The Future of Personal, Everyday Monitoring
By Nassir Marrouche, MD
Director, Cardiac EP, Tulane University School of Medicine
Dr. Nassir F. Marrouche is a globally renowned electrophysiologist and pioneer in the treatment of Atrial Fibrillation. He is a tenured Professor in the Division of Cardiovascular Medicine within the Department of Internal Medicine at Tulane University and is Director of the Electrophysiology Division. He initiated a collaborative arrhythmia center that is bringing together a cross-departmental team of physicians, scientists, researchers, MRI and imaging specialists dedicated to working collaboratively to innovatively improve successful prediction, prevention and outcomes in the treatment of cardiovascular disease. He received his medical degree from the University of Heidelberg, Germany. He went on to complete his residency in Internal Medicine and Cardiology at Klinikum Coburg, teaching hospital of the University of Wurzburg, and completed clinical clerkships at the Cleveland Clinic Foundation, Harvard Medical School, University of Bristol, and University of Washington Medical Center. From there, he moved his training abroad where he completed Fellowships at the University of California, San Francisco, and the Cleveland Clinic Foundation. He is a Fellow of the American College of Cardiology and Heart Rhythm Society. Dr. Marrouche has published his research findings in more than 200 peer-reviewed articles and prominent medical journals, including the New England Journal of Medicine, Circulation and Journal of the American Medical Association (JAMA).
Nassir Marrouche
Director, Cardiac EP, Tulane University School of Medicine
I expect widespread advances in the area of mobile cardiac telemetry. Many currently available monitors are bulky and inconvenient, with some requiring removal for routine daily activities and others sometimes causing skin irritation that may result in low patient adherence rates.
I expect current monitors will be replaced by personally owned and operated smart devices. Devices such as the Apple Watch™ (Apple Inc.) running apps like Cardiogram™ (Cardiogram) currently have the capability of identifying AF with sensitivity and specificity of 98% and 90%, respectively, against reference 12-lead electrocardiography in patients undergoing cardioversion. Ambulatory results, while not as promising, with improvement may revolutionize the way we use ambulatory monitoring.
I believe these devices will cause a significant increase in the identification of occult AF. This will lead to an increase in the overall incidence of AF, perhaps temporarily increasing healthcare costs. However, a resultant decline in population-wide embolic cerebrovascular events with appropriate anticoagulant treatment may lead to a long-term overall decrease in costs for the healthcare system.
Technological advancements in this area will likely also extend to embedded rhythm monitors such as pacemakers and implanted loop recorders. With improvement in wireless communication, a patient may be able to routinely trigger rhythm recording from their implanted devices if or when they have symptoms. This could potentially identify rhythms that were under-detected because of lower rates or duration as well as providing reassurance in the case of normal rhythm findings.
With the amount of data collected from these devices, we may even be able to clarify the temporal relationship between paroxysms of AF and embolic events leading to a treatment strategy that may limit the lifelong, continuous use of systemic anticoagulation with all of its inherent risks. I believe growth in personally owned devices capable of ambulatory rhythm monitoring will be exponential and practice changing.
