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Apple Watches and EKGs

John Bankston John Bankston April 13, 2020
Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

Your smartwatch can time your run, shuffle your playlist, and text your boss. But can it prevent a stroke? 

 

A wearable device saving your life seems more fiction than science. Yet to many, Apple’s Series 4 promised to do just that–save your life by monitoring your heart. In 2018, the company demonstrated how by pairing their watch’s built-in electrodes with an EKG app it could record the timing and strength of the heart’s electrical signals. 

 

The electrocardiogram (called the EKG by most U.S. doctors and ECG by just about everyone else) detects atrial fibrillation (AFib). The most common type of arrhythmia, AFib happens when your heart beats too quickly or too slowly. AFib also occurs when your heart beats irregularly. As described by the U.S. Centers for Disease Control and Prevention, in a person with AFib, “the normal beating in the upper chambers of the heart (the two atria) is irregular, and blood doesn’t flow as well as it should from the atria to the lower chambers of the heart (the two ventricles).” This can happen during brief episodes, or it can be an ongoing problem.

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Electrocardiogram

Electrocardiogram

AFib is a leading indicator for strokes. It contributes to well over 150,000 deaths each year. Will early detection by an Apple Watch save lives? Or do experts see this value-added feature as more hype than heart?

 

The Mismatch 

 

The Apple Watch EKG feature could work as advertised and still not save lives. This is due mainly to the enormous gulf between its average users’ age and that of most AFib victims. Like other wearable devices, the Apple Watch is most popular with buyers under 34. In 2015, 24% of people 25-to-34 owned a wearable device. The year after Apple’s Series 4 watch 2018 release, a trend report predicted that percentage hitting nearly 40%.

 

Unfortunately, the people most likely to have an AFib-related stroke are in their 70s and 80s. One study was unable to find anyone under age 60 who had suffered a “lone AFib” stroke, a stroke where other risk factors like high blood pressure or diabetes were not present. 

 

Still, if the Apple Watch is potentially lifesaving, surely cardiologists can convince their patients to buy one. Maybe grandchildren could give one as a gift to their elderly, cardiac-risk relatives. Of course their smartwatch present should include the gift of their time because besides setting up the watch, they will need to make sure their grandparents have the latest iOS on their iPhones. They will have to download the EKG app and sync it to their phone’s Health app. Assuming the EKG app is available (there are places where it isn’t), the whole family can try on the watch and take individual readings. Just make sure to follow Apple Support’s detailed instructions.

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Atrial Fibrillation: Stroke

Atrial Fibrillation: Stroke

Despite the studies, is it possible that younger users with undetected AFib are being ignored? Maybe only a few people out of millions will be saved. Considering that the test can be done in your home, wouldn’t it be worth it? After Ed Dentel updated his Apple Watch and used its EKG feature, he was warned that he was in the middle of AFib. When the warnings persisted, he drove to an urgent care center. An EKG validated the watch’s warnings. The doctor at the center said the feature probably saved the 46-year old athlete’s life.

 

Despite this, cardiologists are fairly united in their opposition to such tests. In the early 2000’s, young, healthy people subjected their bodies to a variety of tests including the EKG. Companies emerged to provide whole body testing. In the past decade, however, doctors and, not surprisingly, insurance providers have questioned the value of extensive testing on those without underlying health conditions. Even a benign test like the EKG can lead to invasive outcomes, unnecessary (and more risky) additional tests, and medication. 

 

Sure, someone under age 60 who also smokes or is overweight could be saved by an Apple Watch’s AFib warning. It’s just that anyone at high risk should see a specialist. A cardiologist’s EKG uses 12-leads. Electrodes attached to different parts of the body can show more than a watch’s single closed circuit of left wrist to right fingertip (with the heart in between). A professional EKG checks the heart’s electrical activity in three directions. There are also portable machines that will take accurate readings at home.

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Atrial Fibrillation: Transthoracic Echocardiogram

Atrial Fibrillation: Transthoracic Echocardiogram

As for the seniors? Well, regular exercise has a great heart benefit. The motivating functions of an Apple Watch may be more valuable than the monitoring functions. With a doctor’s permission, a new routine of physical activity could add years to their lives. So for them a smartwatch may be the gift that keeps on giving.

Doctor Profile

John Bankston

Author

John Bankston is a published author of over 150 nonfiction books for children and young adults including biographies of Jonas Salk, Gerhard Domak, and Frederick Banting.

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