A study from Stanford University Medical Center found that smartwatches can help doctors detect and diagnose arrhythmias in children. The Apple Watch has some advantages over traditional methods in diagnosing arrhythmias in children, but more validation is needed. The findings come from an electronic medical record survey of pediatric heart disease patients treated at Stanford Medicine's Children's Health Center. The research is published today (December 13) in the journal Communications Medicine.

Over a four-year period, the patient's medical records mentioned "Apple Watch" 145 times. Of the patients whose medical records mentioned smartwatches, 41 had abnormal heart rhythms confirmed by traditional diagnostic methods; in 29 of these children, the arrhythmia was diagnosed for the first time.

"I'm surprised that our standard monitoring often doesn't pick up arrhythmias, but the watch does," said the study's senior author Scott Ceresnak, MD, professor of pediatrics. Ceresnak is a pediatric cardiologist who treats patients at Stanford University School of Medicine. "It's great to see new technology that can really change the way we care for our patients."

The study's lead author is Aydin Zahedivash, MD, clinical instructor of pediatrics.

Most abnormal rhythms detected are not life-threatening, Ceresnak said. However, he added that detected arrhythmias can cause distressing symptoms such as rapid heartbeat, dizziness and fainting.

Doctors face two challenges when diagnosing arrhythmias, or abnormal heart rhythms, in children.

The first is that cardiac diagnostic equipment, while improved in recent years, is still not ideal for children. Ten to twenty years ago, children had to wear a Holter monitor for 24 to 48 hours, which consisted of a smartphone-sized device connected by wires to five electrodes affixed to the child's chest. Now, patients can wear an event monitor (which simply wears a sticker on their chest) for several weeks. While event monitors are more comfortable and can be worn longer than Holter monitors, they can sometimes fall off prematurely or cause problems, such as skin irritation from the adhesive.

A second challenge is that even continuous monitoring for several weeks may not capture the heart's erratic behavior because arrhythmias in children are unpredictable. Children can have arrhythmias that occur months apart, making it difficult for doctors to determine what's going on.

case study

Connor Heinz and his family faced two challenges when he started experiencing a racing heartbeat at age 12: The adhesive monitor was too irritating, and he only experienced irregular heartbeats every few months. Ceresnak thought he knew what caused the irregular heartbeat, but he wanted confirmation. He suggested that Connor and his mother, Amy Heinz, try using Amy's smartwatch to record Connor's heart rhythm the next time his heart started racing.

The use of smartwatches to measure children's heart rhythms has been limited because existing smartwatch algorithms for detecting heart problems have not been optimized for children. Children have faster heartbeats than adults, and they also tend to experience different types of abnormal rhythms than adults with arrhythmias.

Smartwatches appear to help detect heart arrhythmias in children, the paper shows, suggesting that it would be useful to design versions of smartwatch algorithms based on children's real heart rhythm data.

Evaluate medical records

The researchers searched for the phrase "AppleWatch" in patients' electronic medical records from 2018 to 2022, then looked at patients whose records contained the phrase who submitted smartwatch data and received a heart arrhythmia diagnosis.

Data from the watch includes alerts about the patient's heart rate and patient-initiated electrocardiograms, or electrocardiograms, from an app that uses electronic sensors in the watch. When a patient launches the app, the ECG feature records the heart's electrical signals; doctors can use this pattern of electrical impulses to diagnose different types of heart problems.

Of the 145 mentions of smartwatches in patient records, 41 patients were diagnosed with arrhythmia. Among them, 18 patients used their watches to collect electrocardiograms, and 23 patients received high heart rate notifications from their watches.

Information provided by the smartwatch prompted medical tests by the children's doctors, resulting in 29 children receiving new arrhythmia diagnoses. In 10 patients, the smartwatch diagnosed arrhythmias that had never been detected by traditional monitoring methods. Connor Heinz is one of those patients.

"At a basketball tryout, he had another seizure," Amy Heinz recalled. "I put a watch on him and emailed Dr. Ceresnak numerous screenshots [of his heartbeat]. The information on the watch confirmed Ceresnak's suspicion that Connor was suffering from supraventricular tachycardia."

Most children with arrhythmias have the same condition as Connor, a racing heartbeat pattern that originates in the upper chambers of the heart.

"These irregular heartbeats are not life-threatening, but they can make kids feel really bad," Ceresnak said. "They can be a problem and they can be scary, and if wearables can help us figure out what this arrhythmia is, that would be super helpful."

In many cases of supraventricular tachycardia, the abnormal heart rhythm is caused by a small short circuit in the heart's circuitry. This problem can usually be cured with a medical procedure called catheter ablation, which precisely destroys a small, targeted area of ​​heart cells causing the short circuit.

Connor, now 15, has successfully undergone catheter ablation and plays basketball on his high school team in Menlo Park, California. The study also found that smartwatch use was documented in the medical records of 73 patients who were not ultimately diagnosed with arrhythmia.

Ceresnak said: "Many children have palpitations and a feeling of rapid heartbeat, but the vast majority do not have obvious arrhythmias. In the future, I think this technology can help us rule out any serious diseases."

a new study

A Stanford Medicine research team plans to conduct a study to further evaluate the usefulness of the Apple Watch in detecting heart problems in children. The study will measure whether the watch's measurements of children's heart rates and rhythms match those of standard diagnostic equipment.

The study is only open to children who are already heart disease patients at Stanford Medicine's Children's Health Center.

"The market for wearable devices is exploding, and our children are using them, too," Ceresnak said. "We want to make sure the data we get from these devices is reliable and accurate for children. As a next step, we hope to help develop pediatric-specific heart rhythm monitoring algorithms."

This research was conducted without external funding. Apple is not involved in this effort. Apple's Researcher Support Program has agreed to donate watches for the next phase of research.

Apple's "Irregular Heart Rhythm Notification" and "ECG" apps have been approved by the U.S. Food and Drug Administration for use by people 22 and older. High heart rate notifications are only available to users 13 years of age or older.

Compiled source: ScitechDaily