How to read ecg on apple watch?
From measuring your fitness goals to controlling your other Apple devices, the Apple Watch has myriad useful features for users in its newest iteration, including an FDA-approved heart rate monitoring app that can perform an electrocardiogram (ECG).
Here's how to set up the ECG app, measure your ECG, and read the ECG results.
According to the American Heart Association, an ECG "measures the electrical activity of the heartbeat" in order to detect whether a person's heart is beating at a healthy rhythm.
If the ECG measures a heartbeat that is too fast, too slow, or irregular, it could be an early sign of a heart condition.
When administered at your doctor's office, an ECG looks at 12 areas of the heart to give a robust picture of its health, but Apple's ECG app focuses on only one.
Because of its narrow monitoring focus, Apple's ECG app is designed specifically to monitor for just one common heart condition: an irregular heartbeat called atrial fibrillation (AFib).
If left untreated, AFib can lead to blot clots, stroke, or heart failure.
Because the ECG app comes standard or as a software update for newer Apple Watches, setting up the app can be done simply by navigating through your iPhone's Health app. If not immediately prompted to set up the ECG, go to the Browse tab, then select Heart, choose Electrocardiograms (ECG), and finally tap Set Up ECG App to begin.
You'll be prompted to enter your birth date (the app is approved only for those 22 and over) and read through information about the ECG app, including best practice tips for taking your ECG reading, such as having your Apple Watch tight on your wrist and resting your arm on a table or on your leg for the reading.
You'll then be prompted to take a test ECG reading, or skip and wait to do so until after set-up.
Once the ECG app is set up, a reading will take 30 seconds.
To do so, open the ECG app on your Apple Watch and press your finger to the watch's Digital Crown. For best results, Apple suggests resting your arm on a surface and ensuring that the back of your watch is dry and tight to the wrist.
After 30 seconds you'll receive one of four reading results and have the option to add and save symptoms to the reading.
After completing your ECG reading, your Apple Watch will give you one of four results: Sinus rhythm, atrial fibrillation, low or high heart rate, and inconclusive.
If your ECG reading is sinus rhythm then your watch has measured a heartbeat with a uniform rhythm between 50 and 100 BPM. This is considered normal, however if you receive this reading but are feeling unwell you should always follow up with your doctor.
If your ECG reading is atrial fibrillation (AFib) that means your watch has measured an irregular rhythm between 50 and 120 BPM. However, keep in mind that this reading is not a diagnosis of AFib and should be followed up with a visit to your doctor.
If your ECG reading is low or high heart rate then your watch has measured a heartbeat out of its range, either below 50 BPM or above 120 BPM.
This might sound alarming, but it doesn't necessarily mean anything is wrong. It is common to experience a low heart rate when sleeping, or as an extreme athlete, and a high heart rate can be attributed to stress or exercise.
However, as with the other results, follow up with your doctor if something doesn't seem right.
Here's how to use the ECG on Apple Watch.
The ECG app is available on the Apple Watch Series 4, Series 5, and Series 6 in select countries. The tool is not available on the Apple Watch SE or older models. The irregular rhythm notification feature, which is also limited to select countries, is available for users of the Apple Series 1 and beyond.
The ECG app on the Apple Watch is intended to take an electrocardiogram right from your wrist. In doing so, it can capture heart rhythm and detect problems such as rapid or skipped heartbeats. The app uses electrodes built into the back of the wearable device and Digital Crown. With this, you can take an ECG similar to a single-lead reading.
According to The National Institutes of Health, "single-lead reading devices give only limited information as compared to conventional 12‐lead ECGs. Hence, concerns about their accuracy and reliability need to be examined."
As Apple explains, "The ECG app does not detect a heart attack, blood clots, a stroke or other heart-related conditions including high blood pressure, congestive heart failure, high cholesterol or other forms of arrhythmia."
The ECG app is located on the Apple Watch, where other installed apps are located. To set it up, you'll need to open the Health app on your iPhone first.
You'll be asked to take an ECG reading for the first time. Tap Skip if you'd like to do this step later. Otherwise, switch over to your Apple Watch to continue.
Your Apple Watch is now set up for ECG measurements.
