Trystan Casey
The ECG app, available on devices such as the Apple Watch and Fitbit, is a feature that allows users to record an electrocardiogram (ECG) by using an electrical heart rate sensor. This sensor measures the electrical activity of the heart to detect any irregularities in heart rhythm, such as arrhythmia or atrial fibrillation (AFib). While the ECG app provides users with access to preventative heart health tests, it is not a replacement for professional medical advice or equipment. Users can, however, export their ECG results as a PDF and share them with their doctor.
| Characteristics | Values |
|---|---|
| Purpose | To check for irregularities in heart rhythms, which are the electrical impulses that coordinate your heartbeat. |
| Functionality | Can record your heartbeat and rhythm using an electrical heart sensor and then check the recording for atrial fibrillation (AFib), a form of irregular rhythm. |
| Mechanism | Creates a closed circuit from finger to heart to wrist, allowing the watch to record electrical impulses. |
| Usage | Place your fingertip on the electrode to create a closed circuit. Rest your arm on a table or in your lap. Ensure your wrist and watch are clean and dry. |
| Limitations | Not intended for use by people under 22 years old. Not available on Apple Watch SE or in all countries or regions. |
| Heart Rate Range | In ECG version 1, a heart rate under 50 BPM or over 120 BPM affects the app's ability to check for AFib. In ECG version 2, the range extends to 150 BPM. |
| Data Sharing | The ECG waveform, classifications, and symptoms can be saved in the Health app on iPhone or iPad, and shared as a PDF with your doctor. |
| Alerts | If the watch detects signs of an irregular rhythm five out of six times in a row within 48 hours, you'll receive a notification. |
| Other Devices | Fitbit Sense series, Fitbit Charge 5, Google Pixel Watch, KardiaMobile, Samsung Galaxy Watch 5. |
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What You'll Learn
How to set up the ECG app on your Apple Watch
The ECG app on the Apple Watch is a useful tool that can record your heartbeat and rhythm using an electrical heart sensor. It can also check for atrial fibrillation (AFib), a form of irregular rhythm. To set up the ECG app on your Apple Watch, follow these steps:
Firstly, ensure that the ECG app is available in your country or region. Next, update your iPhone to the latest version of iOS and your Apple Watch to the latest version of watchOS. The ECG app is installed during the setup in the Health app on your iPhone. Open the Health app and follow the onscreen instructions. If you don't see a prompt to set up, tap "Browse", then "Heart", "Electrocardiograms (ECG)", and finally, "Set Up ECG App".
After completing the setup, open the ECG app on your Apple Watch. It is important to ensure that your Apple Watch is snug and on the wrist that you selected in the Apple Watch app. To check, open the Apple Watch app, go to the "My Watch" tab, then navigate to "General" and "Watch Orientation".
Now, you are ready to take an ECG reading. Rest your arms on a table or in your lap and relax to avoid excessive movement. Make sure your wrist and Apple Watch are clean and dry, as liquid can interfere with the reading. With the hand opposite your watch, hold your finger on the Digital Crown. The recording will take 30 seconds, after which you will receive a classification. You can then add and save any symptoms before reviewing your results.
Please note, the ECG app is not a replacement for medical advice or a doctor's diagnosis. If you are not feeling well or have concerns, you should always consult a medical professional.
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How to take an ECG reading
To take an ECG reading, you will need a compatible device, such as an Apple Watch Series 4 or later, or a Fitbit Charge 5, 6, Sense, or Sense 2. Make sure your device is updated to the latest version of the software. For Apple Watches, this is watchOS, and for Fitbits, this information can be found in the Fitbit Help Center.
Once your device is updated, open the ECG app. For Apple Watches, this involves opening the Health app on your iPhone and following the onscreen setup steps. If you don't see a prompt to set up, tap Browse, then Heart, and then Electrocardiograms (ECG). For Fitbits, swipe left on the screen to find the ECG app, or press the crown or button, depending on your model.
Now that your ECG app is open, rest your arm on a table or in your lap, and hold your finger from the hand opposite your watch on the Digital Crown. The watch will now record an ECG, which represents the electrical pulses that make your heart beat.
It is important to note that the ECG app is not a replacement for a doctor's visit or a medical-grade monitor. It is also not intended for use by people under 22 years old. Additionally, certain physiological conditions may prevent the creation of enough signal to produce a good recording. For example, water or sweat can interfere with the reading, so ensure your device and skin are clean and dry. Heavy breathing and an elevated heart rate after exercise can also make it challenging to obtain a good reading, so refrain from taking a reading directly after exercising.
