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Credit: Pixabay/CC0 Public Domain
Credit: Pixabay/CC0 Public Domain
Smartwatches can help doctors detect and diagnose irregular heart rhythms in children, according to a new study from the Stanford School of Medicine.
The finding comes from an examination of electronic health records for pediatric cardiology patients receiving care at Stanford Medicine Children’s Health. The study will be published online on December 13 Communication medicine.
Over a four-year period, patients’ medical records mentioned “Apple Watch” 145 times. Among patients whose medical records mentioned the smartwatch, 41 had abnormal heart rhythms confirmed by traditional diagnostic methods; of these, 29 children were diagnosed with arrhythmias for the first time.
“I was surprised how often our standard monitor didn’t pick up arrhythmias and the watch did,” said senior study author Scott Ceresnak, MD, professor of pediatrics. Ceresnak is a pediatric cardiologist who treats patients at Stanford Medicine. “It’s great to see that newer technology can really make a difference in how we can care for patients.”
The study’s lead author is Aydin Zahedivash, MD, a clinical instructor of pediatrics.
Most of the abnormal rhythms detected were not life-threatening, Ceresnak said. However, he added that the arrhythmias detected can cause distressing symptoms such as palpitations, dizziness and fainting.
Skip a beat sometimes
Doctors face two challenges when it comes to diagnosing children’s cardiac arrhythmias or heart rhythm abnormalities.
The first is that cardiac diagnostic devices, although improved in recent years, are still not ideal for children. Ten to 20 years ago, a child had to wear for 24 to 48 hours a Holter monitor consisting of a device about the size of a smartphone attached by wires to five electrodes attached to the child’s chest. Patients can now wear event monitors – in the form of a single sticker on their chest – for a few weeks. Although the event monitors are more comfortable and can be worn longer than a Holter monitor, they sometimes fall off early or cause problems such as skin irritation from adhesives.
The second challenge is that even a few weeks of continuous monitoring may not capture the erratic behavior of the heart, as children experience arrhythmias unpredictably. Children can go months between episodes, making it difficult for their doctors to determine what’s going on.
Connor Heinz and his family faced both challenges when he experienced periods of rapid heartbeat starting at age 12: An adhesive monitor was too irritating, and he had an irregular heartbeat only once every two months. Ceresnak thought he knew what was causing the racing rhythms, but he wanted confirmation. He suggested that Connor and his mother, Amy Heinz, could try using Amy’s smartwatch to record the rhythm the next time Connor’s heart started racing.
Using smartwatches to measure children’s heart rhythms is limited by the fact that existing smartwatch algorithms that detect heart problems have not been optimized for children. Children have faster heartbeats than adults; they also tend to experience different types of abnormal rhythms than adults who have cardiac arrhythmias.
The paper showed that the smartwatches appear to help detect arrhythmias in children, suggesting that it would be useful to design versions of the smartwatch algorithms based on real heart rhythm data from children.
Evaluate medical records
The researchers searched patients’ electronic medical records from 2018 to 2022 for the phrase “Apple Watch,” then checked to see which patients with this phrase in their medical records had submitted smartwatch data and been diagnosed with cardiac arrhythmia.
Data from watches included alerts on patients’ heart rates and patient-initiated electrocardiograms, or EKGs, from an app that uses the electrical sensors in the watch. When patients activate the app, the ECG function records the heart’s electrical signals; Doctors can use this pattern of electrical pulses to diagnose different types of heart problems.
Of 145 mentions of the smartwatch in patient records, 41 patients had arrhythmias confirmed. Of these, 18 patients had taken an ECG with their watches and 23 patients had received a message from the watch about a high heart rate.
The information from the smartwatches prompted the children’s doctors to conduct medical examinations, from which 29 children received new arrhythmia diagnoses. In 10 patients, the smartwatch diagnosed arrhythmias that traditional monitoring methods never picked up.
One of those patients was Connor Heinz.
“At a basketball tryout, he had another episode,” Amy Heinz recalled. “I put the watch on him and emailed a bunch of pictures (of his heartbeat) to Dr. Ceresnak.” The information from the watch confirmed Ceresnak’s suspicion that Connor had supraventricular tachycardia.
Most children with arrhythmias had the same condition as Connor, a pattern of rapid heartbeats originating in the upper chambers of the heart.
“These irregular heartbeats are not life-threatening, but they make children feel terrible,” Ceresnak said. “They can be a problem and they’re scary, and if wearables can help us get to the bottom of what this arrhythmia is, that’s very useful.”
In many cases of supraventricular tachycardia, the abnormal heart rhythm is caused by a small short circuit in the heart’s electrical circuits. The problem can often be cured by a medical procedure called catheter ablation that destroys a small, precisely targeted region of heart cells that is causing the short circuit.
Now 15, Connor has been successfully treated with catheter ablation and plays basketball for his high school team in Menlo Park, California.
The study also found smartwatch use noted in medical records for 73 patients who were ultimately not diagnosed with arrhythmias.
“Many children have palpitations, a sense of funny heartbeats, but the vast majority do not have medically significant arrhythmias,” Ceresnak said. “In the future, I think this technology can help us rule out something serious.”
A new study
The Stanford Medicine research group plans to conduct a study to further assess the usefulness of the Apple Watch in detecting heart problems in children. The study will measure whether, in children, pulse and heart rate measurements from the watches match measurements from standard diagnostic devices.
The study is only open to children who are already cardiology patients at Stanford Medicine Children’s Health.
“The wearable market is exploding, and our kids are going to use them,” Ceresnak said. “We want to make sure the data we get from these devices is reliable and accurate for children. Along the way, we’d love to help develop pediatric-specific algorithms for monitoring heart rhythms.”
The study was conducted without external funding. Apple was not involved in the work. Apple’s Investigator Support Program has agreed to donate watches for the next phase of the research.
Apple’s Irregular Rhythm Notification and EKG app is approved by the Food and Drug Administration for use by people 22 years of age or older. The high heart rate notification is only available to users 13 years of age or older.
Aydin Zahedivash et al, Communication medicine (2023).
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