You can take an ECG reading on your Apple Watch at any time.
When measuring is complete, you'll see the reading on your Apple Watch face. Available choices are AFib (or an irregular heartbeat), Sinus Rhythm (or normal heartbeat), or Inconclusive. All recordings, associated classifications, and any noted symptoms are stored securely in the iPhone's Health app.
You can rerun steps above at any time to measure again.
The first time you launch the Health app on your iPhone, you'll be asked to set up the irregular rhythm notification.
The irregular rhythm notification is now on. The optical heart sensor on the Apple Watch Series 1 or later will occasionally check your heart rhythm in the background. In doing so, it checks for signs of an irregular rhythm that could indicate AFib.
If the watch detects an irregular rhythm over five checks over a minimum of 65 minutes, you'll receive an alert on your watch. It would be best if you considered sharing this information with your doctor since it could be a sign of something serious.
When you want to see your readings on a graph or share the information with your doctor, you can find the data in the Health app on your iPhone.
If your Apple Watch captures an irregular rhythm, you'll receive a notification on your Apple Watch and iPhone. You can view a list of these notifications in the Health app on your iPhone.
Note: You'll still see a message if you've never had an irregular rhythm notification.
You can share individual ECG measures with your doctor by creating a PDF document through the Health app.
When Apple introduced the fourth iteration of its smartwatch, the big new selling point wasn't a feature we typically associate with a watch or any sort of smart device. Instead, the company added a feature that had only recently arrived in the form of specialized consumer devices: an electrocardiograph (ECG), a device made for monitoring the heart's electrical activity.
But the watch was ready before the software was, meaning an examination of the technology wasn't possible in our comprehensive review of the Apple Watch Series 4. Last week, Apple finally enabled the missing features, and we've spent a few days checking them out.
People who haven't used the Apple Watch may not realize just how much it's an extension of an iPhone. This includes the heart-monitoring software, which requires an update to both the Watch and iPhone OSes before it will work. (This caused a small bit of confusion when the software wouldn't launch after we upgraded only the watch's OS.) Once the update is done, the Health app on the iPhone will incorporate any ECG data generated using the watch. On the watch side, the update will install a new app.
From there, doing an ECG is phenomenally easy: launch the app, place your finger on the crown of the watch, and wait. For 30 seconds, the electrical activity of your heart will draw a red trace across the watch's screen. It's incredibly convenient—not much more obtrusive than taking your pulse. And as long as you're wearing your watch on a given day, it's always available to you.
Once complete, the app will let you know whether the trace captured normal heart beats, termed a sinus rhythm. The ECG trace, however, can't be viewed on the watch; the only thing the app allows you to do is record another trace. To look at the results yourself rather than trusting Apple's software, you have to switch to the phone.
That's somewhat annoying. The whole point of the watch appears to be to allow you to interact with it rather than your phone. And there's something more disruptive about pulling out your phone and fiddling with your screen rather than taking some quick glances at your watch.
That annoyance aside, the traces look great. Given how far your fingers are from the heart itself, there's a lot of noise in an ECG signal taken by the watch that software has to filter out. Apple's software does an admirable job. The trace is shown as a thick, red line, making it easy to interpret. On the phone side, the display is equally good, and it's available to share through the usual options. Email or Air Drop will leave you with a PDF that you can keep for your records or send on to your doctor.
Those who have read my previous coverage know I have a personal stake in this system working well. Genetics have left me susceptible to atrial fibrillation, a heart arrhythmia with severe health implications. I currently experience an erratic mix of occasional atrial fibrillation and harmless premature atrial contractions, both of which I can feel as they happen. Medically, I have to monitor things to make sure that the frequency of atrial fibrillation remains low and doesn't start appearing without symptoms I can feel. This doesn't require the detailed information you can get with doctors'-office-grade hardware—a simple outline of the activity is sufficient (but obviously won't be for everyone).
Over the years, this monitoring has changed. It started with week-long sessions with a Holter monitor, a compact, portable version of ECGs that is worn around the clock for a week or so. The hope is that a week is long enough to accurately sample the behavior your heart shows for the rest of the year—something that's typically not true in my case. Over time, I also developed an allergy to the adhesive used to hold the electrodes on.