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How to interpret ECG readings
Interpreting ECG readings is a complex skill that requires knowledge of cardiac function and electrophysiology. Here is a guide on how to interpret ECG readings:
Heart Rate and Rhythm
The heart rate is determined by measuring the interval between two R waves (peaks) in the ECG waveform, known as the R-R interval. The heart rate can then be calculated by dividing 300 by the number of large squares between two R waves. For example, if the interval is five large squares, the heart rate is 60 beats per minute. This is an essential aspect of ECG interpretation and can vary with age and breathing patterns.
Axis Determination
The axis of the heart's electrical activity is determined by the P wave and QRS complex. By examining two perpendicular leads, usually lead I and aVF, the axis can be located in one of the quadrants. For example, if the QRS complex is positive in lead I and aVF, the axis is in the left lower quadrant (0-90 degrees), which is considered normal.
Waveforms and Abnormalities
The ECG waveform typically consists of P waves, QRS complexes, and T waves. An inverted P wave may indicate retrograde conduction. Wide QRS complexes that are not preceded by P waves can suggest a sinus node issue, leading to a slower heart rate as the atrial or AV node takes over as the pacemaker. Learning to identify bundle branch blocks and chamber hypertrophies is essential, with "bunny ears" being indicative of right bundle branch blocks. Additionally, ST-segment elevations can be indicative of acute myocardial infarctions.
Clinical Context
ECG readings should be interpreted in conjunction with other tests and the patient's clinical context. This includes blood tests, physical examinations, and the patient's age. ECG findings can be associated with interesting or rare cases to aid memorization and interpretation.
Limitations and Confirmations
While ECG machines often provide computerised interpretations, these must be confirmed by experienced clinicians. Relying solely on automated results can lead to inaccurate diagnoses and unnecessary treatments. Pharmacists and healthcare professionals should be prepared to discuss ECG results with patients and involve them in any follow-up decisions.
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The accuracy of ECG apps
One study found that the Apple Watch ECG had only "moderate diagnostic accuracy" in diagnosing Afib compared to a 12-lead ECG in a hospital setting. The accuracy of consumer wearables has also been questioned when compared to Holter monitors in ambulatory patients with Afib. For example, the Fitbit Charge HR and Apple Watch Series 3 under-reported heart rates with Afib when the rate was over 80 bpm. The accuracy of these devices in detecting Afib fell to 56% for the Fitbit Charge HR and 77% for the Apple Watch.
Another concern about the accuracy of ECG watches is that the people most likely to use them tend to be young and healthy, with a very low risk of Afib. This could lead to a high number of false positives and unnecessary testing and treatment.
However, it is worth noting that the Apple Watch is approved by the American FDA for screening and detecting AF. A study comparing the results of the Apple Watch I lead ECG with conventional ECG results found no significant differences between the two methods in terms of the studied ECG characteristics. The study documented a strong positive correlation between the heart rate measurements in the 12-lead ECG and Apple Watch ECG, with a sensitivity of 99.54% for automated interpretation and 100% for manual interpretation in detecting AF.
It is important to remember that while these features provide access to preventative medical tests outside of a clinical setting, they are not a replacement for a doctor's visit or the use of any monitor prescribed by a physician.
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Other ECG apps and devices
The Apple Watch ECG app can record your heartbeat and rhythm using the electrical heart sensor. To take an ECG, you need to touch a finger on your opposite hand to the Digital Crown. The watch will check your heart rhythms for any irregularities, specifically atrial fibrillation (AFib). However, the Apple Watch ECG app is not the only device of its kind.
There are several other ECG apps and devices available for at-home use. These include the EMAY Portable ECG Monitor, which is small enough to fit in your pocket and easy to use. The FaceLake FL10 has an LCD screen with an easy-to-read display and offers an iOS and Android app to store and save readings. The Kardia ECG monitor has six leads and three sensors, and the readings can be monitored in the Kardia app. The Eko ECG monitor has four different ways to measure, including a wearable chest strap, and the readings can be monitored in the Eko app.
Some devices have specific applications, such as being wearable or portable, and several models have connectivity features that allow users to view their results from a smartphone or share them with a healthcare professional. It is important to note that while these devices can provide an immediate reading, a doctor should be involved in caring for and monitoring any heart conditions.
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Frequently asked questions
An ECG app is a feature on a smartwatch that allows the user to take an electrocardiogram (ECG) or record their heartbeat and rhythm.
The app uses a single electrode sensor to measure the electrical activity of the heart. When the user places their fingertip on the electrode, it creates a closed circuit from finger to heart to wrist, recording the electrical impulses that make the heart beat.
The ECG app can detect any irregularities in the user's heart rhythm, such as arrhythmia, and atrial fibrillation (AFib).
An ECG app is not a replacement for a doctor's advice or medical diagnosis. If the app detects an irregular heart rhythm, the user should consult a doctor and share the results of the ECG app with them.
