WHAT THIS POST IS ABOUT. It’s how a Series 4 Apple Watch led to the discovery of atrial flutter, not atrial fibrillation.


It makes sense now, once you know what you’re looking at.

To recap: Just over a week ago I had been noticing my daily average heart rate, as recorded by the Apple Watch Series 4 and the app HeartWatch (in addition to Heart Analyzer and Cardiogram), was creeping up — from 89 (Nov. 2018 to Jan. 31, 2019) to 101 by the end of February. Eighty-nine is still high, but manageable. One-hundred-one starts to get uncomfortable, sparking a call to my cardiologist and his desire for me to wear a heart monitor to see what else is going on.

My Numbers

The 24 hours-plus I wore the monitor the Apple Watch told me:

  • My daily average climbed to 114
  • My heart rate was elevated 81 percent of the day (!) with a max of “only” 124
  • My heart rate was in a high resting state (80 to 109 beats per minute) 17 percent of the day, leaving me in a resting (normal) state only three percent
  • (Note the doctor asked me not to perform any extreme cardio, just have an average day.)
  • The ECG part of the Apple Watch indicated I was in sinus (normal) rhythm four of the 14 times I checked, with six Inconclusive readings (these can be equipment or monitoring issues but are often a result of fast heart rhythms), two Heart Rate Over 120 readings, and two Atrial Fibrillation notifications . . . so that’s 10 instances of something amiss . . . not necessarily AFib but what?
What the Doctor Saw

This morning the doctor’s nurse called to say I was in AFlutter the entire time and I need to see the electrophysiologist. (I’ll get specific numbers then. Update: The doctor’s number was 112 for 22-27 hours; mine was 114 for 23-24 hours.)

As I said, having an average heart rate of 101 — mostly ranging from the high 90s to the mid 120s with occasional spikes beyond — is manageable, but when the heart is in a constant state of flutter that complicates matters. I’ve been here before. Numerous times.

(Update: By the time I saw the electrophysiologist in March, my average had climbed to 105.)

What is AFlutter?

Like atrial fibrillation, atrial flutter is a common abnormal heart rhythm and is classified as a type of supraventricular tachycardia. It occurs in people with cardiovascular disease (high blood pressure, coronary artery disease, cardiomyopathy, diabetes mellitus), but it can also occur spontaneously in people with otherwise normal hearts.

The red looks intimidating but it only indicates a fast heart rate over a period of time, not actual AFlutter.

AFib and AFlutter are probably the two most frustrating heart ailments for both patients and the medical profession because there is no actual “cure” or “cures” like ablations and cardioversions that actually work over a long period of time.

AFlutter leads to poor contraction of the atrial chambers and can lead to pooling of blood in the heart, which can then lead to the formation of blood clots. Blots clots are the real danger here, especially if they break off in the heart and travel through the bloodstream to lodge in the brain or elsewhere (I once had one lodge in a kidney). Blood clots, of course, lead to a wide range of clots — from TIAs to mild strokes to severe and incapacitating strokes.

(Aside: Today, by the way, is the ninth anniversary of the blood clot that caused a massive, catastrophic stroke in my Mom, who is unable to speak due to aphasia and apraxia and only able to use about 10 percent of her body.)

In AFib the atria beat irregularly. In AFlutter the atria beat regularly but faster than usual (think hummingbird wings) and more often than the ventricle chambers. Someone may have four or five beats in the atria to one in the ventricular and may feel a flutter in the chest, lightheaded, “spacey,” “cloudy,” tired, and so on. If it persists over days, not just minutes or even hours, the conditions worsen.

AFlutter, like AFib, is not life threatening, although after talking with many who live with both I’d argue that each are life-altering, especially if prolonged, and should not be taken lightly by doctors or the medical profession (a subject of a future post).

What’s Next?

Time to see the electrophysiologist and talk strategy. Those in this situation have a few options, including:

  • Changes to drugs used to manage heart rate, atrial fibrillation, stroke (blood thinners)
  • Cardioversion — shocking the heart back into sinus rhythm (these days it’s almost outpatient care). There’s no guarantee a heart will remain in rhythm with either AFib or AFlutter.
  • Catheter Ablation — a bit more involved but also pretty common these days. There’s no guarantee a heart will remain in rhythm with either AFib or AFlutter.

Between now and the pow-wow with the electrophysiologist, I’ll keep an eye on the Apple Watch results. I remind myself: The Apple Watch didn’t diagnose me with AFlutter (or even AFib). It’s a tool. That’s all.

What’s important is what I do with the watch, the data generated, how I organize, present, and understand (with the help of Notion) and discussions with doctors that result. This isn’t normal.

Stay tuned.

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