Around this time, technology caught up with my needs. A company had created a small, affordable device called the KardiaMobile that would read my heart's activity from my fingers and send the data on to my phone. Assuming that I'd continue to be able to feel whenever my heart is out of rhythm, this would allow me to track what type of arrhythmia I was experiencing and send the information on to my cardiologist. Over time, I got a sense of how to interpret the traces as well.
Better, but not ideal. The Kardia device communicates with phones ultrasonically, making it sensitive to the precise positioning of it and the phone; small shifts mid-recording create strange effects on the trace. While it was very portable, it wasn't something I always had with me, and I didn't always have the space to set it up so it could communicate well with my phone. Finally, it wouldn't be able to answer a critical question: have I started to have periods of arrhythmia that I don't notice because they're asymptomatic?
In many ways, the Apple Watch's heart function seems like it's the next step in the evolution of my monitoring. It's on my wrist enough hours of the day that, should asymptomatic arrhythmias start, there's a good chance it will pick them up. (I have it set up to notify me of high heart rates while resting, and I lied to it about my past atrial fibrillation diagnosis so it would monitor for that, too.) It seems to produce a good enough trace that I can pick out premature contractions. And it's not fussy about how it's set up—I could potentially produce a good trace while continuing a conversation at dinner, for example. Yes, it's more expensive than the dedicated device, but it obviously does a lot more than just monitor my heart.
- Open the Health app.
- Tap the Browse tab, then tap Heart > Electrocardiograms (ECG).
- Tap the chart for your ECG result.
- Tap Export a PDF for Your Doctor.
- Tap the Share button to print or share the PDF.
The latest advancement in hearth health monitoring is from Apple. You can now take a short ECG reading with the ECG app on the Apple Watch Series 4. This will hopefully mean a more widespread awareness and monitoring of heart health – which is great news. But exactly how does the new Apple Watch ECG work and what are the limitations to be aware of? As the leading digital heart health company, we explain the new ECG functionality of the Apple Watch, and look at the different ECG options available, to ensure you look after your full heart health.
An ECG test uses an ECG monitor and measures the electrical activity of the heart and the heart rhythm. This is then displayed as line tracings on a moving strip of paper, or digitally as a line on a screen. The spikes and dips in the tracings are called ECG waves. The results of this ECG reading then needs to be reviewed and analyzed by a cardiologist or specialist for abnormalities or possible heart problems.
An ECG test helps screen and detect a variety of cardiac problems such as arrhythmias, cardiac arrest, heart defects, heart attacks and much more. It’s the most common way to check if your heart is healthy or monitor existing heart diseases. Checking on your heart health is important because many heart problems are without symptoms. Also if left undetected, and therefore untreated, it could lead to further heart problems or worse.
Having an ECG test done periodically is easy, highly beneficial and lets you and your doctor keep an eye on your heart health. As your heart matures your ECG trace might change, so performing an ECG from time to time and keeping a history of your traces can help spot changes sooner, and allow for a faster treatment to prevent further health problems.
This reading is done off your wrist and you can take an ECG at any time, when you’re feeling symptoms such as a rapid or skipped heartbeat, when you have other general concerns about your heart health, or when you receive an irregular rhythm notification.
You open the app, follow the steps and the recording takes 30 seconds. At the end of the recording, the app gives you a heart rhythm classification of either a ‘Sinus Rhythm’ which is a normal beating pattern or ‘Atrial Fibrillation’ (AFib) which is an irregular beating pattern. You can share your results with your doctor via the sharing functionality so your doctor can advise what to do if a Atrial Fibrillation event was detected.
This ECG functionality of Apple Watch 4 series is currently only available in the US, Virgin Islands, Puerto Rico and Guam.
Apple Watch Series 4 offers a lifestyle friendly way to record a short 30 second ECG trace anytime, anywhere. Its ease of use and wide availability means more people can screen for a possible Atrial Fibrillation, one of the most common heart problems today.
Below is a table which explains the range of heart rhythm monitors available.
