So my question is: Has anyone gone into this rabbit hole and come out with any wisdom on whether the info is helpful to afibbers, or to the medical people we consult? So far, I have seen no mention of these concepts in this group.
Given that these all seem related to heart-rate variability (HRV), I'm curious about whether QRS intervals are indicated herein.
By the way, in case you recall my issue with QRS interval and whether it has widened too much for me to continue taking flecainide, after 10 days of it, my cardio P.A. (not an MD or EP) told me that because my widening was less 25 percent, I can continue flecainide. My QRS went up to 116 from 98, which is 19 percent.
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My advice? Don’t overthink it. Nobody cared about HRV until the Apple Watch came out. You’ll notice it’s not a reading on any clinical grade ECGs. As for your QRS readings and whether this has any significance for taking Flecanide, you’ll need to get back to your cardiologist or whoever prescribed it. Nobody here can answer the question of whether you should stop your medication based on a home test.
Yes, of course. Regarding the QRS matter, I'm not seeking decisions here, but experiences of others with their medical advisors. If our experiences are similar, it might be comforting.
So are you saying that these HRV numbers did not exist before the Apple Watch? How does the apple Watch even physically convey all that data -- 10 different numbers? Maybe I'm not understanding. Does the Apple Watch give a *single* HRV number?
HRV is an established indicator of certain aspects of the heart's functioning and to my knowledge was first properly described (in the context of AF) by Professor Coumel in France in I think the 1980s when he published his findings about the neural aspects of heart rhythm control.
I had recognised early on (1990s) that my AF fitted his description of vagal AF, and although I had read his papers in full and sought a top cardiologist on his (Coumel's) advice because I expected such a doctor to know about this and use the information to help solve my AF problems, neither he nor any other cardiologist since seems to use HRV clinically. I may be wrong, but that's just my observation from 30 years of AF experience. It's true a standard 12-lead ECG doesn't report HRV but that's impossible since the capture period is a few seconds whereas HRV needs several minutes, or preferably a full day to be meaningful, so a Holter analysis, really.
The neural aspects of heart rhythm control are still in my view inadequately addressed in clinical practice, but I think it's because it's a difficult subject and not well understood as to how to apply it. Coumel was at one stage asked to withdraw a paper on the neural aspects because it wasn't proven, and he refused saying that he challenged his critics to show him a single case where the neural considerations did not apply. He got published.
The classic AF textbook was(/is?) Falk and Podrid where Coumel had a chapter in an early edition (which I was able to photocopy from the British Library 😀). In a subsequent edition, that chapter was replaced by one by Prof Camm (who many will know of and who is associated with the AFA) saying essentially "it's not quite that simple".
John Mandrola, a cardiologist in the US, also said there were a couple of big names in the States who had a good handle on the neural aspects. If I can find the names I'll post. [Edit: Douglas Zipes is one]
HRV isn’t reliable if you’re on any rate or arrhythmia control medications. However, I’ve noticed that my HRV can spike up to 200 when my heart is acting irregularly, and I’ve heard others mention that their HRV also increases during AFib episodes. For me, my HRV usually ranges between 8 and 30, and it doesn’t rise with my LBBB.
I don’t think HRV is linked to QRS duration since HRV measures the consistency of heartbeats. A heart can beat consistently whether the QRS is wide or not. The idea that the heart beats in a steady ‘boom-boom, boom-boom’ rhythm is a misconception. There are always small variations between beats, and the parasympathetic nervous system is constantly adjusting the rate, slowing it down and speeding it up.
The HRV section on the Wellue report has ten different items. There is *not* a single HRV number. It seems that we are talking about different things. That said, your comments are very helpful -- thank you!
I’ve never heard of it being given as multiple figures. Based on your response I decided to look into it more so that I could learn, and I resorted to ChatGPT to clarify what the numbers were. I’d include the response here, which was great and explained the different values specifically, but the last time I quoted ChatGPT I was banned by the powers to be on here. So if you want to read it, I’m happy to message it. Anyway, thanks for the learning opportunity! I would never have known that my Apple Watch gives an average of one metric only.
I did find your message. Thank you so much! I am inspired to poke at ChatGPT. And how nice that it provided the info about Apple versus Wellue. Amazing!
I get great satisfaction from learning these tiny things, even though I may not apply them in a real-world sense to make me smarter and healthier.
It’s pretty good but still does sometimes make errors. You can ask it specific things - I had asked it why the Apple Watch only gave me a single reading but your Wellue gave multiple levels of data and what the data was. It really is a good resource to add to any library of learning.
Just on another note. This is an example of what my Apple Watch reports - this is from last night. It’s very basic. I was asleep during the period it shot up but based on previous occasions I’m guessing my heart was ‘carrying on’ at that time. It might have been ectopics, AF or even NSVT.
Also, I’m wondering if you wouldn’t mind sharing what Wellue device you have? I’ve been tossing it up for a while but have decided to buy one.
My watch HRV spikes when I’m in AF, and like you, I’ve also had those random overnight spikes but no evidence of AF or a high HR at those times. I’ve not even looked at it for months. You’re also right in reminding us that HRV isn’t a very reliable metric of anything if you have an arrhythmia and /or on medication for arrhythmia or rate control.
