Is it Afib or What?

[Debjimmay]

In the past two years I have worn a doctor prescribed Holter monitor twice. The first time it was for two weeks and the second time it was for 30 days. Both times the reports came back with no Afib, yet my Apple Watch and Kardia pick up Afib quite often. Does anyone else have this issue?

[Paulbounce]

Hi Deb.

I'm not a doctor but it sounds like you have Paroxysmal AFib. This is when it comes and goes. It's entirely possible that you weren't in AFib when you had the Holter Monitor but were when you checked using a Kardia.

Keep your eye on it and consult your Cardio if it continues.

Rgds Paul

[Hugheart]

Hi Debjimmay

That is truly odd, Check to see if you have your iPhone set to detect AF on a weekly basis without your awareness. It might help you with this enigma. I would also be proactive and sit down with your primary and figure this out.

Hugheart

[Debjimmay in reply to Hugheart]

Hi Hugeheart,

Yes I do have my Apple Watch set to check for Afib and I get a report once a week. A few weeks ago I was up to 33% Afib burden. This last week it was 17% burden. That seems quite high for a Holter monitor not to pick it up. I’m waiting for my cardiologist to call me after he reads the Holter monitor report. I will discuss this with him then.

[Cliff_G in reply to Debjimmay]

Agree!

[baba]

Show your doctor the watch and Kardia recordings.You can record up to five minutes on Kardia.

[Cat715]

Hi Debjimmay

When I started to become aware that I was having Afib episodes, I knew that it would be difficult to capture it on an ecg or holter. I bought a Withings watch. When I felt symptoms, I activated the part of my watch that takes an ecg.

I could then send the ecg via pdf to my gp and tgey in turn sent it to cardiology. Within days I was started on anticoagulants. I was diagnosed with paroxysmal AF. I did have a 2 week holter device fitted but it did not show AF. The Withings watch was vital in diagnosis.

[Cliff_G]

Yep, it's the First Law of Holter Monitors, "A Holter monitor is unlikely to detect the patient's arrhythmia during the time it is worn". Second Law is, "the arrhythmia will occur just after the Holter has been removed". Though for this to happen over 14 and particularly 30 days suggests your (paroxysmal) AF burden is very low, and the conflict with your Apple watch and Kardia is strange.

Definitely discuss, but one of the problems a doctor has is that they need their own solid evidence of what is happening, and if a Holter is not picking that up over 30 days, their obvious conclusion would be that your AF is very rare.

Apple watches, for all that they are very useful for a paient, don't really provide decent evidence for a cardiologist. The Kardia is better, so can you get sufficient instances recorded to discuss with your cardio?

The best thing I did was to buy a 'proper' ECG, in my case the single-lead Wellue, reviewed elsewhere on this forum. (I have no link to the company). This clearly showed my new atrial flutter which the cardio agreed with and was eventually confirmed by a Holter. Helped to get me to an ablation.

[Debjimmay in reply to Cliff_G]

Hi Cliff. I believe I have PAF because when I was in my EP’s office a few months ago, he took a EKG and said that it showed Afib. So I believe that I have it. It’s just confusing with all the different readings that I get. I do have the Wellue device also and the strange thing is it rarely comes up Afib and when it does it’s usually 0.3% or lower. Yesterday my Supraventricular heartbeats, according to the Wellue, came up with 33,711 in a 23 hour period. When I bring a copy of these reports into my doctor, he doesn’t seem concerned and just tells me I need to increase my medication. I tried increasing my medication and changing my medication, but nothing is working. My arrhythmias seem to be getting worse. I’m considering an ablation as I’m getting frustrated and I’m at my wits end here.

[Cliff_G in reply to Debjimmay]

Yes, unfortunately, I don't think the Wellue % Afib/flutter figure is very good, at least on "complex" traces (which mine always are). Certainly my traces don't have clear p-waves. I'm not sure if this is due to my original ablation, which was extensive, or because the positioning of the Wellue is such that it doesn't pick one up. AF usually shows as no p-wave and irregular R-R interval. If it can't see a p-wave, it also can't really diagnose atrial ectopics (PACs) and I think goes by a pattern of R-R , regular followed by a short one, then a bit of a gap, then back to regular.

35% supraventricular ectopics is quite high, and I'm surprised they are unconcerned. And yes, meds eventually can stop working.

Yes, wits end describes me before my 2002 ablation. The risks were quoted as relatively high back then (compared to today) but I was desperate to get free of AF. Cried my eyes out on being released in NSR. Good luck with what you decide.

[benmaise]

I had the same problem. I had it on years ago; they said then I didn't have AF. About five years ago, I did. Again, they said I didn't have AF. Then shortly after that. I had terrible palpitations for 24 hours. I went to the hospital and was diagnosed with AF.

[DawnTX in reply to benmaise]

I mentioned earlier unless you were having it happen during the test it probably won’t get picked up. That’s why I ended up with an implant loop recorder within two weeks. They had more than enough information, including more than they actually thought was going on.

[Debjimmay]

I don’t know how they can get such a mixture of comparisons. I have palpitations all the time and sometimes my Apple Watch will say I’m in Afib and other times I’ll have palpitations and it’ll say I’m NSR. Im thinking, if I don’t have Afib, then I shouldn’t have to take a blood thinner.

[DawnTX in reply to Debjimmay]

what medical school did your Apple Watch go to?

[DawnTX]

Unless you are having an EKG at the time or wearing the Monitor it is very possible that it won’t pick up the a fib it has to be active to be noticeable. My first EP seemed sure what it was, but you can’t go around guessing on medical facts. I ended up with a implant the he had me including an anticoagulant. Within two weeks of the implant, they had their. He was not only right, but the implant disclosed it was much more than they had expected to see. At least I knew I wasn’t crazy when I was feeling it. I guess a fib must get the opposite of white coat syndrome and when the doctor is around, it decides to hide lol

the loop recorder took less than an hour for them to implant in the office. I’m not sure what they gave me, but I didn’t feel a thing it did not bother me afterwards either and it put me so that I was constantly monitored. The procedure five years ago was that you would go into the office and from the had a device that would pull out all the information almost like a cash and could tell minute by minute what had gone on. It’s pretty amazing for being so non-invasive. They are good for up to five years. Mine was removed when I got my pacemaker two years ago. My EP did not want me monitoring everything. He said I would drive myself crazy and add to my which only made my worse at the time. I still have an oximeter, even though with my pacemaker the clinic and my doctor knows before I do what is happening. I usually just do it for back up very rarely have I felt bad but when I do it usually just confirms I am a little bit off.

unless your EP tells you to get one I would keep away from those items it becomes a habit like looking at your watch 100 times a day or looking at your cell phone. Everything you do affects you I find if I’m picking things up off the floor. My numbers can shoot up when I sit down. Give me a few minutes and I’m back to normal.

It is nice to have knowledge sometimes people get a little too far into it. I know what I know because of my doctor, but I always reach out to him unless it’s something I am familiar with like flutter or a thump. I prefer to have my knowledge on things to not worry about such as those things and say up it’s just a little bit of flutter shouldn’t have had that ice cream lol when it’s something unfamiliar, call your doctor.

[PurpleGirl05]

I printed out my Kardia readings (6 lead) for my cardiologist at the beginning when my symptoms would resolve right after arriving at the ER so they didn't officially see the flutter on their EKG. My cardiologist was very open to reading my Kardia data. Ultimately we did catch my flutter at the ER, and my AFib on a holter monitor, but I believe the Kardia data helped my Dr form an opinion on the course of action.