Friday, June 18

Cleveland Clinic researchers on how digital is transforming cardiac electrophysiology

While new digital tools are sprouting up all over the medical map, cardiology continues to be an area of breakneck innovation. However, adoption rates among providers in the field are not always equal.

A new review out of the Cleveland Clinic, published in Circulation: Arrhythmia and Electrophysiology, zeroed in on the electrophysiology space and looked at both the opportunities for digital and the challenges.

Consumer products, such as smartwatch ECGs, are becoming increasingly popular on the market. This is just one of the digital tools that has the ability to transform the traditional model of medical innovation, according to the review. 

“As physicians we are used to the model of identifying a need, trying to create solutions, and sometimes working as scientists and physicians in collaboration with industry,” Dr. Khaldoun Tarakji, lead author of the review and a physician at the Cleveland Clinic, said in an interview with MobiHealthNews.

“Whether it’s pharma or medical device companies trying to come up with solutions, they go through vigorous clinical trials to get FDA approval, and then these innovations come back to us as physicians and healthcare providers to be presented at the right time for the right patients. So, the physician has a roll in that equation. 

“Now what you are seeing in the field of digital health, and wearables in particular, is you have great companies, very innovative. They have some medical knowledge, but not that much, coming up with very cool products. And all of a sudden your physicians are on the receiving end … Every week, there is a new company trying to introduce us to new technology, and all of a sudden we are trying to find [out] how to use this technology.” 

In the review, the authors pointed out that it’s important for physicians to understand the limitations of different technologies such heart rate and rhythm monitors. However, Tarakji noted in the interview that these technologies have the opportunity to help both patients and providers, if implemented correctly.

“These are very innovative products, and when we first looked at the Apple Watch or other smartphone ECG when they start coming up on the market, it was almost too good to be true – almost like science fiction – because it was something we were never able to even image that patients could record independently. It was always through medical-grade products, and now we have these tools,” he said. “They could be used efficiently or abused. We see the good and bad. We definitely could see potential to provide better care for the Afib patient … We are also seeing these devices raising anxiety that is not necessary among the healthy.”

Additionally, he noted that sometimes providers can be overwhelmed by the data from this type of device. 

While there are still challenges in the digital space, the review says that future opportunities could be found in digital clinical trials by boosting the patient-provider experience, tapping artificial intelligence in cardiovascular care and closing medical knowledge gaps. 


Digital tools are plentiful in the world of health. However, provider education about the tools varies. 

“The review article came out of recognition of the need that, when you look at the field – the level of engagement from colleagues in the same profession – it is not the same among all of us,” Tarakji said. “You see some who are more engaged than others and … this review is an effort to spread the word and engage everyone in the electrophysiology community about what is going on in the field – trying to bring everyone up to speed.”

Tarakji said that the tools could be helpful not just for providers in the future, but also for patients. 

“Patients are very intelligence and very knowledgeable about their condition, and nobody will have more interest in taking care of them then the patients themselves,” he said. “So, introducing them to the right product to make their care even better, I think they would fly with it.”


Perhaps one of the most notable advancements to come out of the digital cardiology space was the Apple Watch Series 4’s FDA clearance for both an atrial fibrillation-detecting algorithm and an ECG.

Since then, several wearables companies have unveiled ECG capabilities. In August, Samsung revealed that its Galaxy Watch3 landed FDA clearance for its monitoring app. Fitbit has also released a smartwatch with an ECG sensor and corresponding app. 

But wearables-makers aren’t the only digital health companies playing in the cardio space. For example, Caption Health uses AI to guide medical professionals though cardiac imaging that would normally be conducted by an ultrasound expert. Others, like Heartbeat Health, focus on using digital tools to aggregate heart data and provide care management to patients. 

Research on digital tools was also plentiful at the 2019 American Heart Association Scientific Sessions, where studies, reviews and pilots touched on everything from defibrillator delivery-drones to telemedicine. 

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