I have a Wellue 24 hour ECG. When I first got it, I looked at the HRV section of the report, Googling to find out what each of the numbers meant. Some were out of the range of being okay and I was initially concerned. However, I very quickly came to the conclusion that my daily Metoprolol and Flecainide probably impact all of those numbers so they are probably less than meaningful in my circumstances.
In addition, I note they don't rate a mention on the ECG conclusions report. Either that's an oversight or they aren't noteworthy.
To add to that, I had a stress test echocardiogram a few months after getting my Wellue, which includes ECG while resting and during exercise i.e. extensive test of my heart function overseen by a doctor monitoring my vitals/ECG. No issues were raised during the test or in my subsequent consultation with my cardiologist. My cardiologist advised there were no noticeable impacts on my heart from PAF in the 5 years since diagnosis and commented that I have a high tolerance for exercise. I'm sure if there were any HRV values of concern they would have been identified by the test and raised by my cardiologist.
If you have concerns about any of the HRV values you should discuss them with your medical professional. If there are any issues of real concern then they should be investigated.
Indeed I will do that. But the effort that goes into these 10 calculations is impressive, and it seems to me that there must be *some* usefulness.
But your point about the effect of medication superseding any usefulness (if I may put words in your fingers) is certainly an excellent one.
Like you, I am taking Meto (25 x 2) and Flec (50 x 2). The Flec is very recent and still under review and apparently dependent on an expert reading of these sorts of measurement. I'm something of a bean counter, too, you see.
I am 77 years old, quite a bit older than you. Or so I gather from your bio with your Chads Zero.
I've been able to ignore the *possibility* that I'm old for about 76 years, but now I often find myself among the oldest in the room. Maybe being without offspring and grand-offspring helps me be oblivious.
Thank you for your reply! Everyone here writes so well!
I don't think the values are of any importance to us at all. Neither can I find a QRS figure, which is annoying and an omission (although it would be very easy to measure from the graph and is visually rather clear, too, of course). The unique and outstanding value of the Wellue device is in its ability to track the heart rhythm over a long period (up to three days with the latest version), along with a free and unusually comprehensive AI analysis.
Sadly, for anyone with a left bundle branch block, like me, AI of any kind, whether Wellue or Kardia, is unable to work well. On this Wellue scores lower than Kardia as it can easily report ventricular arrhythmias (such as VT) when the arrhythmia is entirely - and much more safely -atrial in origin. At least Kardia just raises its hands in the air and gives up trying! My favourite now is the new Emay / Contec device which, although only reading for 30 seconds, never gets it wrong up even with LBBB present.
I was glad to read that your use of flecainide was deemed safe for you. That is good. I still haven't resumed mine although I sometimes think of trying it as a "PIP". I can't help feeling that while I am able to cope well enough with my current arrhythmias, it seems wrong to take a daily strong anti-arrhythmic even if deemed safe to take.
It's a Contec 6L, which I found online. It's currently only available from their EU office in Germany, although, of course, it's made in China. I paid in sterling, if I recall and I think there was 10% off at the time.
It's a small and lightweight handheld ECG with the extra of a 6 lead reading if needed. It has a built-in sharp and useful screen, so no phone or laptop is needed to use it (although both can be used with the free apps). What I like most is that it gives a fairy wide range of results from its built-in AI algorithm, more than the Kardia I used to have even with the extra payment for advanced determinations. The graph is clear with a good "P" wave visible if it's there.
I attach a 6 lead graph from it, although I mostly use it as single lead these days which seems to offer all I could need. What I like most is that, unlike the handheld Wellue that I also have, it never reports, in error, any worrying presence of VT. The AI most ECG machines use apparently tend to do this in the presence of LBBB which makes the ECG more difficult to read.
And here is the recent single lead. The device is also available form the better known company called Emay and is called "6L". It was on offer from Contec when I bought it, hence my using them.
As always - thank you! You are one of the gems on this forum. I’ve considered buying a Wellue for some time as you probably know and this is a new device I’d never hear of.
I think there's little to choose but on balance, I prefer the Contec PM20 / Emay 6L not for its 6-lead option, which offers not much really, but for the instant AI analysis on-screen. The Wellue AI, as I say, can sometimes be fooled by the presence of LBBB and can report my AF as also having VT involved, for example - which is quite wrong (or so my cardiologist said). The very positive review by the "Sceptical Cardiologist" mentions this and, if you haven't seen it, is worth reading (that's on the 24-hour version, but the AI Wellue uses is the same).
There's no real connection. The LBBB kicks in randomly at any time and rate. It can be with NSR or AF (judging from the width of the peaks on the AF one). I'll send a couple of recent ECGs to show you.
Thanks for raising this matter and posting your HRV report details.
While you seem to be very busy down that rabbit hole, if you come up for air you might be interested in this article related to HRV which arrived in my inbox yesterday ...
Prediction of Sudden Cardiac Death With Ultra–Short-Term Heart Rate Fluctuations
Yes, I have the same problem. I belong to Practice Update, no cost involved, just registering and receiving emails about relevant medical research.
