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HRM

Apple Watch 4: Do ECG Readings Give A-Fib Patients a False Sense of Security?

We received a couple of emails about the new Apple Watch 4. As many A-Fib patients may be aware, recently Apple unveiled the next generation of Apple Watch which includes a second generation optical heart sensor.

Among several interesting features, it can generate an ECG tracing similar to that of a single-lead electrocardiograph.

In her Sept. 14, 2018 editorial on Medscape.com, ECG Readings From the Apple Watch? This Doctor Is Leery, Dr. Hansa Bhargava gives her perspective of this feature for those diagnosed with atrial fibrillation. She writes that she finds the Apple Watch’s ability to do a one-lead ECG interesting but has some reservations.

“…Here’s what I worry about: the false sense of security that a person could have.

Apple Watch 4 screens

Being able to do a one-lead ECG is definitely interesting, but does it always help? Here’s a scenario. A 40-year-old runner starts feeling dizzy, lightheaded, and has chest pain. He worries but remembers that there is an ECG function on his watch. He proceeds to do the ECG which then reads “normal.” Because of this he decides to continue to run.
What he doesn’t know is that this is only a one-lead ECG, and even though it seems normal, it is an isolated data point; more information is needed to diagnose what is going on. What if he is having angina? In fact, 30% of cardiovascular events happen to people under the age of 65. One lead on an ECG could certainly miss this; in fact, even a 12-lead ECG, if the only isolated data point, could miss this.

Dr. Andrew Moore, an emergency department physician at the Oregon Health and Science University is also skeptical of the Apple Watch 4 ECG feature:

“The ECG thing is a little bit overhyped in terms of what it will really provide. …The tech that Apple is working with is very rudimentary compared to what we’d do for someone in a hospital or health care setting.” 

While the watch can detect changes in the patterns of a person’s heart rate such as too fast, too slow, or beating irregularly—signifying A-Fib, the watch doesn’t diagnose a medical issue.

Apple Watch and Other DIY Heart Rate Monitors

Guide to HRMs and Handheld ECG monitors

Keep in mind these doctors’ concerns apply to all consumer heart rate monitors (HRM), those with optical heart sensors and those with electrode-containing monitors.

Wrist vs. Chest Bands: Wrist-band optical heart-rate monitors (like Apple Watch 4) may be more convenient or comfortable and have advanced over the years. But researchers found that electrode-containing chest-strap monitors were always more accurate than their wrist counterparts and more reliable and consistent. To learn about this research, read When Tracking Your Heart: Is a Wrist-Worn Heart Rate Monitor Just as Good as a Chest Strap Monitor?

Blue-tooth chest-band with smartphone app

As an A-Fib patient, when monitoring your heart beat rate is important to you (while exercising or doing heavy work), you’ll want to stick with an electrode-containing monitor (chest band-style, shirts or sports bras with built-in electrode pads, etc.).

For help selecting a HRM, see our article: Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors (Part I). Also take a look at Steve’s list on Amazon.com: Top Picks: DIY Heart Rate Monitors for A-Fib Patients.

Keep in mind: None of these DIY heart rate monitors are diagnostic tools. But they can be helpful once you know you have A-Fib, A-Flutter or suffer from PVCs, PACs, etc. Just don’t make medical decisions based on their readings. See your doctor if you have any concerns or symptoms.

Remember: None of these DIY heart rate monitors are diagnostic tools

Resource for this article
Hansa Bhargava, MD. ECG Readings From the Apple Watch? This Doctor Is Leery: The Apple Watch Gets ‘Medical’. Medscape/NEWS & PERSPECTIVE.  September 14, 2018. https://www.medscape.com/viewarticle/902001?src=wnl_edit_tpal&uac=159481AX&impID=1739393&faf=1

Hauk, C. Data Collected by Apple Heart Study Used to Obtain Apple Watch Series 4 ECG Clearance from FDA. Mac trast.com. Sep 14, 2018.
https://www.mactrast.com/2018/09/data-collected-by-apple-heart-study-used-to-obtain-apple-watch-series-4-ecg-clearance-from-fda/

When Tracking Your Heart: Is a Wrist-Worn Heart Rate Monitor Just as Good as a Chest Strap Monitor?

Wrist-worn heart rate fitness trackers like Fitbit and Apple Watch have become trendy wrist accessories, but are they accurate enough for Atrial Fibrillation patients? How do fitness trackers compare to chest strap heart rate monitors (HRMs)?

What’s Behind the Discrepancies? Different Technologies

Chest-band HRM transmitted to wristwatch

Chest strap style heart rate monitors are consumer products designed for athletes and runners, but used by A-Fib patients, too. They measure the electrical activity of the heart. They’re usually a belt-like elastic band that wraps snugly around your chest with a small electrode pad against your skin and a snap-on transmitter.

The pad needs moisture (water or sweat) to pick up any electrical signal. That information is sent to a microprocessor in the transmitter that records and analyzes heart rate and sends it to a wrist watch display or smartphone app.

Optical HRM with LEDs on inside

Wrist fitness trackers typically sit on your wrist and don’t measure what the heart does. Most glean heart-rate data through “photoplethysmography” (PPG) with small LEDs on their undersides that shine green light onto the skin on your wrist.

The different wavelengths of light interact differently with the blood flowing through your wrist, the data is captured and processed to produce understandable pulse readings on the band itself (or transmitted to another device or app).

HRMs Research Study

A 2016 single-center study was designed to find out whether wrist-worn heart rate monitors readings are accurate. Four brands of fitness trackers were compared against the Polar H7 chest strap heart monitor (HRM) and, as a baseline, with a standard electrocardiogram (ECG).

