A recent study published in the journal Communications Medicine discusses how smartwatches can facilitate the diagnosis of arrhythmias in children.

Background
Smartwatches and other wearable devices are becoming increasingly popular and allow users to constantly monitor their health, leading to their value for medical diagnosis becoming well-recognized. While the utility of these devices for adults has been widely researched, including for cardiac health monitoring and reducing the time needed to detect symptomatic rhythms, little is known about how they can be used to monitor child health indicators. Palpitations and abnormalities in cardiac rhythms are a leading cause of referrals in pediatric cardiology. However, existing non-invasive methods like patch rhythm monitors are not always effective in diagnosing arrhythmias, as symptoms often present infrequently, and children cannot wear monitors for as long as adults.

Invasive methods such as implantable loop monitors (ILR) allow long-term monitoring. However, this approach may not be ideal for children, thus demonstrating a need for better non-invasive methods to monitor children’s cardiac health. There remains a clear need for longer-term noninvasive extended cardiac monitoring in children.

Monitoring the cardiac health of children through wearable technology is associated with significant challenges, as children generally have higher heart rates than adults and are more physically active. Another consideration is that the algorithms used to detect arrhythmias have been designed for adults and may not be attuned to the arrhythmias that are common in children.

About the study
Many smartwatches contain an optical sensor that sends alerts when heart rates reach abnormally high levels. These devices also allow users or their caregivers to initiate electrocardiogram (ECG) recordings when an atypical cardiac rhythm has been detected.

In the current study, researchers hypothesize that smartwatch devices from a well-known electronics manufacturing company could lead to arrhythmia identification in children. To this end, a retrospective study was performed by obtaining and analyzing recordings submitted by children to a pediatric hospital from 2018 to 2022.

The hospital database was queried to identify relevant observations. Patients were included in the study if they or their caregivers documented an arrhythmia using their device, and the diagnosis was subsequently confirmed by a pediatric electrophysiologist. The dataset also included demographic information, the type of arrhythmia, and results of other invasive and non-invasive cardiac monitoring tests.

Study findings
A total of 73 patients without previously known arrhythmias used their smartwatches for cardiac monitoring. Using the eligibility criteria, 41 patients and 145 cases were identified. The average age of children in the study was 13.8 years, with a mean weight of 57.2 kg. Only one patient exhibited moderately depressed ventricular function when an ECG was performed, whereas five patients had congenital heart disease. While 18 patients initiated ECG recordings, the remaining 23 utilized the high heart rate alert system.

In about 71% of patients, the device led to the diagnosis of cardiac arrhythmias that had not previously been identified. Notably, traditional monitors could not detect arrhythmias in 29% of the patients who were subsequently examined using patch rhythm monitors, 30-day event monitors, or Holter monitors.

In 88% of patients, the arrhythmia diagnosis was linked to supraventricular tachycardia (SVT). Other less common diagnoses included ventricular tachycardia, complex heart block, and wide complex tachycardia.

Conclusions
The current study presents compelling evidence regarding the utility of smartwatches for recording arrhythmia events in children and their ability to capture events that traditional methods may not detect. In other cases, the device was also helpful in monitoring the progression or relapse of an existing condition. This is among the first studies on smartwatches as a diagnostic tool for children, thus addressing a gap in the research for this population.

Studies on the accuracy of smartwatches from this particular manufacturer generally suggest that the continuous pulse monitor agrees with that of traditional monitors. However, the manufacturer’s sensor is often considered less accurate for heart rates exceeding 210 beats per minute and events that last less than one minute.

Additionally, the algorithm that identifies high heart rates and sends alerts was designed based on adult users. These limitations emphasize the importance of the ECG feature in characterizing arrhythmias in children.

Notably, the current study was a retrospective case series rather than a randomized clinical trial. As a result, the researchers were not able to calculate the actual rate of false positives.

Furthermore, it could not be concluded with certainty that the patients excluded from the study did not have arrhythmias. The researchers were also unable to remove selection bias from their sample. Since the researchers focused on a specific product, their sample was restricted to individuals who had an interest in and access to that product.
Future studies can strengthen these findings through randomized trials and by focusing on a wider population.

Source:
https://www.news-medical.net/news/20231218/Smartwatches-prove-effective-in-detecting-heart-arrhythmias-in-children.aspx