Your Smartwatch Detected Irregular Heartbeats, Now What?

Smartwatches and smart rings are wearable technological marvels jam packed with sensors and chips that may monitor everything from steps to sleep patterns to stress levels and heartbeats. These devices can help you improve your health, prompting you to walk just a few more blocks to complete your daily step target and to focus on better quality sleep.

Some devices may report irregular heartbeats, even if you feel fine. This information is usually not an emergency. However, you shouldn’t completely ignore the data either. An irregular heartbeat is known as an arrhythmia in medical terms. When these heart events are felt, they are often described as a fluttering or racing heart. But they can also occur without you feeling them.

“Just because the arrhythmia isn’t felt doesn’t mean it’s any less concerning or dangerous,” says cardiologist Boris Arbit, MD, UCLA Division of Cardiology. “The presence of an arrhythmia significantly elevates the risk of stroke.”

Why Hearts Beat Erratically

There are a lot of reasons why your heart may beat erratically (i.e., beat too hard, too slow, too fast, or skip a beat). For example, menopausal women experience heart palpitations due to plummeting estrogen. Stress and some medications also can trigger irregular heartbeats, and of course, it’s normal for the heart to beat faster during physical activity.

One of the most common types of arrhythmias is atrial fibrillation (A-fib). A-fib often occurs with no signs or symptoms. But even if you have symptoms or your digital device reports them, Dr. Arbit emphasizes that diagnosing the type of rhythm, whether it’s A-fib or anything else, cannot be determined by symptoms alone. It warrants a doctor’s visit.

Atrial Fibrillation Increases with Age

A-fib affects about 4% of people ages 60 and older, and the incidence increased with age. One-third of people ages 85 and older with A-fib will have a stroke, a much higher percentage than those in the same age group who do not have the arrhythmia.

A-fib is more common in people with high blood pressure, coronary heart disease, heart valve disease and cardiomyopathy (a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body).

With A-fib the heart beats faster than normal and the heart’s upper and lower chambers do not work together as they should. The lower chambers do not fill completely or pump enough blood to your lungs and body. This can result in low blood pressure (less than 90/60 millimeters of mercury, mmHg). Symptoms (such as fatigue, chest pain, dizziness) may be felt intermittently, or sometimes not at all. Regardless, A-fib may cause blood to pool in your heart, which increases your risk of forming clots. When the normal heart rhythm is restored, these clots can be ejected into the bloodstream and cause complications, including a stroke. Because A-fib often is asymptomatic, it is thought to be the cause of stroke in up to 24% of cases where the cause of stroke can’t be identified.

Also, over time, uncontrolled atrial fibrillation can damage the heart, impair its function, and lead to heart failure. Some people experience paroxysmal atrial fibrillation, an irregular heartbeat that lasts for seconds to days before returning to normal. Others have persistent A-fib, which occurs continuously and requires treatment to correct the arrhythmia. (Paroxysmal A-fib can develop into persistent A-fib.)

The Value of Smart Devices

Smart consumer devices can help you keep track of when and how often symptoms occur and what you feel (if anything), and help you track these symptoms and how they may change through time. These data is valuable to health-care providers who diagnose A-fib and other heart irregularities.

“The Apple watch and KardiaMobile are two of the most popular and tested devices,” says Dr. Arbit. “They use complex algorithms and machine learning to detect A-fib. Their accuracy is decent. They may be useful for confirming a known diagnosis of A-fib or another arrhythmia. A key benefit is that rhythm strips are recorded and can be reviewed with a doctor. Most of the time we would still order a Holter monitor to confirm the findings.”

A Holter monitor is a portable electrocardiogram that can be worn at home. Cardiologists typically prescribe these to be worn for seven to 14 days. A Holter monitor might be ordered if A-fib is suspected, and/or if a person has a history of transient ischemic strokes or heart palpitations. The device records your heart’s electrical activity for long periods of time while you do your normal activities. It can detect how fast your heart is beating, whether the rhythm of your heartbeats is steady or irregular, and the strength and timing of the electrical impulses passing through each part of your heart.

Targeted Screenings Are Best

Though A-fib screenings can be lifesaving, there are some downsides to indiscriminate screenings. “Many studies have shown

© SirVectorr | Getty Images
A physician-ordered Holter monitor, worn at home, can confirm A-fib.

that the more frequently we look for A-fib with devices or in-office electrocardiograms, the more we find it,” explains Dr. Arbit “This can lead to more prescriptions for blood thinners. These dangerous medications can have very serious side effects, such as life- threatening bleeding. However, the correlation between starting these medications and reducing stroke risk is not so clear.”

Insights on Screenings

A study in the Aug. 21, 2021, issue of the Lancet concluded that it is unclear whether screening for A-fib and subsequent treatment with anticoagulants can prevent a stroke. In the study, researchers investigated whether such screening and use of anticoagulants can prevent a stroke in individuals at high risk by using an implantable loop recorder (ILR) to facilitate detection of asymptomatic A-fib. The average age of the study participants was 74.7 years.

Researchers found that in people with stroke risk factors, ILR screening resulted in a threefold increase in A-fib detection and anticoagulation initiation, but they found no significant reduction in the risk of stroke or systemic arterial embolism (a blood clot lodged in an artery). Major bleeding occurred in 4.3% of participants in the ILR group and 3.5% in the control group. The authors concluded that the findings imply that not all A-fib is worth screening for, and not all screening-detected A-fib merits anticoagulation.

A Jan. 25, 2022, editorial in JAMA Open Network, suggests that “… assessing the burden of A-fib, rather than the presence or absence, may be a better approach. Patients identified with A-fib likely would benefit from targeted management of modifiable risk factors that contribute to A-fib, including obesity, hypertension, alcohol use, sleep apnea, smoking, and diabetes.”

Preventing A-fib

A-fib can be an intermittent and fleeting condition for some people. For others, it can be a continuous and extremely uncomfortable problem. If you are diagnosed with A-fib, your cardiologist will determine the best course of action.

Although it’s unusual for an interventional procedure to be recommended before a person has tried and failed medication, catheter ablation has emerged as a first-line treatment for A-fib. For patients who are symptomatic, ablation may offer a way to eliminate A-fib while avoiding the complications that are associated with medications.

Lifestyle recommendations to reduce A-fib risk include avoiding/limiting caffeine, managing stress with breathing techniques and exercise, limiting sodium, eating a fiber-rich diet, staying hydrated, and maintaining a healthy weight. Making your own healthy meals is a good way to better control what you’re putting in your body. Try the easy apple breakfast cobbler recipe below. Put the ingredients in your crock pot overnight and wake up to the delightful smell of cinnamon and apples.

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