Thursday , January 28 2021

A mobile ECG detects atrial fibrillation

Dangerous cardiac arrhythmia is often found at random or often very late. Smart nappies and smartphones open up new opportunities for early detection. In addition, studies shed light on choosing the best therapy.

Interview: Hans Graber

With finger pressure on the Apple Wylfa crown you can get an ECG to do within 30 seconds, with a sign of one 's all in the green zone or if there is suspicion of cardiac arrhythmia. (Photo: PD)

With finger pressure on the Apple Wylfa crown you can get an ECG to do within 30 seconds, with a sign of one 's all in the green zone or if there is suspicion of cardiac arrhythmia. (Photo: PD)

With smartphones and smart patches you can control and record your pulse for some time. The fact that an electrocardiogram (ECG, current cardiac curve) is not possible is completely new, but it should now get a big boost. Apple has just released previously a US ECG function for its Apple Series 4 Watches on Wednesday to Europe. ECG mobile therefore has to be determined by finger pressure. This is intended to detect cardiac arrhythmia as atrial fibrillation. As he was questioned to the chief physiologist at Tregannaus Lucerne Hospital.

Great or real benefit – what do you think as a cardiologist?

Richard Kobza: That's certainly more than a gimmick. The new techniques open up many possibilities effectively. Among other things, they provide very important and uncomplicated information about possible cardiac arrhythmia such as atrial fibrillation. The user can also send his ECG directly to the doctor who attends.

Why is that important?

On the one hand, it is used for early detection, because it does not always make atrial fibrillation by symptoms that are obvious. On the other hand, smartphones and smart nappies are a better way to catch people who are not part of the classic risk groups.

Have you already had experience with the new technology?

Yes, I already had patients I suspected of having atrial fibrillation because of the symptoms. As the symptoms only appeared a few weeks, it was not possible to record the arrhythmia in the hospital using an ECG.

I recommended an ECG band for smart surveillance for these patients, and we were able to make the diagnosis.

Are there any studies on the accuracy of mobile ECGs of this kind?

A few days ago, the results of the Apple Heart Study were published in the United States. It was tested with the function now approved for Apple Watch which is the heart rhythm of 400000 people who belonged to any major risk group. More than half were under 39 years of age. An infrequent rhythm was registered with 2150 participants (0.5 per cent), of which 450 people were diagnosed with atrial fibrillation. So there is still some room for prognostic accuracy, and there are certainly false positives too. But you've just started, the applications are evolving, and with 450 cases that weren't discovered from the front, you probably have been able to save some of a stroke or t complications of other atrial fibrillation.

Let's reach the disease: what exactly is atrial fibrillation?

Atrial fibrillation (AF) is cardiac arrhythmia where the atria is no longer regular, but too fast, irregular and uncoordinated. As a result, the heart may no longer be able to pump enough blood into the circulation, which could affect heart performance and cause severe discomfort in the long term.

About 1 per cent of the population is in Switzerland, which is about 100,000 people.

How does one realize that one could suffer from atrial fibrillation?

Many patients feel that the heart is rapidly falling, wandering the heart or our tachycardia. The latter can last for hours or even longer. Other possible symptoms include a feeling of chest pressure, tiredness and breathlessness. However, it also happens as mentioned that the atrial fibrillation does not cause any complaints. It is often randomly diagnosed and sometimes too late.

What risk factors are there?

Primary age, but also high blood pressure (high blood pressure), heart failure (heart failure), coronary heart disease, caused by atherosclerosis (deposits in coronary vessels), obesity, renal insufficiency, diabetes or sleep apnea.

The lifestyle seems to be playing, suggesting that you can prevent atrial fibrillation.

Yes, and specific measures are important not only for prevention but also for therapy. Overweight patients are recommended to lose weight while avoiding the yo-yo effect. Sport along with weight loss can reduce atrial fibrillation or even disappear. The same is true of a major alcohol disclaimer and refraining from smoking anyway. It is important that the underlying diseases mentioned are treated appropriately.

Is atrial fibrillation immediately dangerous or life threatening?

