kardia and pulse (re: blood pressure) is interesting ...
I was originally diagnosed by private cardiologist on the strength of a Kardia reading and my current NHS cardiologist reviews my Kardia readings during checkups.
Kardia was tested by NICE for accuracy and came out pretty well see NICE guidance mtg64.
Cat
Thank you! That is the best explanation I have seen and, when I learned my Garmin was off by as much as 50 bpm, I was sure looking for answers.
I was wondering whether, in a sense, the pulse that "matters" in terms of health is the radial pulse since this is picking up only those ventricular contractions that are strong enough to circulate the blood to where it is needed. The inefficient contractions that occur occasionally when the AV node allows signals through too soon (when the chambers are not filled with blood), and which results in a radial pulse deficit, as it seems to be called, are not "useful".
I have read on a couple of websites that radial pulse measurement is considered sufficiently accurate in AF, and I was thinking the above might be the reason.
Steve
Ppiman I guess that depends on what it is you are trying to measure. If it is the wear and tear on your heart muscle, then surely the 'empty' contractions are important. If it is the effect on how you are feeling, then it's only the pulse of pressure being generated that will count, and whether that is efficiently circulating the blood. I often felt a strange lethargy and slight mental impairment whilst in AF. Not enough to stop me driving safely, but enough to put me off doing anything more complex or unfamiliar. I put that down to poor circulation, even though the pulse rate was higher than normal.
For sure, the radial pulse will reveal the lack of rhythm, but not the rate your heart is going.
I too sometimes feel an odd mental impairment as a kind if “distancing” from reality, with sounds being somehow further away. I had this first several years ago and, after an ECG, I was told it was likely the LBBB I have; more recently my cardiologist said it was perhaps that but any arrhythmia can cause it.
I have read that “radial pulse deficit” isn’t that common in AF. I certainly don’t think that I get it.
“Wear and tear” on the heart is still not a well understood phenomenon, from what I can read, too. Heart failure seems to leave researchers mystified, also. I suspect genetic predisposition is at the heart of it, to choose an apt metaphor,
Steve
Before my first ablation (in full-time afib for months), when I went in for my doctor appointment and the technician tried to take my heart data, looked at me in shock and said, "you're in tachycardia!" I could only answer, "welcome to my world." Not sure she was quite correct, but the point is, it's hard to tell an accurate actual heart rate with that kind of fibrillation going on.
Really interesting to hear all of your knowledge on this matter and I appreciate the very detailed feedback.My HR is obviously all over the place due to the persistent AF and I will have to get used to it (again) until I hopefully get back into sinus rhythm by one means or another.
I am generally feeling OK at the moment and am carrying on with life as normal with maybe just a little less energy, my big fear is that constant AF will have a negative impact on my heart as that is what happened previously with an end result of an HF diagnosis.
I try not to obsess with checking my HR as this can lead to worry and anxiety.
Thanks all
my big fear is that constant AF will have a negative impact on my heart as that is what happened previously with an end result of an HF diagnosis.
That's a very legitimate "fear"/concern. I don't know your history, but have you looked into cardioversion and or anti-rhythmic medications or ablation? The newrer thinking is that rhythm control is superior to rate control not only for quality of life in most cases, but for the health of your heart. And in some cases, HF can be reversed once the heart starts beating normally over time.
Jim
Hi Jim,I have already had a successful cardioversion (14mths in sinus) and a successful cyro ablation (3 years in sinus), unfortunately I am now back in AF and will start taking more meds from tomorrow (digoxin and Apaxiban) ams my bisoprolol has been increased.
I will definitely push for another procedure as my preference is to ne back in sinus with fewer meds.
Thanks
Given your history, look into a surgical ablation as opposed to a catheter ablation. The number of folks can help you here I'll tag a couple of them. MummyLuv and saulger
Jim
Thanks, I will look into this before my EP appt next week.An interesting comment in your above post "sometimes HF can be reversed",
I have had 2 cardiologists say to me that there were no signs of HF in my MRI last November and again when looking at my recent echo.
I have read in a few places that HF is incurable but that is not what some cardiologists are saying!
After a long period back in sinus ryhtm my heart did get back into very good shape
To me, the takeaway from this discussion is
1. Most gadgets for reading your heart rate use the pulse at the wrist (Fitbit, watch etc.). Pulse rate is not an accurate indicator of heart rate when in AF.
2. Many devices 'average' the heart rate measured whilst in AF. Especially those measuring at the wrist, some of which will only recognise rates in the 'normal' range 60 - 120 bpm.
3. Both the cardiologist and the Kardia Mobile (and some watches, e.g. Apple and some Samsung) will graph the actual irregular heart beat, and give an accurate count - but is this useful to you as a layman?
Bigredhear I am glad to hear you are 'generally feeling OK' and I hope this long continues. Many on this forum have had ablation (myself included) which can be an improvement over the medication approach, but must always be taken on by a skilled electrophysician (EP). There is no permanent "cure" and many have had more than one ablation. Coming from an engineering background, I have always preferred the mechanical approach to the chemical one, so that is perhaps a bias with me.
3. Both the cardiologist and the Kardia Mobile (and some watches, e.g. Apple and some Samsung) will graph the actual irregular heart beat, and give an accurate count - but is this useful to you as a layman?
Why is the ECG tracing not useful? It only takes a few minutes to learn how to count the QRS complexes. Just count them and multiply by two if you're using the default 30 second tracing. Now you have an accurate heart rate.
Jim
Hi momist,I have had an cyro ablation which kept me in sinus us for 3 years, I'm seeing an EP at the Cleveland clinic Tuesday week so will see what they say.
I too prefer a 'mechanical' fix as opposed to more meds.
Thanks
I also found that the Kardia 6L heart rate displayed on the ECG report is too high when one has an irregular heart rhythm. I emailed Kardia about this along with a copy of my ECG report. Here is their reply:
"We would like to confirm that we did review your EKG. We would like to follow up with you and confirm that Kardia does not calculate beats per minute based upon simply counting the beats, but takes into account interval variability and uses the median RR interval of the beats with good signal quality. In cases where the heart rate variability is great, such as atrial fibrillation, this number can be quite different from the beats per minute obtained by directly counting the beats."
It looks like the too high reported heart rate is a result of Kardia's methodology.
Wishing you well and hope the meds help. I was wondering about accuracy of Kardia over other devices so this is useful information. My dad is in persistent AF currently and HF and also started digoxin for a couple of weeks and continuing with apixaban. I'll meet with EP next week to discuss next steps.
I found the Kardia device really useful when I was in sinus rhythm as it gave me peace of mind but I suppose now I'm back in AF its a reminder of how erratic my heart is.Good luck with your dad and tell him he's lucky to have you looking out for him.
Thanks
Thank you. I tell my dad to use any readings as information to help with his treatment and not to worry about it.
Its great but can cause added anxiety and stress. I only really got involved in understanding his health after HF diagnosis and until then he has been managing everything himself. I only understand now the impact AF has had on his health.
The community on this forum are truly amazing and their experiences have taught me more than I will ever learn from what doctors tell us or what I can read elsewhere.
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