Ask the arrhythmia specialist to correct the Apple Watch "ECG"-What to deal with when arrhythmia is recorded?

　"IOS 14" held in January.4 "and" Watchos 7.With the release of "3", ECG applications can now be used in Japan with Apple Watch (Series 4, 5, 6).How should this new feature that can be used with great use use it for daily health management?

　Dr. Yuhiro Kimura of Keio University Hospital Cardiovascular Medicine, who is working on medical treatment for heart disease using Apple Watch as soon as possible in Japan, can understand the correct measurement of ECG in Apple Watch, and use it with ECG applications.I asked if it was good.

―― In Japan, the function that allows ECGs with Apple Watch has been lifted.How do you see this lifting from the standpoint of a doctor who has been focusing on the Apple Watch healthcare function early?

Kimura: The data of the tests that can be seen as medical professionals is limited to the patient's visit.On the other hand, devices such as smartwatches and smartphones continue to accumulate various daily life outside the hospital while wearing them.We have been interested in using healthcare data based on these daily lives for life guidance and treatment.Many healthcare data still has no medical and interpretation, but the big difference is that ECG can be treated as an established data.In the United States, it was available for two years, so I was waiting for the lifting of the ban in Japan.

――What are the benefits of being able to use ECG applications?

Kimura: I think that everyone has done an electrocardiogram once for a medical examination.However, an electrocardiogram does not mean that there is no problem with the heart just because it is okay to do several tens of seconds once a year.Diagnosis, such as arrhythmias and angina, can be diagnosed only by recording an electrocardiogram when the heart is abnormal.If you have symptoms, you can decide whether the symptoms are caused by the heart by recording an electrocardiogram at that time.It is generally reported that the longer you record your ECG, the higher the rate of diagnosis of the disease.At the hospital, a Holter ECG with a 24 -hour ECG is performed, but it is often said that symptoms or seizures happened to happen on that day.

　I think it's a great digital healthcare revolution that you can record your ECG anytime, anywhere, with the Apple Watch you usually wear.If you have any worrisome symptoms, you can always check your self -check, and even if you do not have the symptoms, you may be able to find a change in the state of hidden heart by recording regularly.

――Is it not only can you record data by receiving approval as a medical device, but also makes it easier to use it for medical care?

Kimura: That's right.It can be treated as a healthcare data that has been evaluated for quality by approval of medical devices as a home program.However, this does not mean that you can diagnose or treat with the data and results.Doctors only use them as assistance for medical treatment.This time it is an ECG, but in the future, various healthcare devices will be able to collect information that combines quantity and quality.It is regarded as a new area that fills the groove between health care and medical care.

――What kind of data can you record specifically in ECG applications?

Kimura: When performing an electrocardiogram at a medical checkup, you put a number of electrodes around your limbs and chests.The movement of the heart is electrically recorded from 12 angles, but when recording an electrocardiogram with Apple Watch, it is a mechanism that similars to one of them by touching Digital Crown.

――The waveform is useful for detecting signs of "atrial fibrillation" ... What is this "atrial fibrillation"?

Mr. Kimura: The heart is an organs that move with electricity, and the electricity is transmitted from the atrium to the ventricle, and it plays the role of a pump that carries blood by moving regularly and alternately. The electrocardiogram that records the flow of electricity is an electrocardiogram. Due to the abnormal flow of electricity, the way the heart moves different from normal is called "arrhythmia", and there are many types of arrhythmias because all names are attached depending on the flow of electricity. Atrial fibrillation is one of the arrhythmias, and it writes that "the atrium moves finely", so it moves as if the atrium trembles. As a result, some people feel uncomfortable with pulse as palpitations, but some are completely asymptomatic. Also, when atrial fibrillation becomes atrial, the atrium does not contract well, so if the blood stagnates and a blood clot (thrombus) is formed, it will cause cerebral infarction. It is said that the risk is 5 times compared to those who do not have atrial fibrillation. In addition, the number of patients with atrial fibrillation is more than 1 million in Japan, and it is said to be 5-10 % of the age of 75 and over.

　Cerebral infarction caused by atrial fibrillation, unlike cerebral infarction caused by arteriosclerosis with age, is also merged with young people, often fatal, and the sequelae may recur.I know it's expensive.There are few cases where asymptomatic people are diagnosed with atrial fibrillation after half body paralyzed, and doctors and companies around the world manage to catch the atrial fibrillation before that happens.doing.It is undoubtedly useful for an early detection of illness outside the hospital.There is only one record of the electrocardiogram of atrial fibrillation, so you can take measures to prevent cerebral infarction.

――When should an electrocardiogram application be used?

Mr. Kimura: When patients use a portable electrometer that is also sold at electronics retailers, as in blood pressure measurement, twice a day in the morning and evening, when there is something uncomfortable in the heart, for example.Please record when you have palpitations or pain.However, it was often the case that only when there were symptoms did not have a portable electrocardiogram.In the case of Apple Watch, you can always record for the purpose other than recording an electrocardiogram.I think it's a good idea to make it a habit not only when you have symptoms, but also in your own rhythm.It doesn't make sense to record it once and then forget it again.It is important to increase the frequency of records and notice changes in your health.

　As a specific record timing, I would like you to record at least when you have any discomfort or symptoms.It is said that arrhythmia is likely to occur when you are stressed, when you are not sleeping, or the day after you have a deep alcohol.

　In fact, one of the purpose of clinical research as "Apple Watch Heart Study" is to clarify when to record.Along with the various healthcare data that reflects the lifestyle recorded by Apple Watch, we aim to build an algorithm that can inform you of the timing of recording now.