What can wearables and can’t tell you about heart health?

During routine tests, Marylin Spunar was shocked to learn that at the age of 51, she had been diagnosed with atrial fibrillation – an irregular heart rhythm that, if left untreated, can lead to a stroke. During her visit, the doctor told her about a feature on the Apple Watch that could monitor her heart rate.

“I turned it on and I actually get notified five or six times a day because with Afib it’s constant. It gets annoying,” Spunar said.

Just 10 months after seeing a cardiologist and undergoing treatment, an alert on her watch informed her that her irregular heart rate had returned.

“If I didn’t have this watch. I wouldn’t know. I really wouldn’t do it,” she said. “The watch gives me confidence, and my doctors, that I will know when it happens.”

Symptoms of atrial fibrillation, commonly known as Afib, include fatigue, heart palpitations, breathing problems and dizziness. Afib is one of the most common arrhythmias. Risk factors for Afib include high blood pressure, coronary artery disease, and obesity.

Most people diagnosed with Afib are in their 50s or 60s, but according to Dr. Yasser Rodriguez, an electrophysiologist at Cleveland Clinic Weston, the number of Afib diagnoses is increasing and patients are getting younger.

“As the obesity epidemic grows, we are seeing a much higher incidence of sleep apnea and obesity in younger people, resulting in patients approaching the age of 50,” Rodriguez said.

Dr. Pedro Martinez-Clark, medical director and CEO of Amvita Heart & Vascular Health, also attributes the younger age of diagnosis to better technology such as wearable devices that have enabled conditions to be detected, diagnosed and treated at an earlier stage.

More and more people are using wearable devices such as smartwatches and fitness trackers to monitor their physical activity and well-being. However, others, like Spunar, use them to detect and treat conditions early.

When it comes to wearable technology, consumers have access to many devices, but not all are FDA-approved. The most popular devices, Apple Watch and Fitbit, are cleared by the FDA to identify Afib.

“I think these technologies definitely represent a significant advance in our ability to detect risk patterns,” Martinez-Clark said. “But like anything else, there are positives and negatives.”

What wearable devices can do

Wearables offer a range of features, from tracking activity levels and sleep quality to monitoring vital signs such as heart rate and blood pressure. This may be helpful in detecting heart rate abnormalities in patients who have fewer symptoms.

“Let’s say you’re eating dinner and you’re relaxed and your heart rate is 140-150; this is not normal,” Martinez-Clark said. “In the absence of symptoms, wearable technology can tell us that the growth rate is fast when it should not be fast.”

According to Martinez-Clark, even more important than detecting an arrhythmia may be tracking the frequency and regularity of the arrhythmia. Because symptoms can vary, this is the most important information doctors will use when making a diagnosis – a task that wearable devices have made easier for potential patients.

“Regardless of a patient’s age, an irregular heart rhythm can have very serious consequences,” Martinez-Clark said.

What wearable devices can’t do

On the other hand, obsessive testing and false positives are just a few reasons why doctors advise caution when using wearable device advice.

“Companies prefer to overprice rather than underprice, and since they prefer to overprice, make sure they don’t lose anything, not the other way around,” Rodriguez said. “Many times a patient will come in and it’s not exactly atrial fibrillation, but something else, much milder.”

For example, in younger people, an unusually fast heartbeat may be normal but may cause false alarms. And for patients with significant anxiety, detections and alerts can trigger even more anxiety.

“We actually advise these patients not to wear these devices,” Martinez-Clark said.

Another problem with readings taken by a smartwatch or fitness tracker is the varying level of interference. According to Dr. Andre Landau, an interventional cardiologist at Broward Health North, in the test performed by a doctor, the skin is disinfected and sometimes shaved to ensure close contact. Moreover, the patient remains motionless throughout the examination.

“If the patient moves during the recording, it becomes more difficult to interpret the recording,” Landau said.

For this reason, doctors strongly encourage the public to see a doctor and get appropriate tests if they feel symptoms or receive notifications that an arrhythmia has been detected.

For symptomatic patients or those who have experienced a stressful situation such as a stroke, Landau recommends a more sophisticated device such as KardiaMobile, an FDA-approved device for detecting Afib, to monitor electrical signals in the heart.

“It will record an EKG sent to your cell phone, and then you can text or email your doctor for further analysis,” Landau said.

New Afib treatment launched at Cleveland Clinic

On Monday, Cleveland Clinic Weston is launching a new treatment for Afib known as “pulsed field ablation.” PFA is a non-thermal treatment method that provides shorter treatment times and less risk to adjacent structures.

“It’s just completely revolutionary. “I don’t want to overuse this word, but I probably won’t see another technology in my career that is as revolutionary as this overnight,” Rodriguez said.

Catheter ablation therapy uses electroporation, the delivery of rapid, pulsed, high-voltage electric fields to tissue, causing cell membranes to become permeable, to treat cardiac arrhythmias.

“It’s almost immediate,” Rodriguez said. “Each treatment takes 2.5 seconds. With older technology it was 10 to 15 seconds. You extract the entire vein in a matter of seconds.”

According to Rodriguez, at least 12 million people in the country have been formally diagnosed with Afib, and the prognosis is “reaching sky high.”

“I tell everyone you need to go get your annual exam,” Spunar said. “Because even if you don’t have a watch, at least your physical exam can capture some of it.”