In Eric Topol's book The Creative Destruction of Medicine he speaks about how the precipitous convergence of a maturing Internet, increasing bandwith, near ubiquitous connectivity and miniature pocket computers (smartphones) are taking physicians and patients where no one has gone before.
Palpitations are a common symptoms in patients attending my clinic. Assessment tries to establish when the symptoms started, how frequently they occurs, how long each episode is, whether there are provoking or relieving factors and whether there are any associated symptoms. I try to see whether the patient thought the rhythm disturbance was regular or irregular. Many times people are vague about the precise nature of the symptoms because it is very subjective and truly difficult to describe.
For most patients the frequency of attacks is perhaps once or twice a week at most. What they need is an ECG recorded at the exact time they have symptoms. We still use the so called "24h Tape". in fact these can record for 7 days and don't contain any tape. We use cardiac event monitors such as the Novacor R-test which record loops of ECG for a week or more. One problem with all these devices is that they require wet gel electrodes to be stuck to the skin for long periods which often results in skin irritation and discomfort. The other problem is the so called vanishing arrhythmia that never comes when the monitor is attached. So is there another way to record the ECG which might be useful for someone with intermittent palpitations using a machine which people have to hand most of the time.
This is where the AliveCor smartphone attachment comes in. I ordered one recently. It looks and behaves like a protective smartphone cover. Having already downloaded the AliveCor app I was ready to record my single lead ECG within a moment. The quality is remarkable and the device so simple to use. With two dry electrodes on the back of the phone, one for the left and the other for the right hand you can get a lead 1 type ECG. If you want a better P wave (ie lead II or III) why not put the device on the left leg and the right hand which also works superbly. No skin preparation is needed. One of the recordings I made is shown below - you can judge the quality for yourself. This is a typical recording and because it is on a smartphone it is possible to email the file or store it as a PDF.
I guess the main limitation at present is the need to possess a smartphone and also the cost of the device which currently retails at £169. Certainly for patients with paroxysmal atrial fibrillation or episodic palpitations this device might be very useful. I am looking forward to using it.
For further information about the device and how it works see the dedicate page on my website.
Dr Richard Bogle
The opinions expressed in this blog are strictly those of the author and should not be construed as the opinion or policy of my employers nor recommendations for your care or anyone else's. Always seek professional guidance instead.