Can your ECG-enabled smartwatch really warn you about an irregular heartbeat? (2023)

You've probably heard or read a story about someone first alerted to their irregular heart rhythm by their watch, specifically a smartwatch with built-in EKG capability. With an increasing number of people using these devices, reports of how they have helped someone identify a health problem are becoming more common.

But these stories may seem too good to be true.

It's easy to think that a smartwatch can improve your overall health, so wear one. But can it really warn you of a heart condition that is developing quietly?

After all, it's just a watch.

according to dr. Maged Amine, an interventional cardiologist at Houston Methodist, discovers that EKG-enabled smartwatches may play a role in evaluating and monitoring at least one heart condition: atrial fibrillation (AFib), one of the most common types of arrhythmias.

"Atrial fibrillation occurs when the heart rhythm becomes irregular, usually too fast," says Dr. Amines. “This leads to a reduction in cardiac function. It is a common heart condition that is often asymptomatic, meaning it doesn't always present with obvious symptoms. Unfortunately, the first presentation of atrial fibrillation is often a stroke due to blood clots in the heart."

In fact, AFib increases a person's risk of stroke five times, making it one of the leading causes of stroke.

"Now that people wear devices with built-in ECG capability throughout the day, we are seeing the emergence of a convenient way to comprehensively detect atrial fibrillation," said Dr. amines. "And this technology may also help improve long-term monitoring of this condition."

What is an electrocardiogram and what role does it play in detecting atrial fibrillation?

"Ideally, we detect atrial fibrillation before it leads to a stroke," explains Dr. amines. "And whether it's in a doctor's office or through a portable device used at home for a few days, we've been using an electrocardiogram (ECG) to detect atrial fibrillation for decades."

An electrocardiogram measures how fast the heart beats and can tell if a person's heart rhythm is normal or irregular. Traditionally, this test uses electrodes attached to your chest and other parts of your body. The information collected by these electrodes is sent to a computer and is then checked by your doctor to see if your heart rhythm is irregular.

Your doctor may recommend an EKG if you notice palpitations, chest pain, or shortness of breath, as well as the more subtle signs of atrial fibrillation, such as lightheadedness and extreme tiredness. An EKG is also part of the screening practice for those who are at high risk for heart disease or have a family history of heart disease.

"Since atrial fibrillation is quite common and can present without symptoms, a simpler and more comprehensive form of screening would be very beneficial: it would help detect atrial fibrillation in people who are asymptomatic and ineligible for traditional ECG screening," he adds. Dr. amine. "The idea is that maybe EKG-capable smartwatches could help bridge that gap."

There is a precedent, not with a smartwatch, but with a device that works in much the same way.A 2017 studyResearch into whether regular use of an EKG machine at home could help detect atrial fibrillation more effectively found that it detected more cases than standard screening guidelines.

SonSmart Watcheswith EKG ability really smart enough to detect AFib?

ECG technology in a smartwatch uses LEDs that light up against your skin to detect blood flow and measure your heart rate. Sensors collect this information and algorithms process it to understand your heart rate. Your smartwatch takes these readings throughout the day and sends you an alert if it detects an irregular rhythm.

Because it's so different from traditional EKG technology used in the clinic, you may be skeptical that what's packed into a small watch is sophisticated enough to detect if you have atrial fibrillation. But dr. Amine gives these devices high marks.

"ECG technology in smart watches is very accurate," explains Dr. amines. “And people now have options with these watches. The Apple brand has been at the forefront of this technology, but other brands have followed, including Fitbit and Samsung."

Its precision and usefulness have not gone unnoticed. Certain series of smartwatches from the above brands are FDA-cleared to help users detect signs of atrial fibrillation.

If you're using one of these devices and you get an alert, don't ignore it. Your next step is to tell your doctor. He or she can order the necessary tests to confirm or rule out atrial fibrillation.

ECG-enabled smartwatches may also help better manage atrial fibrillation

The impact of on-demand ECG technology in a personal device, often used by many people, is probably most evident in the detection of atrial fibrillation.

“But these devices can also be very useful for long-term follow-up of people who have already been diagnosed with atrial fibrillation,” explains Dr. amines.

That's because, unfortunately, AFib can come and go. This means that ECGs are not only used for the initial detection of atrial fibrillation, but are also an important part of regular post-treatment checkups: they are used to detect it if it recurs.

"What has been missing is a convenient way to continue to monitor a person's heart very closely so that we can quickly detect atrial fibrillation if it recurs before the next exam," says Dr. amines.

In some cases, an implantable electrocardiograph is used to monitor a person's rhythm for several years after treatment. But implanting this device is a medical procedure, and Dr. Amine notes that this option isn't for everyone.

"Surprisingly, these smartwatches are almost as accurate as implantable EKG machines, with the added benefit that they do not require any medical intervention," adds Dr. Added Amines. "They are amazing devices."

Additionally, Dr. Amine suggests that smartwatches could help reduce reliance on anticoagulants after treatment for atrial fibrillation.

"Treatment for atrial fibrillation usually involves taking medications to help control your heart rhythm or undergoing a procedure called ablation therapy," explains Dr. Aminas. “It also almost always involves the use of blood thinners to reduce the risk of stroke. Once we get someone out of AF and back into a normal rhythm, they often wonder when to stop taking blood thinners. It's an important question to consider, as there are risks to taking these medications."

However, there is a risk of stopping blood thinners too soon because it makes a person more vulnerable to stroke if atrial fibrillation recurs.especiallyif you return without symptoms. But maybe one day smartwatches can help some people safely get off blood thinners.

"If we can trust these devices for long-term control of atrial fibrillation, we can use them to inform us if and when to restart treatment," adds Dr. Added Amines.

However, a smartwatch is not a replacement for healthy lifestyle habits that help manage AFib.

Aside from the smartwatch, the best way for people with atrial fibrillation to manage their condition is to see their cardiologist regularly and prioritize healthy lifestyle choices that have been shown to reduce the likelihood of atrial fibrillation, such as:

  • Elaborate
  • get enough sleep
  • Avoid excess alcohol

"But your smartwatch can be an extra layer of protection," says Dr. Arminé. “You can give your doctor more information that can help guide treatment, as well as help you better monitor your condition and avoid emergency room visits. I hope that one day this will be something that we prescribe to patients to help manage AF. These devices are expensive, but they are powerful."

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