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Real-Time Arrhythmia Detection in Adults With Fontan Palliation

Real-Time Arrhythmia Detection in Adults With Fontan Palliation 1024 683 Pam Georgiana

Evaluating the Utility and Accuracy of Patient-Driven Wearable EKG Monitoring Devices

Patient-driven diagnostic wearables, such as personal EKG devices, are popular among adults interested in heart health. However, little is known about the accuracy of these devices for adults with congenital heart disease.

“Research supports smartphone-based heart monitors for detecting normal rhythms and atrial fibrillation in the general population,” explains Matthew Laubham, MD. He is a cardiovascular fellow in adult congenital heart disease at Nationwide Children’s Hospital. “But there is limited research with patients who have congenital heart disease, especially those with single ventricle Fontan palliation.”

This patient group has a high rate of atrial arrhythmias, which are known to contribute to significant morbidity and mortality. So, early detection is vital for timely intervention. Traditional guidelines for asymptomatic screening rely on scheduled tests, which only record heart activity during specific intervals. Since arrhythmias can appear sporadically and be asymptomatic, critical episodes may be missed. Real-time personal monitoring devices could enable patients to capture heart rhythm during infrequent symptomatic episodes on a regular basis.

“We wondered if this low-cost patient-driven EKG recording device would be valuable to detect arrhythmias in this population of adult single ventricle Fontan patients, a type of congenital heart disease known to have a high likelihood of atrial arrhythmias,” Anna N. Kamp, MD, MPH, director of Adult Congenital Electrophysiology at Nationwide Children’s Hospital and associate professor of Cardiology at The Ohio State University, says.

Drs. Laubham and Kamp devised a single-center prospective study to evaluate the accuracy of a device for detecting arrhythmias in adults with Fontan palliation and to assess it as a screening tool. The device used for the study was KardiaMobile®. The results were recently published in Pediatric Cardiology.

“We wanted to see if a tool like this was accurate, easy to use, and effective for patients with specific congenital heart lesion,” Dr. Laubham explains.

Fifty adult patients with Fontan palliation were enrolled and instructed on device use during a scheduled cardiology visit. At enrollment, researchers performed a 12-lead EKG simultaneously with the device. They compared the device’s report to both a physician’s overread and the standard EKG. Participants then submitted weekly device readings, as well as recordings at times of symptoms for one year.

Overall, the device showed reliable and accurate performance in confirming normal sinus rhythm. However, it sometimes missed arrhythmias. In those cases, a physician review was required to diagnose atrial fibrillation or other atrial tachyarrhythmias.

Proper patient instruction was critical to ensuring quality recordings and consistent use. A structured protocol encouraged patients to periodically check their rhythms, enhancing early detection and management of issues.

The researchers conclude the device provides an easy-to-use option for asymptomatic weekly screening and symptomatic event reporting with the correct patient training. However, the researchers also stress that the device has limitations. Relying solely on the device automated interpretation in this patient population risks missed arrhythmias or misinterpretations. A physician familiar with congenital heart disease should review abnormal or uninterpretable recordings. Dr. Laubham created a clinical workflow that requires physicians to review Fontan patients with symptoms and when recordings show uninterpretable results or a heart rate above the patient’s resting baseline.

“With adequate education, expert review, and adherence to follow-up protocol, incorporating patient-driven cardiac technology into routine care can improve arrhythmia detection and timely intervention in this high-risk patient group,” Dr. Laubham concludes.

Reference 

Laubham M, Dodeja AK, Kumthekar R, Shay V, D’Emilio N, Conroy S, Mah ML, Alvarado C, Kamp A. Patient Driven EKG Device Performance in Adults with Fontan Palliation. Pediatr Cardiol. 2024 Aug 16. doi: 10.1007/s00246-024-03614-6. Epub ahead of print. PMID: 39152263.

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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