Cardiology For Patients

Detecting atrial fibrillation during and beyond the COVID-19 era

The most common form of heart rhythm abnormality is atrial fibrillation (AF), affecting over 33 million people globally. Atrial fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate. Symptoms of AF include heart palpitations, dizziness and shortness of breath. It is also the leading cause of stroke.

The irregular rhythm of the heart caused by AF gives opportunity for the blood to pool and form into a clot. When a clot breaks away and causes a blockage it results in a stroke which can be debilitating or deadly.

Undetected symptoms

Diagnosis of AF can be difficult because symptoms can be intermittent in the early stages of the disease and even a 24-hour electrocardiogram (ECG) can miss the abnormality. Without expert diagnosis, people cannot get the right treatment and are at serious risk of having a stroke.

Dr Shouvik Haldar, consultant cardiologist and electrophysiologist at Royal Brompton and Harefield hospitals, London explains, “An important factor to be aware of is that AF often goes undetected. Many people with AF experience no symptoms until the disease is in an advanced state and they experience a serious complication such as a stroke or heart failure. Heart arrhythmias are often only picked up incidentally in routine tests or investigations for other conditions.”

Atrial fibrillation can affect adults of any age and is more common in older people aged over 65. Whilst the exact cause of AF is unknown it is more common in those with other heart conditions such as high blood pressure (hypertension), coronary artery disease, atherosclerosis, or a heart valve problem.

While it is not possible to prevent all AF-related strokes, research and increased understanding has enabled doctors to assess an individual’s risk of an AF-related stroke, and prescribe a therapy that can reduce this risk significantly.

Can AF put you at greater risk of COVID-19 complications?

COVID-19 can affect anyone, and the response can vary from no symptoms (asymptomatic) or mild, to critical and fatal. There have been cases where people infected with the virus have had unusual cardiac responses. Severe illness can cause widespread inflammation and affect the heart, blood pressure and other functions. But as this is a novel virus, experts are not certain how individuals will respond in different ways.

Having AF or any arrhythmia does not put you at an increased risk of contracting coronavirus than anyone else. However, if you have a cardiovascular condition or other chronic health issues like diabetes or a lung condition, the symptoms may affect you more and may be more dangerous, which is why it is important to take precautions to protect yourself from exposure to the virus.

Wearable technology

Wearable technologies, which use sensors and smartphone applications, have made tracking our activity easier.  Smartphones and wearable technology can even enable earlier AF detection and improved AF management through the use of photoplethysmography (PPG) technology. This non-invasive technology can detect blood circulation changes using a light source and a photodetector at the surface of the skin.

Most wearables are primarily targeted at the fitness and wellness market. Most people do not need to have continual activity or heart rate monitoring for clinical purposes. However, as wearables become increasingly ubiquitous more people are paying attention to their heart rate and rhythm. It is, however, important to understand that your heart rate can go up or down for a variety of reasons.

Medical tracking devices

Fitness trackers and smartwatches have the potential for early detection of acute and chronic conditions, but wearables are not a substitute for medical devices prescribed by a clinician. These devices are FDA approved and provide important information needed to manage a patient’s health. Wearables allow patients to present clinicians with data which should be interpreted in context. When captured over time, versus in limited episodes, data can offer a more complete perspective of an individual’s health. This brings a new dimension to clinical monitoring, particularly in a non-clinical setting.

When using a wearable to track heart rhythm or blood pressure, it is important to understand what’s normal for you as an average adult. Your doctor can advise what is normal for you. Abrupt changes in heart rate, or an irregular rhythm notification, may signify an abnormal heart rhythm. If you experience symptoms such as a rapid heart rate, the feeling that your chest is pounding or fluttering speak to a clinician, they may use an ECG to detect your heart rhythm. An ECG is a graph of the electrical activity of your heart and can determine heart rate and rhythm.

Most wearables come with a mobile app that collects and tracks data, helping you to understand what the data means and track it for you over time. Significant changes over time or repeating events may indicate a health problem. The collection of data over time will help your clinician understand what’s going on and help him or her determine the next best course of action, if any. It is important to appreciate that not all wearable devices are of the same calibre and that certain devices are more widely accepted by the medical community in terms of data accuracy. However, all devices have limitations and the patient does need to know how to use them properly to get the best out of them.

When should you speak to an expert?

If you are not feeling well, or have symptoms such as rapid heart rate, dizziness or fluttering in your heart, you should talk to a doctor. If you are using a wearable device and get a notification, such as “possible atrial fibrillation,” from your device and something is not normal, for instance high or low heart rate, high or low blood pressure, continue to monitor and talk an expert. If you get a notification from your device and you’re taking medication, do not start, stop or make any changes to your medications without speaking to a clinician first.

Palpitations may seem alarming, but in most cases, they are harmless and are not normally a sign of a serious problem. Sometimes you may feel an extra or missed beat. These are known as ectopic beats and are also usually nothing to worry about.

If you have continuous chest pain, or think you are having a heart attack, then you must seek immediate medical help.

The COVID-19 pandemic has accelerated an already growing market of fitness and wellness wearables. In many cases they can be used as a supplementary tool to detect abnormalities in heart rate and rhythm. If you are suffering from heart rhythm problems and wish to use a wearable to help monitor the problem then speak to your clinician first regarding the pros and cons of various devices to help you decide which is the best for you.


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