Marco Perez, MD, discusses his session entitled “Can Medical Treatment of Supraventricular Tachycardia and Atrial Fibrillation be Guided by Smartphone Apps?” during this onsite interview from Heart Rhythm 2023.

Transcripts:

My name is Marco Perez, I'm one of the associate professors at Stanford University. I'll be talking about some of the innovations in using applications to manage atrial fibrillation (AF) and supraventricular tachycardia (SVT). We've learned a lot over the last few years. We conducted the Apple Heart Study almost 4 years ago. Since then, we've learned a lot about how these wearable devices behave out in the community. Since the initial publication, we have some updated information on what these devices are actually detecting. For example, we recently published a study with Dr Alexander Perino that looked at patients in the Apple Heart Study who had irregular rhythm notifications who did not have AF on their monitor, but other things such as frequent PACs and PVCs. So, we learned a lot about that behavior. 

This is still unpublished, but we have also been trying to understand why certain participants did not go through with some of the study. It was one of the problems that we ran into in the Apple Heart Study, and others are encountering this in digital studies. We're studying aspects such as race and ethnicity, and how those play a role in participation. So, you'll be hearing a little more about that. 

There have been a lot of devices and applications that have come out to help manage AF. For example, the AF History algorithm is now available on the Apple Watch for patients with AF. I think the interesting thing that we're starting to see now is the innovation in not just detecting undiagnosed AF, but rather, managing the patients who already have AF. What we're starting to see now are clinical trials that are geared around that concept. Dr Rod Passman is leading a study called REACT-AF, and we are participating in that study as the clinical coordinating center. That study is designed to test the idea of “pill-in-the-pocket” using the Apple Watch algorithm and only taking anticoagulation medication when there is an episode of AF. That's going to be a randomized controlled trial starting in just a couple of months.

There are a few take-home points that I'd like to highlight. One is that these applications and devices are here to stay. Our patients are using them. They're going out and purchasing them. In some ways, it's out of our control. These patients are going to get these products. So really, the onus is on us to understand them better, study them, and validate them. I think that's what we all in the scientific and clinical community need, is to better understand how these devices impact our patients and what we need to do to help better manage our patients. How to take that data that these patients come to us with and integrate it into our existing medical system to provide optimal care. So, those are the main things I wanted to chat about. Thank you for joining us, and I look forward to talking more about all these things!