Short communicationSmart watches for heart rate assessment in atrial arrhythmias
Section snippets
Methods
Patients aged ≥18 years were prospectively recruited from the coronary care unit, intensive care unit and emergency room. Recruitment was based on findings identified on admission 12-lead ECG. The two pre-specified cohorts of patients recruited based on underlying rhythm included: a) Atrial arrhythmias and b) Sinus Rhythm. All patients were confirmed to be in the same rhythm for the duration of the study. Bradyarrhythmias and tachyarrhythmias were defined as mean HR < 60 bpm and ≥100 bpm
Results
There were 102 consecutive patients recruited (65% male; mean age 68 ± 15 years) including 50 in sinus rhythm (SR). Fifty-two patients were included in the arrhythmia cohort, including atrial fibrillation (AF, n = 32) and atrial flutter (n = 20).
Across all devices, 38,616 HR values were recorded. SR cohort demonstrated strong agreement for both devices with a low bias and narrow LoA (FB bias 1 beat, AW bias 1 beat, FB LoA −9 to 8 beats, AW LoA −3 to 4 beats). Overall, both SW devices were
Discussion
Our study sought to determine the accuracy of the two leading SWs for HR estimation in atrial arrhythmias. The principal findings were: 1) both SWs demonstrated strong agreement with ECG-HR in SR; 2) SW-HR in atrial flutter was consistent with ECG-HR with a mean bias<1, while AF demonstrated weak to modest agreement with HR underestimation; 3) SW readings HR ≥ 100 bpm in atrial arrhythmias were closely associated with ECG-HR.
While previous studies have evaluated the accuracy of wearable devices
Limitations
The ‘Workout’ mode was selected in both devices to maximize HR sampling frequency, but this may not be representative of ‘real world’ HR monitoring where continuous high sampling frequency has implications for battery life. Second, as HR values were recorded while patients were immobile in bed, SW accuracy described herein may not be representative of ambulant patients, where exercise may exaggerate contact artifact [[5], [6], [7]]. This methodology however, was deliberately chosen to allow
Conclusion
SW estimation of HR demonstrated highest agreement with ECG in patients with SR and atrial flutter. The devices tended to underestimate HR in AF, which limits their utility for chronotropic assessment. On occasions when SWs recorded a tachycardic episode, this accurately represented the ECG-HR in the majority of patients with an atrial tachyarrhythmia. Therefore, tachycardic readings on wearable devices occurring at rest may be suggestive of an underlying atrial arrhythmia and warrant further
Conflicts of interest
None.
Funding acknowledgements
This work was supported by the Eastern Health Foundation Research Grant [EHFRG2017_029]. The sponsor had no role in study design, collection, analysis, interpretation of data and in the decision to submit the article for publication. Dr. Nerlekar is supported by the National Health and Medical Research Council of Australia and National Heart Foundation Scholarship (1115172). Dr. Teh is supported by an Early Career Fellowship from the National Health and Medical Research Council of Australia.
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.