Apple Watch Series 4 new ECG features is a real game changer in heart health, offering a simple yet powerful way to keep your heart checked without the need to visit a doctor. If your Apple Watch detects a possible heart problem, your doctor is likely to perform further tests using traditional ECG monitors or QardioCore that can give a more in-depth, detailed view into your heart. But the availability of the simple test, such as the one Apple Watch Series 4, now offers the first step towards a better awareness and an easy way to screen for possible heart problems.
Take the first step to better heart health with the Apple ECG app. For a full understanding of your heart and continuous tracking of your ECG, QardioCore offers a lifestyle friendly way to track your heart on the go and share your heart readings with your doctor. Invest in your health with technologies that help you live a healthier longer life and give you peace of mind.
Heart disease and stroke, despite being preventable, remain the leading cause of death for both men and women in the US, so it makes sense that people would be eager to adopt any sort of preventative heart-related technology. Stories about the Apple Watch's ECG feature saving lives certainly haven't hurt either.
But how helpful are these AFib features really? And are they right for you or a loved one? If you're considering buying a Series 4 -- or holding out for a Series 5 -- just for the ECG app, here are a few things cardiologists want you to know.
Sales research from the NPD Group shows that adults aged 18 to 34 are buying smartwatches more than any other age demographic. And EMarketer predicted that in 2019 consumers aged 25 to 34 will remain the largest group to purchase wearables.
Contrast that with the fact that the CDC estimates AFib affects somewhere between 2.7 million and 6.1 million Americans, but the majority of those people are over the age of 65. In fact, only approximately 2% of people younger than age 65 have AFib and it's estimated that only 1% of the population may have undiagnosed AFib. In the latter two groups, AFib episodes are often brief, cause no symptoms and may not require treatment.
This is all to say that if you're young, healthy and don't already have any diagnosed health problems, you might not experience significant benefits from the ECG app, or the watch's other heart rate features. However, the Apple Watch has, on multiple occasions, alerted people both young and old about heart issues they didn't know existed.
The American Heart Association and the American Stroke Association has found that screening for AFib in the primary-care setting among people older than 65 years of age using pulse assessment followed by ECG, if warranted, can be useful.
But when the US Preventive Services Task Force weighed the potential benefits (early detection) against the potential harms (misdiagnosis, additional testing, invasive procedures and overtreatment), it found that the available evidence was too inadequate to support a conclusion one way or the other.
And because most of the AFib and stroke prevention studies have focused on the older populations who are most at risk, even less is known about the value of screening for AFib in healthy individuals under age 65. For instance, Dr. Venkatesh Murthy, professor of preventive cardiology at the University of Michigan, estimates that 90% of irregular rhythm alerts in younger groups are false alarms.
As a result, experts worry that putting Apple's screening technology on the wrists of millions of people who are likely to be young and healthy could increase the risk of overtreatment. Especially when that technology is still so new and based on studies that haven't been published in peer-reviewed journals. You can read some of the comments from the medical community here, here and here.
"I'm an advocate of identifying asymptomatic atrial fibrillation, especially in high-risk populations," says Dr. Anthony Pearson, a Missouri-based board-certified cardiologist. "But we have to have a highly sensitive and specific way of doing it. In the younger population, if they don't have two or more risk factors then identifying them is nice but it's not going to prevent a stroke."
The Apple Watch can be a useful tool for monitoring your heart health, but it has limitations.
It's able to check your heart rhythms, or the electrical impulses that coordinate your heartbeat, for any irregularities. Occasionally throughout the day -- about every two hours, depending on your activity levels -- the Apple Watch will check your heart rhythms, looking for arrhythmia, which occurs if these impulses don't work properly, causing your heart to beat too fast, too slow or irregularly. If the Apple Watch detects signs of an irregular rhythm five out of six times in a row within 48 hours, you'll receive an irregular rhythm notification.
The Apple Watch can also detect possible AFib via its ECG app. This feature replicates a single-lead ECG with a titanium electrode in the watch's Digital Crown and a layer of chromium silicon carbon nitride on the back of the watch. When you place your fingertip on the electrode, it creates a closed circuit from finger to heart to wrist and allows the watch to record the electrical impulses that make your heart beat.