Atrial fibrillation is therefore not a fatal hazard. But if the heart rate is too fast for weeks – usually over 100 per minute – heart muscle is tired and weak. Then one talks about heart failure, which itself is a serious problem. In addition, the atrium has no more regulated mechanical activity. follow:

The blood is not carried away well, and if the blood flows too slowly or not at all, clots can form.

If a clot of such kind is washed away from the forecourt, it can get into the brain, lock a boat there and lead to a stroke. But even without such a dramatic event, the brain can be affected.

In what way?

These days, a major study (Swiss Fibrillation Study, Switzerland, AF) was published. Detailed studies of 1737 patients with atrial fibrillation examined possible changes in the brain, particularly the effects on cognitive functions, including attention, perception, learning ability, memory, speech recognition and motivation.

What came out?

From the 1390 patients without previous brain flesh, it can be seen that about one in seven of the brain's flesh is clinically quiet. Interestingly, cognitive performance had dropped significantly in a known and quiet out blown. That is another reason why early detection is important.

How is atrial fibrillation treated?

This is very individual depending on the patient and form of atrial fibrillation. Two aims focus on: Avoiding stroke through thinning and rhythm control.

How do you achieve these goals?

The thinning of blood is medicinal. There are several therapy options available for rhythm control. Primarily, you will try drug treatment first. This is often very effective at the initial stage. However, atrial fibrillation can still occur. Medicines also have side effects at all times. If these are severe or a patient is generally difficult with medication, catheter ablation can be offered (see box).

What is the success rate of catheter ablation?

Depending on the type of atrial fibrillation 60 to 80 percent. Success means: no atrial fibrillation a year after treatment without supportive medication. Deciding whether to talk about healing is not final. We often see patients who haven't stayed relapsed for years. However, it also happens that atrial fibrillation occurs again some years after successful initial treatment.

What do you do then?

That depends on the individual case. There are also advanced stages of atrial fibrillation on initial intervention where stabilization of the sinus rhythm is no longer possible. Then comes the alleged frequency control: To lower the heart rate, so the pulse is used, drugs. If this is not enough, there is a possibility of catheter ablation, from which this AV mark will be removed. It belongs to the heart and delivery system.

This treatment is associated with the implantation of a pacemaker.

Is catheter ablation better than drug treatment?

Certainly, you can't say that completely, to the opposite. Absolutely independent of medication, those patients suffering from atrial fibrillation and heart failure should be offered catheter ablation. Study results (the Castle AF study) have shown that these patients have survived better.

And what about those patients who have "atrial fibrillation" only?

There is also a very recent study (Cabana). 2204 patients were randomly assigned to two groups who had either had catheter ablation (lung insulation) or primary drug therapy. From the results, the conclusion can be that the ablation in terms of rhythm stability and reduced symptoms is better than the drug therapy, moreover, our method is safe. But: Ablation generally showed no advantage over drug therapy in the patients studied.

What does this mean in practice or for the individual patient?

The study confirms that we have no reason for patient ablation without suffering and / or a good response to medication. This is suitable for patients who do not wish to be treated. But we also have a lot of patients who say clearly that they don't want to take medicine for life and they prefer ablation. Even more information can bring another study (East), where we are also involved again.

Atrial fibrillation intervention: This is how the catheter ablation runs

During catheter ablation, the veins opening to the left left chamber of the heart are isolated by our electric (medical term: isolating veins and the lungs). Ablation is performed over the groin. The catheter is developed over the veins to the left atrium. With a three-dimensional mapping system, a "map" of the left atrium is created, then the ablation is performed. Lung vein isolation is achieved by providing radio frequency energy or by releasing a cold.
According to cardiologist Richard Kobza, the complexity rate is about 3 to 4 percent, with more than half the site problems in the groin (refilling, bruising, etc.). More severely ventricular piercing and stroke start. The two complexities occur in less than one per cent of the procedures.
The procedure lasts between 60 and 150 minutes. In Lucerne Cantonal Hospital, it is performed regularly under general anesthesia. According to Kobza, this leads to better comfort for patients and better treatment results. The patient can usually be discharged home the following day. (Hag)

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