{
  "id": "AIBD-0289",
  "title": "Smartwatch low-heart-rate alert (<40 bpm) sends a 32-year-old woman to hospital, where ciprofloxacin is identified as the cause of her bradycardia and replaced",
  "summary": "A smartwatch alert for a heart rate under 40 bpm two days after discharge on ciprofloxacin led to an ED visit; telemetry showed 30–50 bpm, the antibiotic was switched and the rate normalized.",
  "date_observed": "2022-01-24",
  "date_basis": "unassessed",
  "date_precision": "unassessed",
  "benefit_status": null,
  "source_collection": null,
  "source_entry": null,
  "account": "Cordova Sanchez, Chohan, Olatunde and White of SUNY Upstate Medical University, Syracuse, reported a case in the Journal of Investigative Medicine High Impact Case Reports. It was published 24 January 2022; the event date is not given. A 32-year-old woman was seen two days after discharge from a hospital stay for cholangitis, during which she had an ERCP. She was sent home on ciprofloxacin and metronidazole. She developed dizziness on minimal exertion, and her smartwatch triggered an alert for a sustained heart rate below 40 beats per minute. She attended an outside emergency department, where telemetry confirmed 30–50 bpm. She was transferred to the authors' hospital for cardiology review. Her electrocardiogram (ECG) showed sinus bradycardia at 51 bpm, against 66 bpm before the antibiotics. The procedural drugs given two days earlier have short half-lives. Other work-up (blood tests, thyroid function, Lyme serology, drug screen, echocardiogram) was unremarkable. Ciprofloxacin was replaced with ceftriaxone; by the next day her heart rate was 60–70 bpm. She was discharged on cefpodoxime and metronidazole. The authors conclude ciprofloxacin was the likely cause and early recognition of the bradycardia prevented a potential adverse event. The watch's brand and model are not stated; the authors describe wearable heart-rate detection generically as photoplethysmography.",
  "category": "benefit created",
  "unexpected": false,
  "purpose": "Smartwatch low-heart-rate alerts are built to prompt the wearer to seek review; this alert was that purpose. The authors add that consumer wearables may surface less commonly reported medication side effects.",
  "system": "Smartwatch low-heart-rate alert (brand and model not stated)",
  "model_version": null,
  "developer": "Not stated (the report does not name the device's maker)",
  "deployer": null,
  "location": "Syracuse, United States",
  "domain": "Healthcare (cardiology; adverse drug reaction)",
  "segment": "Consumer wearables",
  "benefit_type": "Improved Physical Health",
  "taxonomy_note": null,
  "registry_ids": {},
  "ratings": [
    {
      "group": "personal",
      "depth": 2,
      "reason": "The alert led to recognition of symptomatic drug-induced bradycardia and a change of antibiotic, after which her heart rate normalized. The authors say a potential adverse event was prevented but document no event that was imminent."
    }
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    "status": "assessed",
    "statement": "The watch's sustained low-heart-rate alert, combined with her symptoms, is what the authors say prompted the hospital visit. Telemetry confirmed the rate and clinicians identified ciprofloxacin by exclusion and re-challenge-free withdrawal. The threshold alert is a simple rule on a photoplethysmographic heart-rate estimate, and the brand is unknown, so no learned model can be credited."
  },
  "evidence": [
    {
      "kind": "case report",
      "citation": "Cordova Sanchez A, Chohan M, Olatunde O, White C (2022). A Rare Case of Ciprofloxacin-Induced Bradycardia Recognized by a Smartwatch. Journal of Investigative Medicine High Impact Case Reports 10:23247096211069761. doi:10.1177/23247096211069761 (PMC8793425).",
      "title": "A Rare Case of Ciprofloxacin-Induced Bradycardia Recognized by a Smartwatch",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8793425/",
      "date": "2022-01-24",
      "written_by": "independent",
      "quote": "Her smartwatch had triggered an alert for a sustained heart rate of less than 40 beats per minute (bpm), prompting her to present to the Emergency Department"
    },
    {
      "kind": "case report",
      "citation": "Cordova Sanchez A et al. (2022), J Investig Med High Impact Case Rep 10:23247096211069761, management.",
      "title": "A Rare Case of Ciprofloxacin-Induced Bradycardia Recognized by a Smartwatch",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8793425/",
      "date": "2022-01-24",
      "written_by": "independent",
      "quote": "She was placed on continuous telemetry and ciprofloxacin was replaced with ceftriaxone."
    },
    {
      "kind": "case report",
      "citation": "Cordova Sanchez A et al. (2022), J Investig Med High Impact Case Rep 10:23247096211069761, discussion.",
      "title": "A Rare Case of Ciprofloxacin-Induced Bradycardia Recognized by a Smartwatch",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8793425/",
      "date": "2022-01-24",
      "written_by": "independent",
      "quote": "Early recognition of bradycardia prevented a potential adverse event."