While these features are a big step in giving everyday consumers access to preventative medical tests outside of the doctor's office, neither of these methods are a replacement for going to the doctor or using any monitor that your doctor may give you (and Apple agrees). Here's why:
To properly diagnose when someone is in AFib, doctors use 12-lead ECG machines. (Doctors in the US usually call them EKGs, but it's the same thing, an electrocardiogram.) They use electrodes placed on different parts of the body to evaluate the heart's electrical activity in three directions (right to left, up and down, and front to back), which provides a clearer picture of its movement through the heart's four chambers.
Because AFib is known to come and go, if it's not present during an appointment, a doctor may ask a patient to wear a simplified version of the 12-lead ECG at home so they can monitor their heart rhythms over a longer period of time. However, even these mobile monitors typically use two to three leads and run continuously over days, weeks or even months, says Murthy.
A woman recently wrote to Dr. Pearson, the cardiologist, asking whether the Apple Watch could help detect a future heart attack in her husband, who had already had one at age 36. "The answer is a resounding and unequivocal NO!" Pearson responded via his blog, The Skeptical Cardiologist.
The Apple Watch can only detect irregular heart rhythms, which are a risk factor for stroke. As Apple's website states: The ECG app can't detect a heart attack, blood clots, stroke or other heart-related conditions, including high blood pressure, congestive heart failure, high cholesterol or other forms of arrhythmia.
Apple's main disclaimer about the ECG app is that it should only be used by people 22 years old or above. But it also states that heart rates under 50 or over 120 beats per minute can affect the app's ability to check for AFib, leading to inconclusive results.
Low heart rates are common among fit, athletic individuals, but can also be caused by certain medications. High heart rates may be caused by exercise, stress, alcohol, dehydration, infection or AFib itself.
The irregular rhythm notification feature is only cleared for use in people who are at least 22 years old and have no prior history of AFib. Apple is also careful to point out that the watch is not constantly looking for AFib, stating, "This means the Apple Watch cannot detect all instances of AFib, and people with AFib may not get a notification."
Portable and home-based ECGs are becoming increasingly common and have the potential to transform medical care, according to a 2018 study in the Journal of Arrhythmia. But, as the study authors note, research supporting their accuracy and ease of use is still scant.
If you think you could benefit from an at-home ECG monitor, talk to your doctor about whether that strategy is right for you and what device they'd recommend.
Pearson has been using AliveCor's KardiaMobile single-lead ECG device with dozens of AFib patients since 2013 and Kardia Pro, a cloud-based software platform that allows him to monitor their results, since 2017. He says the combination is "eliminating any need for short- or long-term cardiac monitors."
"It's like night and day how much more information I get and how I'm able to manage their atrial fibrillation without bringing them into my office or an emergency room or putting expensive monitors on them," says Pearson, who does not receive any compensation from AliveCor. "It's dramatic how improved my care is with these devices."
Last month, AliveCor also launched KardiaMobile 6L, the first FDA-cleared direct-to-consumer six-lead ECG. It can detect AFib, bradycardia (abnormally low heart rate), tachycardia (abnormally high heart rate) and more.
If you're healthy and haven't been diagnosed with AFib or any conditions that put you at risk for it -- such as high blood pressure, diabetes or heart failure -- Murthy says the best thing you can do to take care of your heart is to follow what the American Heart Association calls Life's Simple 7. "Exercise, eat right, stop smoking and lose weight. If you have high blood pressure, high cholesterol or elevated blood sugar, manage that under the care of a doctor."
If an Apple Watch can help you or motivate you to do those things, great. If not, using one isn't necessary.
If you've already been diagnosed with AFib or are experiencing prolonged periods of heart palpitations or a racing heartbeat, talk to your doctor about whether at-home monitoring is right for you. For now, both Murthy and Pearson are holding off on recommending that their patients get an Apple Watch solely for its irregular heart rhythm features.
"I generally recommend devices that can record continuous ECGs over long periods of time rather than the intermittent snapshot of the Apple Watch," says Murthy. "That said, future data may help us decide if that's necessary or if intermittent ECGs coupled with photoplethysmography-based rhythm monitoring is sufficient."