Data show Apple Watch records arrhythmia events in children
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Key takeaways:
- Electronic medical records data show a wearable smartwatch can record arrhythmia events in children.
- The smartwatches captured arrhythmia events that traditional ambulatory monitors did not.
A review of electronic medical records show the Apple Watch detected heart rhythm abnormalities in children that led to a new arrhythmia diagnosis for some, and also recorded some arrhythmias that traditional ambulatory monitors did not.
Palpitations and concern for heart rhythm abnormalities are among the most common causes of referral for subspecialty care in pediatric cardiology, yet ambulatory monitors like patch rhythm and Holter monitors can miss arrhythmias that occur very sporadically, such as once every few months, Scott Ceresnak, MD, a cardiac electrophysiologist and director of the pediatric electrophysiology program at Stanford Medicine Children’s Health, told Healio.
As the use of smartwatches has grown exponentially among adults, more children are also now wearing the wearable devices, which have been shown to detect arrhythmias in adults. Ceresnak said Stanford clinicians have noticed an uptick in parents reporting wearable notifications for heart rhythm abnormalities in their children.
“We started to see clinically that children were using these devices and kids were coming to us with one of two things,” Ceresnak said during an interview. “Either [their] watch picked up a potential high heart rate notification or arrhythmia, or a child used their parent’s smartwatch because they had episodes of palpitations, and using the ECG feature of the watch, they captured an arrhythmia. We as providers wanted to look back, retrospectively, on what our experience has been with smartwatches detecting arrhythmias in children. We had started to change our practice a bit because patients were coming in with their smartwatches reporting some really difficult-to-detect arrhythmias.”
Apple Watches detect SVTs, other arrhythmias
In a single-center, retrospective study, Ceresnak and colleagues analyzed data from children who had signs of arrhythmia documented by an Apple Watch from 2018 to 2022 who received a formal arrhythmia diagnosis. All data were voluntarily submitted and originated from patient- or caregiver-owned Apple Watches. The researchers assessed the type of arrhythmia identified, the role that the Apple Watch had in arrhythmia diagnosis, the results of other ambulatory cardiac monitoring studies, interventions based on Apple Watch data and findings of any invasive electrophysiology studies.
The findings were published in Communications Medicine.
Of 145 EMR identifications of an Apple Watch, arrhythmias were confirmed for 41 children (28%). The mean age of patients was 14 years. The most common arrythmia found was supraventricular tachycardia (SVT; 88%), followed by ventricular tachycardia (7%), heart block (2.5%) and wide 1 complex tachycardia (2.5%).
Invasive electrophysiology studies confirmed diagnosis in 94% of patients with SVT.
The researchers also found that the smartwatches helped prompt a workup resulting in a new arrhythmia diagnosis for 71% of patients. Additionally, 85% of patients wore traditional ambulatory cardiac monitors; however, there were no arrhythmias detected for 29% of those patients.
Among 73 patients who used an Apple Watch for recreational or self-directed heart rate monitoring, 25% sought care due to device findings without any arrhythmias identified, according to the researchers.
Concern about false positives
The researchers noted they were unable to characterize the true false-positive rates of smartwatch findings in children, as false positives were defined only as patients who did not receive an eventual arrhythmia diagnosis after seeking a consultation based on smartwatch rhythm notifications. Additionally, 29% of the patients had a previously known arrhythmia, increasing the “yield” of captured arrhythmias.
“These algorithms are not designed for children,” Ceresnak told Healio. “There was some concern about children using these and the notifications leading to unwarranted care. That is the hardest part to tackle because we cannot determine false positives with a retrospective series. But I was surprised that about one-third of the patients truly had an arrhythmia detected by their smartwatches. That number could even be higher if the arrhythmias were detected later. That lead to significant changes in their care, an improvement in their care and, for some, great outcomes.”
Ceresnak said he would like to next work on a prospective study to better understand how to detect arrhythmias in children vs. adults.
“Can we create pediatric-focused algorithms for better arrhythmia detection for children?” Ceresnak said. “Children have different heart rates and activity levels than adults. How good are children at using the smartwatch? How good are the tracings? There are so many different variables. This technology is just the beginning. It would be great to have even better detection parameters for children in the next 5 to 10 years. That could transform the way we care for arrhythmias for children.”
Ceresnak said the data, although thought-provoking, do not suggest parents should use a smartwatch as a diagnostic tool.
“The important point is these data were used in conjunction with consultation with a cardiologist,” Ceresnak told Healio. “We must be careful about looking at data and self-diagnosing based on smartwatch notifications. We do not know the false-positive rate in children and we must be careful how we interpret these data. But this technology is already a game changer for adults, and it’s going to be a game changer for children as well.”
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