
ECG app and irregular rhythm notification on Apple Watch - Austin_Conlon
https://www.apple.com/newsroom/2019/03/ecg-app-and-irregular-rhythm-notification-on-apple-watch-available-today-across-europe-and-hong-kong/
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Unklejoe
On a somewhat related note:

The Apple Watch gave me a false positive for atrial fibrillation. I was having
premature ventricular contractions (PVCs), which are _generally_ benign as
long as your heart has no structural abnormalities. Basically, your left
ventricle contracts spontaneously on its own in beteeen regular beats, which
throws off the timing of the next beat. The end result is an irregular heart
beat, similar to that of atrial fibrillation, but can be easily distinguished
by human inspection of the EKG.

Needless to say, the result scared the crap out of me. I made an appointment
at the cardiologist the next day, and I couldn’t sleep until I was finally
able to see him. The stress from this actually made the PVCs more frequent...

The cardiologist took one look at the EKG strip from the watch and was able to
identify the abnormalities as PVCs rather than afib. He still had me wear a
holter monitor for 48 hours though. It turns out I had over 38,000 PVCs in two
days, which is a large enough amount to cause concern about the risk of
cardiomyopathy (“they” say under 10,000 per day is okay as long as they’re not
bothering you).

So, at the end of the day, I’m glad I got the alert. I probably wouldn’t have
gone to the doctor if not.

I do hope they improve the classification though so that it can distinguish
between afib and PVCs.

~~~
bayesian_horse
I am working on algorithms related to PVC and AFib detection. I can see why
the app might make that mistake. PVCs and AFib are not mutually exclusive, and
AFib can be "paroxysmal", meaning it doesn't occur all the time. Basically the
way AFib "works" is that instead of steady and constant p-waves, where all the
cells in the atria contract in one swoop (as they should), the excitation of
the cells spreads chaotically without a clear beginning and end.

Of course, as a Human watching an ECG you can recognize the PVCs at one
glance. AFib can be a lot harder to see, and it can start and stop. Also, AFib
seems to be less of a problem than high PVC counts, speaking in general terms.
Of course, don't take this as medical advice, I'm just a Veterinarian...

~~~
Unklejoe
> PVCs and AFib are not mutually exclusive

Right. I didn’t mean to imply that they were, just that the watch
misinterpreted frequent PVCs as being afib.

In my case, it was easy to determine that they were PVCs with a normal
underlying rhythm because the underlying rhythm was steady like clockwork, and
the PVCs were occurring in a telltale bigeminal pattern for a few seconds at a
time.

> Also, AFib seems to be less of a problem than high PVC counts

I’m no doctor, but this doesn’t align with what I’ve been reading. It seems
like they don’t even recommend treatment for PVCs most of the time unless
they’re symptomatic. In extreme cases like mine (20,000/day), there’s a chance
that it can weaken the heart over time, but I’m not sure how this compares to
the risk of stroke for untreated afib sufferers. I’ve heard mentions of PVCs
being an indicator for increased sudden cardiac death risk, but I can’t find
any reference for this pertaining to people with otherwise normal hearts. I
think it may be the case for people who have just had a heart attack or
something though.

From what I gather, occasional singleton PVCs are generally harmless and occur
in almost everyone. Apparently, the issue arises when you start having
multiple PVCs in a row without a regular beat in between. After three in a
row, it’s considered non-sustained ventricular tachycardia, which is very
dangerous, I guess because there’s a chance it might never stop?

Once again, not a doctor, so please correct me if I’m wrong. This will
probably show up in someone’s Google search one day.

~~~
bayesian_horse
I think PVCs in high counts can accompany more serious problems, like AV Block
etc. I had read somewhere that AFib is often not treated. Maybe a statement
about what is more serious in general isn't possible because both symptoms can
be found in serious conditions.

~~~
TheOtherHobbes
Afib itself is hard to fix, but persistent Afib causes clotting which can lead
to strokes, and sufferers are often put on blood thinners to help minimise
their stroke risk.

~~~
bayesian_horse
There are medications to achieve "cardioversion", meaning transitioning the
atria to a coordinated rhythm. Another way is to insert a catheter and use
electric shocks to reset the myocardium.

But yes, it's not easy.

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deca6cda37d0
Austria, Belgium, Denmark, Finland, France, Germany, Greece, Guam, Hong Kong,
Hungary, Ireland, Italy, Luxembourg, Netherlands, Norway, Portugal, Puerto
Rico, Romania, Spain, Sweden, Switzerland, the UK, US and US Virgin Islands.

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Lukassus
Fingers crossed for Canada to be next.

