Tag Archives: arrhythmia

A Review Of SonoHealth’s EKGraph Portable ECG Monitor: Comparison To Apple Watch ECG And AliveCor’s Kardia ECG

The skeptical cardiologist keeps his eyes open for new, potentially improved ways of personal mobile ECG monitoring and when I saw the following comments on an afib forum I was intrigued:

I recently started using a SonoHealth product that I find MUCH MUCH superior to Kardia..

Really? MUCH MUCH superior? The more someone utilizes all caps
to emphasize theirs points the less I tend to believe them. But, as I am on a mission to discover the truth in all things cardiologic I went to the SonoHealth website and encountered this:

The EKGraph would indeed appear to be MUCH MUCH superior to Kardia mobile ECG if the website marketing can be believed.

Like the Kardia the EKGraph offers a personal ECG monitor obtained using the fingertips and syncing to an app on your smartphone.

The EKGraph claims to have 3 lead capability, something it emphasizes in its marketing but it is only capable of displaying one lead at a time and ,  similar to Kardia one can obtain lead II and precordial ECG leads by putting one electrode on the leg or chest.

Also similar to Kardia, the EKGraph promises “rhythm detection.” As we shall learn, however, rhythm detection by the EKGraph cannot be trusted whereas Kardia has a wealth of published data supporting its accuracy.

Unlike the Kardia, the EKGraph does have a “bright LCD screen” which displays the ECG wave pattern and heart rate along with the heart rhythm diagnosis.

I emailed SonoHealth and they were  kind enough to send me one of their ECG devices to demo. After spending some time with it I can say unequivocally that it should not be purchased or utilized by any patient who wants reliable personal mobile ECG monitoring with accurate diagnoses.

A few days later a package arrived containing the EKGraph in an Applesque box which also contiained a USB charging cable. In addition they included a carrying case and a tube of ECG gel.

 

 

Working With The SonoHealth APP

To make a recording one puts the metal strip on the left side of the device on hand, arm or leg and the other metal strip on the right side of the device on an opposing limb or the chest.

This very happy model gives you a feel for the size of the device and the method of making a Lead I recording.

 

 

 

 

 

 

 

 

It is possible to made a decent single lead ECG tracing with this device and view the tracing on the associated smartphone app. However, the recordings are typically very noisy and full of artifact making it hard to discern the rhythm. The software appears to lack appropriate filtering.

The SonoHealth app is free but getting it registered was a problem. On the company website support area several readers have complained of the same problem over the last few months:

 I am having trouble registering on the phone because when I hit the red button to register, I see the email and username fields at the top of the form, but when I click on email, the info fields jump to name, and I can’t scroll up to access those two fields. I then get a notification that those two fields are required to register. Any suggestions?

There is no response to this issue posted 3 months ago from the company.

Syncing with the app via Blutooth is straightforward. Pressing the sync button transfers all new tracings to the app where they can be reviewed.

Tracings can be emailed or printed.

Rhythm Detection

The major problem with the EKGraph  is that its  ability to diagnose  rhythm  is  very limited. This device has no published data verifying the accuracy of its rhythm diagnoses whereas the Apple Watch 4 and Kardia ECG devices do.  It it is not approved by the FDA.

I used the device on my self and despite identical rhythms the EKGraph called one “tachycardia” and the other “bradycardia.”

I tried using the SonoHealth on patients in my office who were in normal sinus rhythm and received wild, seemingly random diagnoses.

Whatever algorithm the device is using to diagnose rhythm is clearly not making allowances for poor quality recordings.

This patient is in NSR but the EKGraph calls it “tachycardia, VPB bigeminy” mistaking the artifact between the normal QRS beats and ventricular ectopic beats.

Multiple Sketchy Companies Utilizing Similar Hardware

I have noted other mobile ECG device with a remarkably similar appearance to the EKGraph.  A search on Amazon yields AliveCor’s devices and  the SonoHealth Ekgraph . The Amazon comparison page shows 3 additional  EKGraph identical-appearing devices seemingly from 3 different sketchy companies all priced at $79.

A consumer asked SonoHealth about the identical external appearance of SonoHealth’s and EMAY’s devices  and the company’s response was::

As a small new company making a new design for the outside shell didn’t seem viable. A mold from scratch costs anywhere from $65,000-$85,000. So our manufacturer allowed us to use their current mold to make the EKGraph.

