When Do Smartwatch Heart Rate Concerns in Children Indicate Arrhythmia?

Area of Science:

• Cardiology
• Pediatric Cardiology
• Digital Health

Background:

• Smartwatch cardiac data is increasingly common in pediatric cardiology.
• Concerns arise regarding the accuracy and clinical significance of smartwatch-detected arrhythmias in children.

Purpose of the Study:

• To determine the incidence of true arrhythmia in pediatric patients with smartwatch cardiac data concerns.
• To identify predictors of true arrhythmia in this population.

Main Methods:

• Retrospective cohort study of 126 children (aged 10-18) presenting with smartwatch rhythm concerns.
• Data collected from January 2018 to December 2021.
• Primary outcome: diagnosis of arrhythmia via clinical evaluation or testing.

Main Results:

• 15% of patients (19/126) were diagnosed with true arrhythmia.
• Tachycardia was present in 89% of cases.
• Heart rate ≥190 beats/min was a significant predictor (OR 14.3), while symptoms were less so (OR 3.2).
• Positive predictive value of HR ≥190 and symptoms was 39%; negative predictive value was 95%.

Conclusions:

• True arrhythmia is uncommon in pediatric patients with smartwatch-based heart rate concerns.
• Smartwatch electrograms or trend data are seldom sufficient for diagnosis.
• Clinical evaluation remains crucial for confirming arrhythmias.