On a personal note, I used a Polar-brand chest-band monitor when I had A-Fib, and that’s what I recommend to other A-Fib patients.

Researchers at the Cleveland Clinic enrolled 50 healthy adults, mean age, 37 years. In addition to ECG leads and the Polar chest-band heart rate monitor, patients were randomly assigned to wear two different wrist-worn heart rate monitors (out of the four).

Participants completed a treadmill protocol, in which heart rate was assessed at rest and at different paces: between two and six miles per hour. Heart rate was assessed again after the treadmill exercise during recovery at 30 seconds, 60 seconds and 90 seconds.

In total, 1,773 heart rate values ranging from 49 bpm to 200 bpm were recorded during the study. Accuracy was not affected by age, BMI or sex. The four wrist-worn heart rate monitors assessed were the Apple Watch (Apple), Fitbit Charge HR (Fitbit), Mio Alpha (Mio Global) and Basis Peak (Basis).1

HRMs Study Results

Chest Strap Monitors: The chest strap monitor was the most accurate, with readings closely matching readings from the electrocardiogram (ECG).

The chest strap monitor was the most accurate, closely matching the ECG; The wrist-bands were best when the heart was at rest.
In general, the chest straps were more accurate because the sensor is placed closer to the heart (than a wristband), allowing it to capture a stronger heart-beat signal.

Wrist-Worn Monitors: Accuracy of wrist-worn monitors was best at rest and became less accurate with more vigorous exercise, which presumably is when you’d most want to know your heart rate.

None of the wrist-worn monitors achieved the accuracy of a chest strap-based monitor. According to the electrocardiograph, some wrist-worn devices over- or underestimated heart rate by 50 bpm or more.

What Patients Need to Know

Blue-tooth chest-band with smartphone app at A-Fib.com

Blue-tooth chest-band with smartphone app

Wrist-band optical heart-rate monitors may be more convenient or comfortable and have advanced over the years. But in this small study, researchers found that chest-strap monitors were always more accurate than their wrist counterparts and more reliable and consistent.

When monitoring your heart beat rate is important to you (while exercising or doing heavy work), you’ll want to stick with an electrode-containing monitor (chest band-style, shirts or sports bras with built-in electrode pads, etc.).

To help you choose a HRM, see Steve’s Top Picks: DIY Heart Rate Monitors for A-Fib Patients at Amazon.

Bottom line 
Leave the wrist-worn trackers for the casual fitness enthusiasts

References for this Article
• Accuracy of popular wrist-worn heart rate monitors varies during exercise. Cardiology Today. Healio.com. October 19, 2016. http://tinyurl.com/Healio-Wrist-Worn-Monitors

• Safety Recall of Basic Peak Watch, Sept. 16, 2016: http://www.mybasis.com/safety/

• Wang R, et al. Accuracy of popular wrist-worn heart rate monitors varies during exercise; JAMA Cardiology. 2016;doi:10.1001/jamacardio.2016.3340. October 19, 2016

• Phend, C. Wrist-Worn Heart Monitors Unreliable During Exercise: Popular devices don’t stand up to ECG. MedPage Today. October 12, 2016. http://www.medpagetoday.com/cardiology/prevention/60751

• Ross, E. You Can Monitor Heart Rhythm With A Smartphone, But Should You? NPR.org. October 15, 2016. http://tinyurl.com/NPR-wrist-heartratemonitors.

• Margolin, M. Your Heart Rate Monitor Is Nonsense, Study Says. Oct 18 2016. https://motherboard.vice.com/en_us/article/your-fitbit-heart-rate-monitor-wrong-cardiology

• Palladino, V. How wearable heart-rate monitors work, and which is best for you. The choice between chest straps and optical monitors is more complex than it seems. Ars Technica 4/2/2017. https://arstechnica.com/gadgets/2017/04/how-wearable-heart-rate-monitors-work-and-which-is-best-for-you/

Footnote Citations    (↵ returns to text)

  1. Safety Recall of Basic Peak Watch, Sept. 16, 2016: http://www.mybasis.com/safety/

Updated Report: Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors

One of our most visited pages on A-Fib.com is our report: Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors. Patti and I just completed an update, adding new content and revising others. The report is a starting point for those making a purchase. (There are many good products, so we pared down the list for you.)

Not to be Confused with Optical Fitness Wristbands

The HRM sensors/monitors in this article work by being in contact with the skin. Don’t confuse these with fitness bands like Fitbit that use an optical sensor to shine a light on your skin illuminating your capillaries to measure your pulse.

Our Recommendations of Heart Rate Monitors (HRM)

In the first part, we have updated our recommendations of Heart Rate Monitors (HRM):

Wrist watch monitors with chest sensor bands
Bluetooth app-enabeled sensors for smartphones
Wearable technology with wireless sensors.

Consumer, DIY or ‘Sport’ Heart Rate Monitors (HRM) are designed for runners and other recreational athletes but can be useful to A-Fib patients who want to monitor their heart rate and pulse when exercising or when performing physically demanding activities (i.e., mowing the lawn, climbing stairs, loading and unloading equipment, etc.).

Affordable Handheld Real-Time ECG monitors

The second part is about the emerging new category of affordable Handheld Real-time ECG monitors that let you capture and share your ECGs. We’ve update the reviews for the following and added one new monitor:

Kardia Heart Monitor by AliveCor
The HeartCheck™ PEN handheld ECG device from CardioComm Solutions
PC-80B ECG Monitor (Heal Force or Creative Easy)
BodiMetrics Performance Monitor NEW REVIEW
Handheld ECG Monitor CMS-80A (FaceLake or Contec Medical Systems)

Continue reading…go to our updated report: Guide to DIY Heart Rate Monitors (HRMs) & Handheld ECG Monitors.

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