So even though the outside is similar the software side is totally different. We have new and improved software. There’s also our own SonoHealth app that we developed from scratch.

SonoHealth is a USA company that provides excellent customer support.

I would disagree with SonoHealth’s assessment-there is nothing to suggest their software is either new or improved or even accurate.

The app that they developed from scratch is clunky and difficult to use.

Ratings and Online Presence of SonoHealth

SonoHealth posts on its website alleged reviews of EKGraph. They are uniformly positive. It’s hard to find anything that isn’t 5/5 stars. Apparently, all the problems I found with the product are unique to me.

However, these reviews should be taken with a grain of salt. A few weeks after acquiring my SonoHealth EKGraph I received an email from the company offering a gift card if I followed their precise instructions in writing a review:

TERMS: In order to receive the $10 giftcard reward you MUST write both a Company and a Product review. We will send each reviewer the egiftcard to the email that they provided when leaving the review. (For verification purposes, the email you enter when leaving the review must match the email associated with your order.)

This manipulation of the review process is shady and calls into question the validity of any review on the company website or Amazon.

Let The (Mobile ECG) Buyer Beware

The SonoHealth EKGraph is capable of making a reasonable quality single lead ECG. Presumably all the other devices utilizing the same hardware will work as well.

However, the utility of these devices for consumers and patients lies in the ability of the software algorithms to provide accurate diagnoses of the cardiac rhythm.

Apple Watch 4 and AliveCor’s Kardia mobile ECG do a very good job of sorting out atrial fibrillation from normal rhythm but the SonoHealth EKGraph does a horrible job and should not be relied on for this purpose.

The companies making and selling the EKGraph and similar devices have not done the due diligence Apple and AliveCor have done in making sure their mobile ECG devices are accurate.  As far as I can tell this is just an attempt to fool naive patients and consumers by a combination of marketing misinformation and manipulation.

I cannot recommend SonoHealth’s EKGraph or any of the other copycat mobile ECG devices. For a few dollars more consumers can have a proven, reliable mobile ECG device with a solid algorithm for rhythm diagnosis. The monthly subscription fee that AliveCor offers as an option allows permanent storage in the cloud along with the capability to connect via KardiaPro with a physician and is well worth the dollars spent.

Skeptically Yours,

-ACP

Can AliveCor’s Mobile ECG Device Combined With Its Kardia Pro Cloud-Based Platform Replace Standard Long Term Rhythm Monitors?

In March of 2017 AliveCor introduced Kardia Pro, a cloud-based software platform that allows physicians to monitor patients who use the Kardia mobile ECG device.

I have been utilizing the Kardia mobile ECG  device since 2013 with many of my atrial fibrillation (AF)  patients and have  found it be very useful as a personal intermittent long term cardiac monitor. (see here and here)

I signed up for the Kardia Pro service about 3 months ago and all of my patients who purchased Kardia devices prior to March of 2017 have been migrated automatically to Kardia Pro by AliveCor.

Now (post March 2017),  patients who acquire a Kardia device must sign up for the Kardia Pro service at $15 per month to connect with a  physician.

I think this is money well spent and I’ll demonstrate how the service works with a few examples.

Monitoring Patients With Atrial Fibrillation

 I saw a 68 year old man with persistent atrial fibrillation that was first diagnosed at the time of pneumonia in late 2017.

He underwent a cardioversion after recovering from the pneumonia but quickly reverted back to AF. His prior cardiologist offered him the option of repeat cardioversion and long term flecainide therapy for maintenance of normal sinus rhythm (NSR) but he declined.

When I saw him for the first time in the office  a  month ago I  listened to his heart and to my surprise, noted a regular rhythm: an AliveCor recording in the office confirmed he was in NSR. The patient had been unaware of when he was in or out of rhythm

We discussed methods for monitoring his rhythm at this point which include a 24 Holter monitor, a 7 to 14 day Long Term Monitor, a Cardiac Event Monitor and a Mobile Cardiac Outpatient Telemetry device. These devices are helpful and although expensive are often covered by insurance.  They require wearing electrodes or a patch continuously and the results are not immediately available.

I also offered him the option of monitoring his AF using a Kardia device with the recordings connected to me by Kardia Pro.

