Apple Watch Series 4 vs. 12-Lead Ecg: A Comparison of Manual Electrocardiographic Waveform Analysis

Use of a Smartwatch for Assessment of the QT Interval in Outpatients with Coronavirus Disease 2019

“…A recent validation study performed in 129 healthy volunteers showed a reasonable concordance between QTc intervals measured from the Apple Watch and a 12-lead ECG (mean difference: −11.67 ± 8.32 ms; r = 0.57). 7 In addition, a prior study demonstrated the ability to use a smartphone-based heart monitor to accurately detect QTc prolongation in a patient receiving QT-prolonging medications, the results of which revealed a difference of 4 ms with standard deviation of 11 ms as compared with the 12-lead ECG. 8 Elsewhere, another study found that QTc measurement using a single-lead handheld mobile device is feasible, but the QTc measurement was underestimated (23 ms; 95% confidence interval: 13–34 ms) when only a lead I rhythm strip was obtained; when a vector analogous to lead II could be recorded, QTc measurements had a very close correlation with the maximum QTc interval determined by 12-lead ECG.…”

“…While these devices have been validated for their ability to monitor heart rates and differentiate sinus rhythm from atrial fibrillation, 6 their accuracy for other ECG-interpretation purposes has not been well studied to date. However, the waveforms produced have been shown to correlate reasonably well with standard ECG intervals including the corrected QT (QTc) interval 7 and have previously been used to detect drug-induced QT interval prolongation. 8 As patients with COVID-19 infection continue to overwhelm our global health care system and resources, the ability to remotely monitor patients for cardiac complications of COVID-19 infection and ensure their safety during pharmacologic treatment has become increasingly important.…”

“…While these devices have been validated for their ability to monitor heart rates and differentiate sinus rhythm from atrial fibrillation, 6 their accuracy for other ECG-interpretation purposes has not been well studied to date. However, the waveforms produced have been shown to correlate reasonably well with standard ECG intervals including the corrected QT (QTc) interval 7 and have previously been used to detect drug-induced QT interval prolongation. 8 …”

Minimal or No Touch Electrocardiography Recording and Remote Heart Rhythm Monitoring during COVID-19 Pandemic Era

“…The study also found moderate to strong agreement in manual measurement of heart rate and basic intervals between devices represented by Bland-Altman plots, including QTc interval. 21 Based on this finding, it is likely that the Apple Watch may have a role in the diagnosis of other heart rhythm disturbance, however, the access to its ECG feature is currently restricted in Asia, including Indonesia . Another challenge in the utility of Apple Watch for routine clinical practice is affordability, especially in developing countries.…”