Key result
Wearable smart device captures Coumel's sign, establishing the definitive diagnosis of orthodromic AVRT.
Why the study?
Diagnosing the mechanism of supraventricular tachycardia requires ECG documentation, which is often missed by standard Holter ECG evaluation.
Can a patient-operated wearable smart device with ECG function accurately document paroxysmal palpitations to diagnose the underlying arrhythmia mechanism?
Case Report (n=1)
Can a patient-operated wearable smart device with ECG function accurately document paroxysmal palpitations to diagnose the underlying arrhythmia mechanism?
Wearable smart devices can capture critically distinct episodic ECG patterns in symptomatic paroxysmal arrhythmias, facilitating advanced diagnostic pattern recognition (e.g., Coumel's sign) that standard monitoring frequently misses.
May aid diagnosis of paroxysmal tachycardias missed by standard monitoring; leaves open broader validation before clinical adoption.
Background: Patients with supraventricular tachycardia (SVT) are often symptomatic, but frequency of symptoms is very variable. Definition of tachycardia mechanism and diagnosis is dependent on documentation of the arrhythmia by electrocardiogram (ECG), but this documentation is often missed by standard evaluation with a Holter ECG. Wearable smart devices with ECG function are valuable diagnostic tools in such patients. Case summary: We describe a case of a 59-year-old male patient who suffered from infrequent palpitations, where documentation of two distinct tachycardia ECG tracings with a wearable smart device led to the correct diagnosis. One tracing showed an episode of narrow QRS complex tachycardia at a heart rate of 200 b.p.m. and the other a broad complex tachycardia with left bundle branch block morphology at a slower heart rate. Based on these findings, which demonstrate Coumel's sign, atrioventricular re-entrant tachycardia with left lateral accessory pathway was suspected. Electrophysiological study confirmed the diagnosis, and an accessory pathway located at the lateral mitral isthmus was successfully ablated. Discussion: Aberrant ventricular conduction due to functional bundle branch block is an important finding during SVT. In the presented case, a wearable smart device was able to document two episodes of tachycardia with two distinct ECG morphologies, one with broad QRS complexes at a slower heart rate and the other with a faster episode of narrow QRS complexes. Therefore, the wearable device was not only able to document an episode of symptomatic tachycardia, but it also additionally offered important keys to the correct diagnosis.
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Wiederkehr et al. (2025) conducted a case report in Supraventricular tachycardia (Orthodromic AVRT) (n=1). Wearable smart device with single-lead ECG was evaluated on Documentation of symptomatic tachycardia and elucidation of arrhythmia mechanism. A wearable smart device documented two distinct ECG tachycardia morphologies, demonstrating Coumel's sign and enabling the correct diagnosis of orthodromic atrioventricular re-entrant tachycardia.
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