Rate-controlled atrial flutter (not afib)– can any wearables show it?

[FraserB]

Has anyone with 4:1 atrial flutter used a personal ECG device like Apple watch or Kardia Mobile to detect it? Since 4:1 flutter produces a regular rhythm around 75 bpm, I’m wondering if these devices simply display it as a normal heart rate rather than flagging an arrhythmia. Or does it show anything unusual, such as tachycardia alerts or irregularities?

I’m considering getting a personal ECG device, but I primarily experience atrial flutter rather than atrial fibrillation. Since I’m on diltiazem (for rate control), my flutter often conducts at 4:1 (75 bpm). I'm not complaining about the rate, it's liveable, and I'm on apixaban, just need to know if there’s a reliable personal ECG device that can actually detect flutter rather than only afib.

[mjames1]

Not a "wearsble" but the Kardia 6L should document it, because flutter is better recognized on Lead 2. Keep in mind the Kardia will not call it flutter -- might call it afib or unclassified-- because it's not programmed for flutter, however, the EKG itself should suggest flutter to someone that knows how to read it, be at yourself or a doctor.

Another option is the Wellue which you do wear with a chest strap and I believe is used in conjunction with a computer. Never personally used it so maybe someone else will jump in.

Jim

[FraserB in reply to mjames1]

Thanks Jim, It does then look like Kardia Mobile 6L is the best bet because of its multi-lead capability or at least the best chance to visualize and read flutter waves such as a doctor.

[SlothOnSpeed]

Can confirm, Kardia will call it Unclassified.

[mjames1 in reply to SlothOnSpeed]

Or it may incorrectly say afib, but it really doesn't matter what Kardia calls it because the only thing that matters is the EKG itself, which can be read by someone trained,. That could be yourself or it could be an electrophysiologist. At this point in time all AI interpretations of EKG.'s are inferior to a trained human.

Jim

[Buffafly]

If you get a Kardia or similar I would be interested to see the recording as my determination when not in AF is usually Unclassified and my average HR is about 74 however the rate does vary a lot over the day. My recording has an R, S and T but no P or Q.

[FraserB in reply to Buffafly]

That's interesting, so it could show unclassified and your own recording show the absence of P waves but the presence of R, S, and T waves makes sense if you're in atrial flutter.

[mjames1 in reply to FraserB]

Kardia will never make a flutter call, because it's currently not in the program probably because of FDA regulations.

But again the important thing is the EKG that Kardia generates. That can be read by a trained human better than any machine.'s AI.

Jim

[Cliff_G]

Yes, my Wellue has picked that up for me. The AI analysis will often it flag it incorrectly, but if you look for the tell-tale sawtooth wave between the main beats you'll see it. Have a look on the web for pics of Atrial Flutter. It's one of the easiest patterns to recognise.

I don't know if the Kardia will show it in the "raw" form needed to make this assessment.

[mjames1 in reply to Cliff_G]

You see flutter best on lead 2 which Kardia 6L has. Not sure what you mean by "raw form" -- what you got us a six lead E KG and that's what you want only rrumped by a 12 lead. Does Wellue have lead 2?

Jim

[Cliff_G in reply to mjames1]

By raw I mean uninterpreted by a machine.

The Wellue states it is lead II (using the recommended 45° pectoral orientation). I'm not sure that's entirely true for any single lead device, but is probably a reasonable approximation. I certainly saw the classic saw tooth on mine.

[mjames1 in reply to Cliff_G]

Yes, Kardia generates a real (raw) medical grade 6 lead EKG, in addition to its interpretation which I always take with caution, as with any AI interpretation. Btw fluttered does not always present with the classic sawtooth pattern. That's why lead two is important to help differentiate the various tachy arrhythmias. Where the Wellue maybe superior here is that you were able to see the before and after i.e. the transition which can also offer clues. With basically just getting a short rhythm strip..

Jim

[FraserB in reply to Cliff_G]

It does start to make sense about the AI analysis and it's misclassification especially regarding flutter. Then it looks like the AI algorithms in the personal ecg are mostly trained for afib and tachy. So it comes down to Kardia 6L is more likely to reveal flutter (and better with a visual and a trained doctor viewing) and the Wellue slightly better for detailed waveform?

[Cliff_G in reply to FraserB]

The Kardia 6L gives six leads, giving simultaneous waveforms from different "viewpoints" and is inherently more useful for anyone ECG-trained than a single lead (actually 2 contacts). Most Holters give a more than a single lead trace.

