“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive.
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I have written about atrial fibrillation (AF) multiple times in this column because, despite many cardiovascular advances over the past decades, AF remains an albatross vexing both patients and clinicians. The incidence of this most common type of rapid heartbeat continues to increase, in part due to aging of the population as well as increased survival from other cardiological problems such as heart failure, that march together with AF.
For years we considered AF a “trivial” heart rhythm disturbance easily managed and without major consequences. We’ve come to realize that we have underestimated its impact and that it is associated with significant morbidity such as heart failure and strokes, as well as an increase in mortality. Recognizing these effects highlights the need to diagnose AF’s presence, particularly since as many as one third of AF episodes may be asymptomatic. We’ve also learned that lifestyle management including alcohol cessation, weight reduction, and exercise can help reduce its presence, leading to a decrease in its related comorbidities.
Therapy is challenging because antiarrhythmic drugs to establish and maintain a normal sinus rhythm are often ineffective and replete with side effects. Catheter ablation, i.e., using a catheter inserted into the heart to destroy specific areas of heart tissue responsible for the arrhythmia, is preferable and more successful, but it requires at least one, and often several, invasive procedures with therapeutic success dependent on the skill set of the operators. That approach is difficult to meet large scale population needs.
A major therapeutic advance over the past few years, and still evolving, is the concept of diagnostic wearables. Our usual outpatient practice is to evaluate a patient in an office setting, or increasingly today by some sort of telecommunication, to prescribe a therapeutic approach, and then re-evaluate the patient again at some future date. We rarely know what happens to the patient in between visits. That is where diagnostic (and even therapeutic) wearables will play an increasingly important role. Clothes, cell phones, jewelry, and almost any other conceivable article that can be held close to the body can be fitted with sensors to monitor heart, blood pressure, brain, and lungs, and functions such as activity, sleeping, eating, and so forth.
A recent study examined a novel optical sensor-based algorithm to detect undiagnosed AF from a range of wrist-worn devices in almost half-a-million participants. The authors found that the Fitbit wearable-based irregular heart rhythm algorithm provided early detection of undiagnosed AF with a high degree of accuracy, confirmed by a subsequent ECG patch monitor.
This is only one example of many smart wearables containing an array of sensors that can detect a variety of disorders encompassing cardiovascular, metabolic, neurologic, and other illnesses, as noted above. The vast amount of information produced by diagnostic wearables will require new analytic approaches such as artificial intelligence and machine learning algorithms for interpretation but will provide tailored treatments for patients with cardiovascular diseases.
Medicine is on a new course to provide precision diagnosis and treatment for vast numbers of patients. The future is indeed exciting.
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