Mobile Health for Arrhythmia Diagnosis and Management

Smartphone-based six-lead ECG: A new device for electrocardiographic recording in dogs

Smartphone-based technology for electrocardiographic recording is now part of the new concept of mobile health in both human and veterinary medicine. Although smartphone-based ECG for electrocardiographic screening in dogs is reliable, one-lead ECG devices have mainly been evaluated. This prospective study assessed the feasibility and the diagnostic reliability of a new smartphone-based six-lead electrocardiograph (smECG) in dogs, in comparison to a standard six-lead electrocardiograph (stECG). All ECG tracings were blindly reviewed by an expert operator, who judged whether tracings were acceptable for interpretation, performed the electrocardiographic measurements, and assigned a diagnosis. The agreement in the electrocardiographic interpretation and diagnosis between smECG and stECG was assessed using the Bland-Altman test and Cohen's k test. The study included 108 client-owned dogs. The tracings obtained by the smECG were interpretable in 100 % of cases. No clinically relevant differences between smECG and stECG were found in the assessment of heart rate, interval duration, and QRS mean electrical axis. The smECG tended to underestimate the amplitude of the P and R waves. Perfect agreement was found in the detection of sinus rhythm, atrial fibrillation, ventricular arrhythmias, atrioventricular blocks, and bundle branch blocks. Our study suggests that the tested smartphone-based six-lead ECG is a clinically reliable device for the assessment of heart rate and heart rhythm in dogs, and thus could be used in a clinical setting in dogs and for telemedicine.

Democratizing Health Care in the Metaverse: How Video Games can Monitor Eye Conditions Using the Vision Performance Index: A Pilot Study

Objective

In a world where digital media is deeply engrained into our everyday lives, there lies an opportunity to leverage interactions with technology for health and wellness. The Vision Performance Index (VPI) leverages natural human-technology interaction to evaluate visual function using visual, cognitive, and motor psychometric data over 5 domains: field of view, accuracy, multitracking, endurance, and detection. The purpose of this study was to describe a novel method of evaluating holistic visual function through video game-derived VPI score data in patients with specific ocular pathology.

Design

Prospective comparative analysis.

Participants

Patients with dry eye, glaucoma, cataract, diabetic retinopathy (DR), age-related macular degeneration, and healthy individuals.

Methods

The Vizzario Inc software development kit was integrated into 2 video game applications, Balloon Pop and Picture Perfect, which allowed for generation of VPI scores. Study participants were instructed to play rounds of each video game, from which a VPI score was compiled.

Main Outcome Measures

The primary outcome was VPI overall score in each comparison group. Vision Performance Index component, subcomponent scores, and psychophysical inputs were also compared.

Results

Vision Performance Index scores were generated from 93 patients with macular degeneration (n = 10), cataract (n = 10), DR (n = 15), dry eye (n = 15), glaucoma (n = 16), and no ocular disease (n = 27). The VPI overall score was not significantly different across comparison groups. The VPI subcomponent "reaction accuracy" score was significantly greater in DR patients (106 ± 13.2) versus controls (96.9 ± 11.5), P = 0.0220. The VPI subcomponent "color detection" score was significantly lower in patients with DR (96.8 ± 2.5; p=0.0217) and glaucoma (98.5 ± 6.3; P = 0.0093) compared with controls (101 ± 11). Psychophysical measures were statistically significantly different from controls: proportion correct (lower in DR, age-related macular degeneration), contrast errors (higher in cataract, DR), and saturation errors (higher in dry eye).

Conclusions

Vision Performance Index scores can be generated from interactions of an ocular disease population with video games. The VPI may offer utility in monitoring select ocular diseases through evaluation of subcomponent and psychophysical input scores; however, future larger-scale studies must evaluate the validity of this tool.

Financial Disclosures

Proprietary or commercial disclosure may be found after the references.

Early myopericarditis diagnosed in a 31-year-old patient using smartwatch technology: A case report

INTRODUCTION

Smartwatches, wrist-mounted devices with computing capacity able to connect with other devices via short-range wireless networking, are today commonly used by the general population to monitor their health status using specific applications. Currently, these devices offer new possibilities in remote health care monitoring and integration with other applications, through alert notifications, collection of personal data by a variety of sensors and the storage of these data. Several companies are introducing smartwatches with "health status" monitoring software with multiple functions, i.e. electrocardiogram (ECG) sensors. Recently, detection of atrial fibrillation based on heart rate monitoring by optical sensors resulted to be feasible and reliable when using the Apple Watch® and its corresponding application. Indeed, previous case reports highlighted its sensitivity in detecting morphological changes typical of the Acute Coronary Syndrome.

CASE REPORT

We report the case of a healthcare worker, who experienced chest pain and diffuse myalgia, detected ECG alterations in the ST segment, and reached the Emergency Department Myopericarditis was diagnosed and treated promptly to prevent complications.

DISCUSSION

Acute viral myocarditis and pericarditis are clinical conditions, usually characterized by 21 a benign course that does not require medical evaluation. However, ventricular arrhythmias are also common in viral myocarditis, and the latter is associated with a large proportion of sudden cardiac deaths in the young population without previous structural heart disease. In this case report, smartwatch technology allowed the preventive implementation of interventions against potentially life-threatening complications. Further developments in smartwatch technology could lead to more sensitive and specific diagnostic algorithms for conditions that require immediate medical intervention.

Evaluation of a new smartphone-based digital stethoscope featuring phonocardiography and electrocardiography in dogs and cats

This study assessed a new smartphone-based digital stethoscope (DS) featuring simultaneous phonocardiographic and one-lead electrocardiogram (ECG) recording in dogs and cats. The audio files and ECG traces obtained by the device were compared with conventional auscultation and standard ECG. A total of 99 dogs and nine cats were prospectively included. All cases underwent conventional auscultation using an acoustic stethoscope, standard six-lead ECG, standard echocardiography and recordings with the DS. All the audio recordings, phonocardiographic files and ECG traces were then blind reviewed by an expert operator. The agreement between methods was assessed using Cohen's kappa and the Bland-Altman test. Audio recordings were considered interpretable in 90% animals. Substantial agreement was found in the diagnosis of heart murmur (κ = 0.691) and gallop sound (k = 0.740). In nine animals with an echocardiographic diagnosis of heart disease, only the DS detected a heart murmur or gallop sound. ECG traces recorded with the new device were deemed interpretable in 88 % animals. Diagnosis of heart rhythm showed moderate agreement in the identification of atrial fibrillation (k = 0.596). The detection of ventricular premature complexes and bundle branch blocks revealed an almost perfect agreement (k = 1). Overall, the DS showed a good diagnostic accuracy in detecting heart murmurs, gallop sounds, ventricular premature complexes and bundle branch blocks. A clinically relevant overdiagnosis of atrial fibrillation was found but without evidence of false negatives. The DS could represent a useful screening tool for heart sound abnormalities and cardiac arrhythmias..