I described in detail in March (see here) my early experience in utilizing AliveCor’s KardiaMobile ECG device in conjunction with their Kardia Pro cloud service to monitor my patient’s with atrial fibrillation (afib). Since that post the majority of my new afib patients have acquired the Kardia device and use it regularly to help us monitor their afib.
This capability has revolutionized my management of atrial fibrillation. In those patients who choose to use AliveCor there is really no need for long-term monitors (Holter monitors, Zio patches, cardiac event monitors) and no need for patients to come to the office to get an ECG when they feel they have gone into afib.
When one of my Kardia Pro patients calls with symptoms or concern of afib, I quickly pull up their chart at Kardiapro.com and review their recordings to determine if they are in or out of rhythm. Most treatment decisions can then be handled over the phone without the need for ordering a monitor or an emergency room or office visit.
One 24 hour period will suffice to show how important KardiaPro is now to my management of my patients with afib
A Day In The Afib Life
Tuesdays I spend the day working in the heart station at my hospital. Typically, on these days I will supervise stress tests, read ECGs and echocardiograms, perform TEES and electrical cardioversions. On a recent Tuesday I had 3 patients scheduled for cardioversion of their atrial fibrillation.
The day before one of these patients called indicating that he suspected he had reverted back to normal rhythm (NSR) based on his Kardia readings. He had had a prior cardioversion after which we know (thanks to daily Kardia recordings) he reverted to afib in 5 days. Subsequently we had started him on flecainide, a drug for maintenance of NSR and scheduled him for the cardioversion.
Not uncommonly after starting flecainide patients will convert to NSR but if they don’t we proceed to an electrical cardioversion.
I logged into KardiaPro and reviewed his dashboard and sure enough his last two ECGs showed sinus rhythm. I congratulated him on this and we canceled his cardioversion for the next day, saving the lab the time and expense of a cancellation the day of the procedure. The patient avoided much stress, time and inconvenience.
It is important to note that in this patient there was no great jump in heart rate with afib compared to NSR. For many patients the rate is much higher with the development of afib and this is often detected by non ECG wearable monitors (like an Apple Watch.) But for patients like this one, an ECG is the only way to know what the rhythm is.
A second patient with afib who had elected not to acquire an AliveCor ECG device showed up for his cardioversion on Tuesday and after evaluating his rhythm it was clear he had spontaneously reverted back to NSR. Prior to my adoption of KardiaPro this was a common and scenario.
The third scheduled cardioversion of the day showed up in afib and we successfully cardioverted him back to NSR. I had not addressed utilizing AliveCor with him. Prior to the procedure he asked me about likely outcomes.
My standard response to this question is that we have a 99.9% success rate in converting patients back to NSR at the time of the cardioversion. However, I can’t predict how long you will stay in NSR after the cardioversion. NSR could last for 5 days or it could last for 5 years. Adding medications like flecainide or amiodarone can significantly reduce the risk of afib recurrence after cardioversion.
At this point he asked me “How do I know if I am in afib?” Whereas many afib patients immediately feel bad and are aware that they have gone out of rhythm, this man like many others was not aware.
Prior to AliveCor my answer would have been to check the pulse daily or look for evidence of high or irregular heart rates on BP monitors or fitness wearables. This scenario provided a wonderful opportunity to test the AliveCor’s accuracy at detecting AF in him. I pulled out my trusty AliveCor mobile ECG and prior to the cardioversion we made the recording below
After the cardioversion we repeated the Alivecor recording and the rhythm (AliveCor’s interpretation) had changed from afib to NSR.
Needless to say, this patient purchased a Kardia device the next day and since the cardioversion he’s made a daily recording which has confirmed NSR. I just logged into Kardia Pro and sure enough he made a recording last night and it showed NSR.
Later in the week I received a call from a patient I had electrically cardioverted a few days earlier. His Kardia device had detected that he had gone back into afib.
I logged into my Mac and saw his KardiaPro chart below.
Kardia Pro displays green dots corresponding to NSR and orange triangles corresponding to afib with 100% accuracy in this patient.
With perfect precision KardiaPro had verified NSR after the cardioversion lasting for 36 hours. For some reason after dinner the day after the cardioversion, the patient had reverted back to afib. This knowledge greatly facilitates subsequent treatment and eliminates the need for in office ECGs and long term monitors.
Utilization of the Kardia device with the Kardia Pro monitoring service has proved for me to b a remarkable improvement in the management of patients with afib. Managing non Kardia afib patients feels like navigating a forest with a blindfold.
The improvement is so impressive that I find myself exclaiming to my assistant, Jenny, several times a week “How do other cardiologists intelligently care for afibbers without AliveCor?”
I have a few patients who balk at the 15$ per month charge for Kardia Pro and ask why the device and this monthly charge aren’t covered by insurance or Medicare. Given the dramatic reduction that I have noticed in my use of long-term monitors as well as office and ER visits in this population, CMS and third-party insurers would be wise to explore Kardia monitoring as a more cost-effective way of monitoring afib patients.
N.B. I realize this post appears to be an unmitigated enthusiastic endorsement of a commercial product which is quite uncharacteristic for the skeptical cardiologist.
One might wonder if the skepcard is somehow biased or compensated for his endorsement of Kardia.
In all honesty, this sprung from my love of the device’s improvement in my afib management and I have received no payment, monetary or otherwise from AliveCor and I own none of their stock (and I’m not even sure if it is on the stock market.)