I doubt the Wellue is better or more detailed than the 6L. But machine / AI interpretation is always tricky. Even full 12-lead hospital ECGs provide interpretation (plus for example QRS width), but that's only rough and the traces need properly-trained human interpretation.

Having said that, some machine learning projects on ECGs have proven startling. One paper I read found their ML was able to predict future AF! I think it's a case of training the AI/ML on the most relevant data set. I dug into Wellue's "FDA approval" claim. Turns out it was merely a recognition by the FDA that a (rather old) data set comprising different rhythms was valid for training AI on. It didn't say the AI interpretation was correct.

[FraserB in reply to Cliff_G]

So Wellue said they got FDA approval, but then that approval was just for the data they used, not for how well the computer works at predicting heart problems -- if the data wasn’t good to start with, the AI's predictions could still be wrong. Then data ideally must be from a diverse group of people -- ages, genders and of course those with heart conditions and those without. Good data is everything.

[JezzaJezza]

Hi an Apple Watch will capture it but diagnose it as possible Atrial Fibrillation “ or undetermined.

I use an app called Qaly to analyse my ECGs and you can either have AI or pay a bit more for a human technician to analyse it.

After capture on the Apple Watch it imports automatically into the app.

[Twosumsmum]

I have had flutter for years , no home monitors picked it up my atrial rate was initially 300 ventricular rate 100 repeated cardio versions converted it initially for ever shorter periods of time and caused sick sinus tachybrady syndrome so I needed a pacemaker. I still have atrial rate of 250 and paradoxical a fib at odd times and other arrhythmias so pacemaker changed to CRPT followed a year later by AV node ablation. So now my ventricular rate is paced at 80!which is best to control the AFib , the problem doesn’t go away after node ablation as the atria are still having their own party with balloons and pretzels and when the afib joins in I decompensate and get acute pulmonary oedema . In the last 18 months I am in congested heart failure .

As flutter is always there unless you have been cardioverted why are you wanting to monitor it . I was having regular pacing interrogation to keep an eye on things .

[FraserB in reply to Twosumsmum]

Thanks for sharing your experience. And I agree, atrial flutter can be challenging to manage and I was interested reading your experience and how it can progress, in some cases to heart failure. Currently I am paroxysmal atrial flutter and I was mainly wondering if these devices can detect atrial flutter when it does happen, since my flutter as well as when I'm in sinus rhythm rate can stay the same 75 bpm due to my medication. I wasn’t sure if they’d just show a normal heart rate or detect it as an issue. And you're right about the regular checking --I’ll be going for further Holter monitoring as well to get a more detailed picture of my heart’s rhythm.

[Vnorkus1]

FraserB.....I have the Kardia mobile(6 leads) and my aflutter showed up as tachycardia. My EP had me get an EKG at a hospital when this showed up 4 days in a row and he called me and said that the tachycardia was AFLUTTER...which I had a successful ablation for!

[FraserB in reply to Vnorkus1]

That’s really helpful to know. It’s interesting that your Kardia Mobile (6L) picked up the flutter as tachycardia. It confirms that for the final result a hospital EKG or a doctor experienced in reading them is still the most accurate way to confirm. it’s great to hear that your ablation was successful.

[Vnorkus1 in reply to FraserB]

THank you. Very grateful.

[Halfheart]

I don't think any of the popular devices will automatically detect it. You will have to look at the ecg yourself to diagnose it. The Kardia 6L can show the flutter waves, but it may not be very clear. The easiest way to confirm 4:1 flutter is to note the rock-steady 75 bpm and no p-waves. If you have access to an HRV reading, you will see that go down dramatically as well, due to the rate being stuck like a metronome.

[FraserB in reply to Halfheart]

I am due soon to wear a Holter and what you've mentioned about the HRV reading if I do go into flutter being stuck like a metronome says it completely. Thanks for the info. The Holter is definitely above the wearables for an HRV reading. But I didn't know if there was something out there besides having to wear a Holter regarding flutter.

[Puffnstuff]

Both my wife and I have a smart watch and both only show heart beats. I have irregular heart beat and it definitely doesn't show mine so I don't think any would show it. I hope you get sorted soon.

[Deary63]

hi

Just to say I wear the Apple Watch and suffer with ectopic beats and flutters .. my watch never says anything is wrong .. I’ve tried using ecg also it does pick up the missed beat .. you can print the recording off and show to your doctor too..

All the best

Sue

[PurpleGirl05]

At first, my EP diagnosed my atrial flutter from 6L Kardia readings, but my rate was much higher than yours at 150 bpm. Later we managed to catch the beast at the ER on an "official" EKG.