Use of a smartphone electrocardiogram to diagnose arrhythmias during exercise in athletes: a case series

Abstract

Background While athletes are generally very fit, intense exercise can increase the risk of atrial fibrillation. Moreover, other arrhythmias such as atrial flutter or supraventricular tachycardia can cause distressing, exercise-related symptoms. Given symptoms are infrequent and may occur during intense exertion, traditional monitoring devices are often impractical to use during exercise. Smartphone ECGs such as the Alivecor Kardia device may be the portable and reliable tool required to help identify arrhythmias in this challenging population. This case series highlights the use of such devices in aiding the diagnosis of arrhythmias in the setting of exercise-related symptoms in athletes. Case Summary The six cases in this series included one elite non-endurance athlete, two elite cricketers, one amateur middle-distance runner, and two semi-elite ultra-endurance runners, with an age range of 16-48. An accurate diagnosis of an arrhythmia was obtained in five cases (atrial fibrillation/flutter and supraventricular tachycardias) using the smartphone ECG, which helped guide definitive treatment. No arrhythmia was identified in the final case despite using the device during multiple symptomatic events. Discussion The smartphone ECG was able to accurately detect arrhythmias and provide a diagnosis in cases where traditional monitoring had not. The utility of detecting no arrhythmia during symptoms in one case was also highlighted, providing the athlete with the confidence to continue exercising. This reassurance and confidence across all cases is perhaps the most valuable aspect of this device, where clinicians and athletes can be more certain of reaching a diagnosis and undertaking appropriate management.

Wearable and Portable Devices for Acquisition of Cardiac Signals while Practicing Sport: A Scoping Review

“…Some wrist devices present a monitor that allows one to check data in real time. Among all the devices, the Kardia by AliveCor [ 22 , 45 ] stood out for its target user, the clinician, and is the only one FDA-cleared. This portable device is able to detect atrial fibrillation, bradycardia, tachycardia and normal heart rhythm.…”

“…The BioHarness 3.0 by Zephyr was used in a great variety of sports [ 42 , 43 , 49 , 50 , 51 , 52 ] to evaluate the health status of athletes based on HR variability [ 42 ] and to characterize ECG during the pre-exercise phase [ 43 ], providing reference values for future diagnosis. ECG has also been acquired using a portable device called AliveCor Kardia, which helps the diagnosis of arrhythmias during exercise in athletes [ 45 , 56 , 57 ].…”

Diagnostic Accuracy of a Portable ECG Device in Rowing Athletes

“…Although many devices are available, only three have received medical device regulatory approval to discriminate between sinus rhythm and AF; these include the Apple Watch, Fitbit and AliveCor Kardia system. The Kardia device has been found to accurately detect arrythmias in athletes in a case series [ 23 ] and deemed to have good reliability compared to a 12-lead ECG device [ 24 ]. The Apple Watch (series 4 and newer) has been shown to have agreement with a standard 12-lead ECG device for the classification of the rhythm as sinus or AF.…”

Wearables as an Aid to Cardiovascular Diagnosis in a Young Runner

“…What to do when the evaluation does not produce an answer leaves a gap in the clinical decision making. Wearables may provide additional information to help determine the diagnosis especially for athletes in whom their clinical events happen out in the field during practice or competition (4). Depending on the manufacturer, the wearable may generate graphs showing the sudden onset and record the heart rate, as well as the pace and terrain.…”