Author + information
- Joseph M. Bumgarner, MD,
- Cameron T. Lambert, MD and
- Khaldoun G. Tarakji, MD, MPH∗ ()
- ↵∗Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, Ohio 44195
We thank Drs. Giancaterino and Hsu for their interest in our paper demonstrating the performance of automated detection of atrial fibrillation (AF) using the Kardia Band (KB) smartwatch algorithm (1). They raise several important points addressing the future applications of mobile cardiac monitoring devices. Our study importantly assessed the KB’s accuracy by comparing its algorithm to the rigorous standard of the physician-interpreted 12-lead electrocardiogram. This validation process is foundational in the development of new health care technologies, and we share in Drs. Giancaterino’s and Hsu's optimism regarding the positive impact the KB may have in the lives of patients with AF.
Stroke remains an unfortunate first presentation of AF in some patients, and the role of AF as a risk factor for stroke has been established by large epidemiological studies (2). When supported by physician review, the KB is capable of detecting brief (<30 s) episodes of AF. One may rightly wonder whether some of these debilitating strokes could have been prevented if AF had been detected earlier. However, the extent to which oral anticoagulation can mitigate stroke risk without increasing bleeding complications in patients with short paroxysms of AF is unknown, but it represents an exciting possible application of the KB algorithm. This is not a failure of the device, but rather a gap in our knowledge that hopefully ongoing studies such as the ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients with Device-Detected Sub-Clinical Atrial Fibrillation) trial and the large-scale follow-up to the REACT COM (Rhythm Evaluation for Anticoagulation With Continuous Monitoring) trial will help fill in the future (3,4). In our study, it was demonstrated that the accuracy of the KB algorithm was most pronounced in the setting of physician oversight. We must remain thoughtful about how new technologies are integrated into the longitudinal care of patients with AF. A smart device can only be smart if it is used intelligently.
As new technologies evolve at an unprecedented pace, it is an exciting era in which we practice medicine. As a medical community, we have an obligation to test these products, question their accuracy, and more importantly, examine their ability to change outcomes. An abundance of data could simply become noise if it is not accompanied by thoughtful clinical investigation. Using data obtained through well-conducted clinical studies will allow us to provide the guidance that our patients will need as future technologies emerge.
Please note: Dr. Tarakji has served on the medical advisory board and received honoraria from Medtronic and AliveCor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation
- Bumgarner J.,
- Lambert C.,
- Hussein A.,
- et al.
- ↵ClinicalTrials.gov. Apixaban for the reduction of thrombo-embolism in patients with device-detected sub-clinical atrial fibrillation (ARTESiA). September 10, 2013. Available at: https://clinicaltrials.gov/ct2/show/NCT01938248. Accessed June 29, 2018.
- Passman R.,
- Leong-Sit P.,
- Andrei A.C.,
- et al.