Miguel Angel Cobos Gil

Miguel Angel Cobos Gil (Instituto Cardiovascular, Hospital Clinico San Carlos, Madrid, Spain) outlines in Annals of Internal Medicine a novel method of using the Apple Watch to record a multilead, quasi-standard ECG. He reports that the method is feasible but that a “broad range of clinical studies are needed to determine the role of such devices [i.e. Apple Watch] in the diagnosis and follow-up of patients with known or suspected heart disease. He talks to BIBA Briefings about the use of wearable ECG monitors vs. traditional 12-lead ECGs.

What are the benefits of a wearable ECG monitor vs. a traditional 12-lead ECG?

A wearable ECG monitor—especially if it is as ubiquitous as an Apple Watch—can provide a diagnostic ECG anytime, anywhere.

What are the disadvantages of recording a multilead ECG, as you did, with an Apple Watch?

Our method can be a little cumbersome for some people.

In your study, you sought to record multi-lead quasi-standard ECG using the Apple Watch. How did you achieve this?

Moving the watch over different places in the body. Lead I is recorded as instructed by Apple: wearing the watch in the left wrist and touching the digital crown with a rght-hand finger. Leads II and III are easily obtained by moving the watch to the ankle or any place on the leg and touching the digital crown with a finger on the right hand for lead II or the left hand for lead III. To record the precordial leads (V1 to V6), the back of the watch is placed on the chest, in the precise points wired in a traditional ECG, and the digital crown is touched by a right-hand finger. A lead very similar to the precordials (V1 to V6) is recorded.

What were your results?

The ECG recording obtained by the Apple Watch was very similar to the conventional ECG and, thus, could be used to diagnose conditions other than atrial fibrillation (which the Apple Watch ECG can currently diagnose), such as a myocardial infarction.

What further studies are needed?

At present, my colleagues and I are working on methods to simplify the acquisition of the ECG using the Apple Watch.

If we are able to obtain a similar ECG with the Apple Watch as with conventional ECG, what are the potential applications?

Any person with an Apple Watch can obtain a diagnostic ECG in any place—for example, on a flight or even in an isolated country house.

What advice should be given to patients about collecting and interpreting ECG data (i.e. what they should do if the Apple Watch identifies they have atrial fibrillation etc)?

The instructions for use in the Apple Watch app are detailed in Apple brochure. Patients using our method to obtain a quasi-standard ECG should send the recording to a doctor.