Apple Watch, With Some Maneuvering, Can Deliver 12-Lead ECG

From today’s news.  I have actually done this when I was feeling unusual after water aerobics.


A “quasi-standard” multilead ECG can be recorded using just the Apple Watch, a report showed.

The ECG function on the Watch is designed to monitor electrical activity of the heart in the direction of lead I only, ignoring the superoinferior axis captured by the standard leads (II and III) and the horizontal plane captured by the precordial leads (V1 to V6).

Yet certain workarounds can give the Apple Watch the “quasi-standard” 12-lead information of a proper ECG recording, according to Miguel Ángel Cobos Gil, MD, PhD, of Hospital Clínico San Carlos in Madrid, Spain, reporting online in the Annals of Internal Medicine.

Users can generate lead II by touching the digital crown with a finger on the right hand and lead III by touching with the left hand after moving the smartwatch to the ankle or somewhere on the leg, he said.

And although it’s not possible to generate the conventional precordial leads (V1 to V6), bipolar chest leads (CR1 to CR6) may be sufficient: those can be obtained by placing the back of the watch on the chest and touching the digital crown with a right-hand finger, according to the author.

Cobos Gil showed the similarity in ECG recordings between a standard 12-lead device and the Apple Watch in three test subjects: a healthy person (the author himself), someone with ST-segment-elevation MI, and another with non-ST-segment-elevation MI.

“Standard limb leads (I, II, and III) obtained using both methods are identical, and the precordial leads (V1 to V6 vs. CR1 to CR6) bear a strong resemblance,” he reported.

“Considering the sales figures of Apple devices, the watches likely outnumber conventional ECG machines worldwide. The availability of a method to record an ECG with diagnostic potential anytime and anywhere could potentially revolutionize our approach to cardiac emergencies,” the author suggested.

This report presents a “new twist” on how the Apple Watch can be used and shows that getting the 12-lead information from this device is “definitely something that can be done,” commented Jeffrey Goldberger, MD, of the University of Miami.

But when and why it would be done are unclear, he told MedPage Today in an interview.

Perhaps it could be useful in an urgent scenario where a 12-lead ECG machine is not available, somewhere where medical resources are very limited and there are no hospitals or doctor’s offices around that can do the standard test, he suggested.

Yet the Apple Watch ECG recording would need to be transmitted somewhere to someone who can give advice over the phone — and that would require Internet access. “If it’s a remote area, where do you call for medical care and attention?” Goldberger said.

The smartwatch ECG could be a niche strategy in theory and is certainly not going to replace the conventional machines, he said.

“You need a fair amount of cooperation from the patient to do the various maneuvers to make the various recordings,” he added. “It’s probably more time-consuming to do than just a standard 12-lead where you make the recording and you’re done. Here you do everything in sequence.”

More clinical studies are needed to determine the role of smartwatch ECG recordings, Cobos Gil acknowledged.

Another consumer-oriented device, the AliveCor KardiaMobile 6L, provides 6-lead ECG recordings when paired with a smartphone app.


Heart Attack? Doctors Soon May Have an App for That

There are apps that turn your smartphone into a metal detector, a musical instrument and a GPS system, and now there’s an app that may help doctors save your life if you’re having a heart attack.

The app, which was designed by engineers and critical care physicians, helps doctors rapidly diagnose certain kinds of severe heart attacks, called STEMIs, before patients get to the hospital.

The app currently is in the experimental stage, but it has undergone field testing.

In a STEMI heart attack, which stands for ST segment elevated myocardial infarction, a clot completely blocks blood flow to the heart. About a quarter of a million people have STEMIs each year in the United States.

These kinds of heart attacks create a unique pattern of pulses when doctors hook up patients to an electrocardiogram, or EKG, machine, which measures the heart’s electrical activity.

The problem is that doctors need to see the EKG reading, which is called a tracing, to properly diagnose the attack and quickly assemble the team of specialists that is needed to clear the clot.

There are proprietary systems that use EKG machines hooked up to modems to send images back to hospital computers, but those systems are expensive and not all hospitals and EMS systems can afford them.

As an alternative, paramedics can use their smartphones in the field to snap a picture of the tracing and send it to a doctor at the hospital via email.

But as anyone who has ever tried to email a picture from their phone knows, it’s far from foolproof. Large, high-quality images — the kind doctors need to see — can take several minutes to send and receive.

To address the issue, Dr. David Burt, an associate professor of emergency medicine at the University of Virginia, challenged a class of systems engineering students to develop an app that could shrink images to make them faster to send, but still maintain the clarity needed for diagnoses.

“It’s very easy to use,” Burt said. “You hold it over the EKG tracing, you snap a picture.” Hitting a button sends the image. When it’s finished, the app shakes and makes noise to alert senders to the successful transmission.

“It’s very simple but we want it to be very rugged, so that it’s kind of like a hammer — it always works,” he said. He also wants to offer the app at no cost to doctors and hospitals.

So far, Burt said, they have tested the app more than 1,500 times using different wireless carriers in a city.

They also have pitted the app against the alternative method of using an iPhone to email a picture. In that study, the app consistently sent images within four to six seconds. Emailed images could take nearly two minutes to go through. The app failed less than 1 percent of the time, while the emailed images flopped between 3 percent and 71 percent of the time, according to the study.

The study is scheduled for presentation Friday at an American Heart Association meeting in Baltimore. Studies presented at medical conferences are considered preliminary because they haven’t yet undergone the scrutiny required for publication in a peer-reviewed journal.

Dr. Iltifat Husain, founder of the iMedicalApps website, which keeps up with news about technology in medicine, said he was impressed by the app, but also by how thoroughly the team has been testing it. Husain estimates that less than 1 percent of apps that are developed for doctors are field tested to see if they actually work.

“Something like this would have to be tested before it was put to use because of how critical the information is that you’re relaying,” said Husain, who was not involved in the research.

Husain, who also is an emergency medicine resident at Wake Forest University in Winston-Salem, N.C., said the time the app shaves off image transmission could be critical.

“The longer you wait, the more heart muscle dies, so every minute counts,” he said. “Actually, every second counts.”

Surviving a STEMI depends on how quickly doctors can restore blood flow, which often is done by snaking a catheter up to the heart and using a small balloon to clear the clot.

“We’ll get an EKG reading and the ER physician will activate the cath lab. Once you activate it, a huge team has to be assembled,” Husain said. “If it’s overnight, people are sometimes coming in from home. If you can get someone coming in from home five minutes faster, I think it’s a big deal.”

More information

For more about heart attacks, head to the U.S. National Heart, Lung, and Blood Institute.

SOURCES: David Burt, M.D., associate professor of emergency medicine, University of Virginia, Charlottesville; Iltifat Husain, M.D., second-year emergency medicine resident, Wake Forest Baptist Health System, Winston-Salem, N.C., and founder, iMedicalApps website; May 17, 2013, presentation, American Heart Association meeting, Baltimore