This transcript has been edited for clarity.
I am Walid Amara. I am a cardiologist and electrophysiologist. Thank you for joining me today for this discussion about: Do we need smartwatches to screen for arrhythmias in clinical practice?
As you know, smartwatches now are increasingly used. They can be used by any person. You might not even have an arrhythmia. You might have a smartwatch just to stay aware about your health. But these smartwatches offer the opportunity to detect many abnormalities and, as an electrophysiologist, I pay attention to atrial fibrillation.
Different trials have demonstrated an interest in the detection of atrial fibrillation. The first was the Apple Heart study. But there were other studies with other manufacturers that evaluated how we can detect atrial fibrillation.
If you want to use a smartwatch to detect atrial fibrillation, the first thing to consider is that it is rare for atrial fibrillation to be detected this way. This is because the majority of smartwatch users are young and the probability of atrial fibrillation increases with age. If we look at the Apple Heart study, there were around 400,000 people wearing smartwatches and only 2000 received a notification by the smartwatch regarding atrial fibrillation. When they had a notification, the positive predictive value of detection of atrial fibrillation was high, more than 80%. So that means that we can detect atrial fibrillation for asymptomatic patients and we know that, in clinical practice, half of the cases of atrial fibrillation are asymptomatic.
The second thing to consider is that smartwatches can be used to conduct electrocardiograms. These are not 12-lead electrocardiograms; they are just one-lead electrocardiograms. When you do this one-lead electrocardiogram, you can detect different arrhythmias and extra beats, and you can also detect atrial fibrillation or other arrhythmias like junctional tachycardias, etc.
I think it would be interesting to think about how this can be used in everyday practice. Can the cardiologist or electrophysiologist recommend a smartwatch for their patient?
Consider a patient experiencing palpitations. Frequently, these patients come to our offices and we’ll do a cardiological exam, an electrocardiogram, an echo, or even a Holter ECG. Often these exams come back normal, but we don’t tell the patient that they don’t have anything. We just say that we haven’t detected anything at this stage. I think this scenario is an excellent example of where a smartwatch might be useful. When the patient feels a palpitation, they can manually do an electrocardiogram with their smartwatch. This single-lead ECG can help you diagnose a pathology.
I have many patients in my practice who I have reassured that they had infrequent ventricular extra beats, for example. But I also have frequent patients with reentrant tachycardia or junctional tachycardia, leading to me conduct a final step of ablation for these patients.
From an electrophysiology point of view, I have used this approach frequently to diagnose these types of arrhythmias without waiting months or years.
Smartwatches are also recording rhythm all the time, so they can detect abnormalities like atrial fibrillation.
For example, you could recommend smartwatch use to an older patient to help detect atrial fibrillations. And if they have a high ischemic risk and a high CHA2DS2-VA score, you might decide to recommend anticoagulation. You might do this even if we don’t yet have all the evidence needed to say that treating asymptomatic atrial fibrillation can be positive and efficacious.
Also, if you are managing a patient with palpitations, wearing a smartwatch might help them think more about their health, physical activity, and heart rate. This can help you in your clinical practice and it’s a situation that I frequently see.
As an electrophysiologist, I especially think about patients after an atrial fibrillation ablation. Even if smartwatches are a little bit expensive, they can help you diagnose earlier recurrence of atrial fibrillation.
If you have any comments regarding this clinical practice, there is a comment section under this video, so feel free to add any comments about your clinical practice. It could be very interesting to learn how everyone is using them. Some may be earlier users and some may be unconvinced. I hope that I have explained how smartwatches have been useful in my clinical practice as a cardiologist and electrophysiologist.
Walid Amara, MD, is general secretary of the French National Professional Council for Cardiovascular Medicine, immediate past-president of the French College of Cardiologists, and associate professor at the College of Medicine of the Hospitals of Paris. He started his medical studies in his country of birth, Algeria, and completed them in Paris. He is involved in many educational initiatives in the Arab region and Africa.