I thought I would only get that short abstract myself, but further down I found a menu, "access this abstract now", and I was able to download the full article in a pdf.
If you can't access the article and want a copy, I would be happy to send you the pdf if you send me your email address in a PM.
I will attempt an interpretation of how this study is relevant to the HRV numbers in the Wellrue report. Hardly relevant at all: "Associations between conventional HRV parameters (measured at any stage of exercise or at rest) and SCD were substantially weaker and statistically nonsignificant after adjusting for other risk factors." (SCD means sudden cardiac death,)
I'm guessing that the 10 numbers on the Wellrue report are the "conventional HRV parameters" in the sentence I quoted.
That said, the HRV parameter that *is* associated with SCD seems easy to obtain, at least in terms of time (one minute).
But am I correct in saying that sometimes the SCDs occurred years after this special measurement was taken? (I don't have the patience to read the whole thing.)
Whatever! It seems that these HRVs could be a worthy pursuit, especially if the variations are variable. After all, the vaunted Apple Watch sets forth an HRV from what I gather.
Sorry if the article sent you down another "rabbit hole". I wasn't recommending the article, just drawing it to your attention as it appeared on the same day as your Post. I'm hardly in a position to understand even my own HRV, as I have no Apple ecg watch nor Wellue ecg device. But I am still looking for an ecg device that will monitor my nights to better understand whether I'm missing anything from my known AF burden, but also not requiring a laptop. Maybe when I am then confronted with my own personal HRV parameters, my personal interest will peak.
I hope you find the device that doesn't require a computer. You say "monitor your nights." How are you monitoring your days? Are you proactively using a Kardia-type device that requires your initiative?
I take it that you don't use a computer for other tasks. Do you know anybody who could take your Wellue device and plug it into *their* computers? You'd have the turn-around problem, but maybe after a couple of weeks, you'd have reports on 8 or 10 nights.
I can tell you that I had a hell of a time getting my Wellue to work. I never did get it to work with my up-to-date, high-end Windows 10 desktop computer. But It works wonderfully with my 12-year-old Windows 8.1 laptop. And even then, it takes more computer savvy than it should. Maybe you could find a computer-repair sort of shop (shoppe?) and pay someone a few quid? Or a senior center (if you're one of them)?
As far as HRV parameters, I suppose I have mine, but I haven't had the gumption to poke at them, other than to seek the wisdom of others who will advise me not to bother.
We are both 77. I used to work with computers in the early days of Computing in Australia when 4K of storage was a device about the size of a small fridge. But I managed to escape that career and haven't wanted a device of my own since. I did use the local library computers for many years, but since my mobility has worsened, I only have a phone to fulfill my internet needs. Good enough for me. But I do need a better phone than my 6 year old Motorola running Android 9.
I did enjoy the contributions of Cliff_G not long ago as he was attempting to share information as to how best to get the 24 hour Wellue ecg device to work amid all the different confusing versions of the Wellue software available. Sounds like you were part of that discussion?
Yes, I did see that we both are 77 after I sent my last.
I started using computers at the workplace in the early 70s.
I bought my first personal computer in 1984. It cost $3,000 and had a hard disk of 20 megabytes. I complained about that, because I ordered one with 10 megabytes and worried that the data would be too close together on the 20 disk and get corrupted from being crushed too much.
Yes, that was me in that conversation with Cliff_G. He was pretty smart in seeing that one problem was -- or seemed to be, and still seems to be -- sort of an old-fashioned hardware problem of recognizing an inserted external device, not a software problem.
I have never been one to desire the latest. I still have a flip phone, and I didn't get a Windows computer until around 2005. I still think WordPerfect for DOS is the best word processor ever created. I use the latest only to barely survive.
I started paid work in the computing section of a large Australian manufacturing conglomerate in 1964 after winning a scholarship which included simultaneously studying for a degree in maths and computer science in term time. No holidays in those days. No wonder it gave me a rash.😄
PS. I remember the confusion mentioned in the Post over access to different versions of Wellue software. And recognising an external device is also dependant on the software surely. It's always the humans that cause the problems!🤔
I have had considerable problems with the Wellue software too (on Win 10), and they eventually advised me to download and use the Livenpace software. This has worked fine with the Wellue ECG device, and it's identical in function to the Wellue. The other thing they told me was that there is no need to do a Safely Remove for the USB connection to the ECG device. Apparently there's an anti-write-protection built in to their software and you can (and should) just pull it out. The device seems to take over the USB control of the computer when plugged in, but as soon as you remove it, all suddenly works properly again. Not totally impressed, but it is what it is.
Finally, the Livenpace instructions say to run the program as an Adminstrator. I've been doing this though haven't properly tested it as an ordinary app yet.
You might be interested in the research that links HRV to the functioning of the sympathetic/parasympathetic nervous system and how breathing exercises can increase HRV and correct the sympathetic/parasympathetic balance. See “Heart Breath Mind, Conquer Stress, Build Resilience, and Perform at Your Peak” by Leah Lagos, Psy.D.
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