He purchased the device on his own for $99, downloaded the app for his smartphone and began making recordings.

I enrolled him in my Kardia Pro account and he received an email invitation with a code that he entered which connected his account with mine, allowing me to view all of his recordings as they were made.

When I log into my Kardia Pro account I can now view a graphic display of the recordings he has made with color coding of whether they were considered normal or abnormal by Kardia.

The patient overview page also displays BP information if the patient is utilizing certain Omron devices which work with Kardia.

kardia pro wc monthly

The display shows that after our office visit he maintained NSR for 3 days (green dots) and then intermittently had ECG recordings classified as AF (yellow dots) or unclassified (black).

The more he used the device and got feedback on when he was in or out of rhythm the more he was able to recognize symptoms that were caused by AF.

I can click on any of the dots and six second strips of the full recording are displayed.  In the example below I clicked on 2/27 which has both an unclassified recording (which is atrial flutter) and an AF recording

Clicking on the ECG strips brings up  the full 30 second recording on a page that also allows me to assign my formal  interpretation. In the example below I added atrial flutter as the diagnosis, changing it from Kardia’s unclassified (Kardia’s algorithm calls anything it cannot clearly identify as AF that is over 100 BPM as unclassified.)

The ECG can then be archived or exported for entry into an EHR.

The benefits of this patient being connected
to me are obvious: we now  have an instantaneous patient-controlled method for knowing what his cardiac rhythm is doing whether he is having symptoms or not.

This knowledge allows me to make more informed treatment decisions.

The Kardia Pro Dashboard

When I  log into kardia pro I see this screen.

dashboard karia pro It contains buttons for searching for a specific patient or adding a new patient. Adding new patients is a quick and simple process requiring input of patient demographics including  email and birthdate.

From the opening screen you can click on your triage tab. I have elected to have all non normal patient recorded ECGS go into the triage tab.

Other Examples

Another patient’s Kardia Pro page shows that he records an ECG nearly every day and most of the time Kardia documents NSR in the 60s. Overall, he has made 773 recordings and 677 of them were NSR, 28 unanalyzed (due to brevity) , 13 unclassified and 55 showing AF.

Monitoring Rate  Control  In Patients With AF and Reversion Post-Cardioversion

Another patient I saw for the first time recently has had long-standing persistent AF.  His previous cardiologist performed an electrical cardioversion a year ago but the patient reverted back to AF in 40 hours.   Before seeing me he had purchased a Kardia mobile ECG device and was using it  to monitor his heart rate.

After he accepted my email invitation to connect via Kardia Pro I was able to see his rhythm and rate daily. The Kardia Pro chart belowshows his daily heart rate while in atrial fibrillation. We utilized this to guide titration of his rate controlling medications.  Such precise remote monitoring of heart rate in AF (which is often difficult to accurately assess by standard heart rate devices) obviates the need for office visits for 12 lead ECGs or periodic Holter monitors.

I performed a  second cardioversion on him after which he made  daily recordings documenting maintenance of NSR. With this system we can determine exactly when AF returns, information which will be very helpful in determining future treatment options.

Kardia Pro Plus Kardia Mobile ECG Creates Personal Intermittent Long Term Rhythm Monitor

There are many potential applications of the Kardia ECG device beyond AF monitoring (assessing palpitations, PVCs, tachycardia, etc.) but they are all enhanced when the device is combined with a good cardiologist connected to the device by Kardia Pro.

I’ve gotten spoiled by the information I get from my AF patients who are on  Kardia Pro now. When they call the office with palpitations or a sense of being out of rhythm I can determine within a minute what their rhythm is wherever I am (excluding tropical beaches and mountain tops)  or wherever the patient is (for the most part.)

On the other hand patients who are not on Kardia Pro have to come into the office for  12-lead ECGs. When they call I feel like my diagnostic tools are limited. Such patients usually end up getting one of the standard Long Term Monitoring (LTM) Devices. If I am fortunate, after a  few days to weeks , the results of the LTM will be faxed to my office.

I am optimistic based on this early experience with Kardia Pro that ultimately this service in conjunction with the Kardia Mobile ECG device (or similar products) will replace many of the more expensive and inconvenient long term monitoring devices that cardiologists currently use.

Skeptically Yours,

-ACP