    }
  ],
  "replication": {
    "produced_by": [
      "A wearer on a newly prescribed drug whose smartwatch has a low-heart-rate alert enabled",
      "Symptoms vague enough that the alert, not the symptoms alone, prompted presentation",
      "Clinicians who excluded other causes and withdrew the suspected drug"
    ],
    "must_hold": [
      "The bradycardia is sustained long enough to trip the watch's threshold",
      "The wearer treats the alert as a reason to seek care"
    ],
    "echoes": []
  },
  "paired_incident": null,
  "headline": "Smartwatch alert under 40 bpm reveals ciprofloxacin bradycardia",
  "metric": "by the next day her heart rate was 60–70 bpm",
  "comparator": {
    "against": "presentation without the smartwatch alert",
    "before": "a potential adverse event",
    "after": "Early recognition of bradycardia",
    "basis": "assumed",
    "quote": "The combination of symptoms and smartwatch notification prompted her presentation to the hospital. Early recognition of bradycardia prevented a potential adverse event.",
    "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8793425/"
  },
  "later": {
    "status": "unknown",
    "date": null,
    "note": "Nothing after discharge on cefpodoxime and metronidazole was found.",
    "quote": null,
    "url": null
  },
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  "unrated_because": null,
  "brief_notes": null,
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  "revisions": [
    {
      "date": "2026-10-20",
      "change": "Record drafted from the cited sources.",
      "source": null,
      "editor": "AIBD"
    },
    {
      "date": "2026-10-21",
      "change": "Added what the benefit is measured against from the cited sources.",
      "source": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8793425/",
      "editor": "AIBD"
    },
    {
      "date": "2026-10-21",
      "change": "Benefit type set to Improved Physical Health under Trustible's full taxonomy of 23 types; it was Improved Accessibility among the six first used.",
      "source": "https://trustible.ai/post/a-framework-for-measuring-the-benefits-of-ai/",
      "editor": "AIBD"
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    {
      "date": "2026-10-21",
      "change": "Prose pass: a rating reason, account, the system's part rewritten in shorter sentences with abbreviations expanded; facts, figures and quotations unchanged.",
      "source": null,
      "editor": "AIBD"
    }
  ],
  "confidence": "studied",
  "shade": "high",
  "claim_status": "Independently studied",
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                "editor": "AIBD"
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              {
                "date": "2026-10-21",
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        "review_state": "record_mapped",
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                "title": "A Rare Case of Ciprofloxacin-Induced Bradycardia Recognized by a Smartwatch",
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        "state": "not_assessed",
        "review_state": "not_assessed",
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        "state": "not_assessed",
        "review_state": "not_assessed",
        "coverage": "partial"
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        "state": "not_assessed",
        "review_state": "not_assessed",
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        "state": "not_assessed",
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        "state": "not_assessed",
        "review_state": "not_assessed",
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        "value": {
          "kind": "structured",
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            "application_developer": "Not stated (the report does not name the device's maker)"
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        "state": "not_assessed",
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        "coverage": "partial"
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          "fields": {
            "title": "Smartwatch low-heart-rate alert (<40 bpm) sends a 32-year-old woman to hospital, where ciprofloxacin is identified as the cause of her bradycardia and replaced",
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          "kind": "record_fields",
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            "account": "Cordova Sanchez, Chohan, Olatunde and White of SUNY Upstate Medical University, Syracuse, reported a case in the Journal of Investigative Medicine High Impact Case Reports. It was published 24 January 2022; the event date is not given. A 32-year-old woman was seen two days after discharge from a hospital stay for cholangitis, during which she had an ERCP. She was sent home on ciprofloxacin and metronidazole. She developed dizziness on minimal exertion, and her smartwatch triggered an alert for a sustained heart rate below 40 beats per minute. She attended an outside emergency department, where telemetry confirmed 30–50 bpm. She was transferred to the authors' hospital for cardiology review. Her electrocardiogram (ECG) showed sinus bradycardia at 51 bpm, against 66 bpm before the antibiotics. The procedural drugs given two days earlier have short half-lives. Other work-up (blood tests, thyroid function, Lyme serology, drug screen, echocardiogram) was unremarkable. Ciprofloxacin was replaced with ceftriaxone; by the next day her heart rate was 60–70 bpm. She was discharged on cefpodoxime and metronidazole. The authors conclude ciprofloxacin was the likely cause and early recognition of the bradycardia prevented a potential adverse event. The watch's brand and model are not stated; the authors describe wearable heart-rate detection generically as photoplethysmography.",
            "replication": {
              "produced_by": [
                "A wearer on a newly prescribed drug whose smartwatch has a low-heart-rate alert enabled",
                "Symptoms vague enough that the alert, not the symptoms alone, prompted presentation",
                "Clinicians who excluded other causes and withdrew the suspected drug"
              ],
              "must_hold": [
                "The bradycardia is sustained long enough to trip the watch's threshold",
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        "provenance": {
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        },
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    },
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      "by_state": {
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        "not_applicable": 0,
        "withheld": 0,
        "source_unavailable": 0
      }
    }
  }
}