~~~
Lukassus
It looks like Apple has still not applied in Canada as of March 2019
[https://mobilesyrup.com/2019/03/21/health-canada-apple-
apple...](https://mobilesyrup.com/2019/03/21/health-canada-apple-apple-watchs-
ecg-canada/)

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pdimitar
Not understanding the limited geographic rollout of this feature. Can somebody
explain why is this done in such a way?

~~~
Lukassus
The feature is subject to approval process in each jurisdiction similar to FDA
in US.

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Daniel_sk
Missing Poland, Slovakia, Czech Republic ... :(

~~~
securityfreak
Slovakia still doesn’t have Apple Pay, Apple News and no operator supports an
eSIM. I honestly don’t understand how this is possible.

~~~
Daniel_sk
Not entirely true - Orange has just announced eSIM support
([http://dsl.sk/article.php?article=22304](http://dsl.sk/article.php?article=22304))
and Apple Pay is definitely coming in next months (I have this confirmed from
inside banks).

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iamben
Are there any fitness trackers that offer this?

And whilst on the subject of fitness trackers - are there any that offer great
heart monitoring but aren't a whole smart watch thing? I used to love the
jawbone design, and I'm currently wearing an Alta HR - but I wear a proper
watch. I have a phone to sync to. I want heart and steps and sleep without the
bulk or screen.

~~~
wlesieutre
For one that's still a watch but much less smartwatchy you might like the
Withings Move ECG, which is "coming this spring".

[https://www.withings.com/us/en/move-ecg](https://www.withings.com/us/en/move-
ecg)

Or for no ECG but an on-face heartrate display, their Steel HR:

[https://www.withings.com/us/en/steel-
hr](https://www.withings.com/us/en/steel-hr)

Their least watchy one is the Pulse HR:

[https://www.withings.com/us/en/pulse-
hr](https://www.withings.com/us/en/pulse-hr)

I have a pretty positive impression of them as a company. The iOS app
aggregates its data into Apple Health (unlike FitBit where your data is stuck
in their own apps last I checked), and it's back under the original founder.
They had a stint as Nokia Health but separated off last year.

[https://www.withings.com/us/en/event/nokia-
withings](https://www.withings.com/us/en/event/nokia-withings)

Note I haven't had any personal experience with their fitness tracker watch;
I've got one of their scales.

~~~
FPGAhacker
I have the Steel HR. It's pretty nice, basically looks like a decent "normal"
watch. good pedometer, heart rate tracker, sleep tracker.

I have an Apple Watch now, but I still wear the Steel HR when I go to bed for
sleep tracking.

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lavezzi
This was a lot faster than expected wasn't it?

~~~
soneil
I really wasn't expecting Ireland to be on the list this soon. I mean, we're
still waiting for "visual voicemail" ..

~~~
yipeedipee
Thats more a network limitation, the networks have to buy in the kit to do it
and they dont bother. I think only o2 and possibly EE do it in the UK.

~~~
jw1224
Another iOS thing the rest of the world is still missing is Voicemail
Transcription.

Been out for nearly 3 years, yet remains USA-only to this day.

~~~
philjohn
I'm on Three in the UK and no visual voicemail, but subscribe instead fo
HulloMail which does voicemail transcription and is a very low monthly/yearly
cost.

Would still rather my network provided it though, but it's been 10 years now
and Three still haven't updated their systems, so I doubt they ever will.

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taspeotis
Looking forward to it arriving in Australia soon!

------
VectorLock
I'd really like to get one of these for my Mom but getting her to use an
iPhone would probably be a bridge too far.

~~~
dmead
[https://www.alivecor.com/](https://www.alivecor.com/)

~~~
VectorLock
She has one of these and it works amazingly well. The reason the Apple Watch
is interesting is because it offers this and fall detection.

------
stevefan1999
Aww, Watch 4; I still love my Watch 2 though, any alternative app to replace
it?

~~~
photojosh
It's not just an app, there's dedicated hardware to support it.

------
dharma1
My dad has aFib... should I get him this or Kardia?

------
781
> _With over 400,000 participants, the Apple Heart Study was the largest
> screening study on atrial fibrillation ever conducted, and one of the
> largest cardiovascular trials to date._

Were the users aware that they were participating in a medical study? Or was
this burried in the EULA.

~~~
saagarjha
Yes: it was opt-in and conducted in conjunction with Stanford. You had to
download the app and enroll:
[https://med.stanford.edu/appleheartstudy.html](https://med.stanford.edu/appleheartstudy.html)

~~~
caprese
Very cool

Most health survey apps I'd seen over the last decade had the worst designs
and glitchy user experience, it was clear the app itself was a total after
thought while fawning over the possibilities of the technology, likely a
testament to cash-strapped reseachers

Apple's privilege being put to good use here

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caprese
I bought a premium series 4 last week because of this ECG talk

Tried to see if my carrier t-mobile had the same 24 month payment plan, but
not for this specific model and combination and I wanted it now

Imagined the idea of trying to get approved for my tax-free health account,
but then realized I'm already paying for my whole healthcare plan by myself
instead of an employer, so it would be redundant even if I could get the
doctor plus tax authority to agree

briefly looked at all the cheaper alternatives to Apple Watch Series 4
GPS+Cellular Aluminum body, metal wristband. Quickly dismissed them.

so I just made the big consumptive purchase because my health is more
important :)

love the device

~~~
tzs
If by tax-free health account that you pay for yourself you mean an HSA plan,
then if you could putting it on that would be a net win because you'd be
paying with pre-tax dollars. It would effectively be a discount equal to your
marginal federal tax rate.

Unfortunately, as far as I've been able to find you cannot put one on an HSA
yet, but many people seem to think the IRS will eventually allow it.

