SMart watches & mobile smart phone electrograms assessing ARrhythmia TrendS: Smarts Study Assess utility of smart watches and mobile smart phone electrograms in arrhythmias

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Utilization of wearable technology in estimation of heart rate has wide reaching implications. Firstly, validation of heart rate measurement using this technology in healthy individuals at rest and exercise is vital for any future research going forward. Secondly, if smart watches prove to be accurate in monitoring heart rate trends among patients with arrhythmias, it could be a useful tool in guiding and monitoring response to pharmacological therapy. Smart watches and wearable technologies also have the ability to provide longer term monitoring of heart rate compared to 24 hour ECG holter monitoring also called ambulatory monitoring or telemetry - the current standard of care. It may be a cost effective and non-invasive method for patients to remotely assess their heart rate trends and communicate any abnormalities with their cardiologist or general practitioner. This would ensure timely assessment and an earlier change in management strategy that could lead to reduced presentations to the emergency department and improve overall patient satisfaction. Moreover, the ability for patients to accurately track their biometric indices may empower them to be more engaged in their health leading to improved clinical outcomes and quality of life. In addition to heart rate analysis, a versatile and validated mobile platform for heart rhythm analysis through the use of a mobile single lead ECG device may lead to more widespread adoption of this technology by the clinician. Methodology Patients that consent for the study will be provided with two smart watches that use wrist PPG technology as well as a hospital grade pulse oximeter for heart rate assessment. The two smart watches intended for use in this study are the Apple Watch and the FitBit Blaze given their popularity and global market share. Heart rate readings in all patients will be documented using data from an ECG linked with the ward telemetry unit (in the case of inpatients) or an ECG ambulatory monitor (in the case of outpatients undergoing stress echo or ECG) as per standard ward or stress testing protocol. Each patient will be monitored for a period of approximately 30 minutes with heart rate data being recorded every fifteen seconds among each different modality. Additional parameters recorded include a blood pressure reading at the start and end of the period of monitoring. Baseline characteristics including cardiovascular risk factors, history of arrhythmias and medication use will be noted. For patients when using the mobile smart phone electrocardiogram, three heart rate recordings using a single lead mobile ECG device (each lasting approximately 30 seconds) will be taken. These readings will be compared to a 12 lead ECG which will be performed during this period as a comparator. For patients undergoing cardioversion, this will be repeated after the cardioversion procedure.