Feasibility and Reliability of SmartWatch to Obtain 3-Lead Electrocardiogram Recordings

Amirali Behzadi, Alireza Sepehri Shamloo, Konstantinos Mouratis, Gerhard Hindricks, Arash Arya, Andreas Bollmann, Amirali Behzadi, Alireza Sepehri Shamloo, Konstantinos Mouratis, Gerhard Hindricks, Arash Arya, Andreas Bollmann

Abstract

Some of the recently released smartwatch products feature a single-lead electrocardiogram (ECG) recording capability. The reliability of obtaining 3-lead ECG with smartwatches is yet to be confirmed in a large study. This study aimed to assess the feasibility and reliability of smartwatch to obtain 3-lead ECG recordings, the classical Einthoven ECG leads I-III compared to standard ECG. To record lead I, the watch was worn on the left wrist and the right index finger was placed on the digital crown for 30 s. For lead II, the watch was placed on the lower abdomen and the right index finger was placed on the digital crown for 30 s. For lead III, the same process was repeated with the left index finger. Spearman correlation and Bland-Altman tests were used for data analysis. A total of 300 smartwatch ECG tracings were successfully obtained. ECG waves' characteristics of all three leads obtained from the smartwatch had a similar duration, amplitude, and polarity compared to standard ECG. The results of this study suggested that the examined smartwatch (Apple Watch Series 4) could obtain 3-lead ECG tracings, including Einthoven leads I, II, and III by placing the smartwatch on the described positions.

Keywords: Apple Watch; electrocardiogram; feasibility; mobile health; reliability; smartwatch; wearables.

Conflict of interest statement

Andreas Bollmann and Gerhard Hindricks report research grants from Pfizer, Abbott and Boston Scientific to the institution without personal financial benefits. Other authors do not declare any conflict of interest.

Figures

Figure 1
Figure 1
The positioning of the Apple Watch Series 4 for obtaining leads 1, II, and III using the Einthoven triangle. In the Apple Watch, the negative electrode is placed in the digital crown and the positive electrode is on the back crystal of the watch.
Figure 2
Figure 2
Principles of electrocardiogram assessment.
Figure 3
Figure 3
Comparison of a 3-lead ECG recorded by an Apple Watch 4 (left side) and a standard ECG device (right side).
Figure 4
Figure 4
A sample of temporary artifact (around one second) due to instability of the Apple Watch 4 on a patient’s wrist.

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Source: PubMed

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