The following is a summary of “Diagnostic accuracy of apple watch ECG outputs in identifying dysrhythmias: A comparison with 12-Lead ECG in emergency department,” published in the May 2024 issue of Emergency Medicine by Paslı, et al.

Wearable devices, notably smartwatches such as the Apple Watch (AW), have gained traction for their ability to record crucial cardiac data like single-lead electrocardiograms (ECGs). While they are increasingly utilized to identify conditions like atrial fibrillation (AF), research on their effectiveness in detecting a broader spectrum of dysrhythmias and abnormal ECG findings remains limited.

The single-center prospective observational study was conducted in a tertiary care emergency department (ED) from October 1, 2023, to October 31, 2023. The study encompassed all patients assessed in the critical care areas of the ED, each undergoing standard 12-lead ECGs for various clinical indications. Participants were consecutively included. An AW was affixed to patients’ wrists, and an ECG lead-I printout was acquired. Heart rate, rhythm, and abnormal findings were assessed and compared with lead-I of standard ECGs. Two emergency medicine specialists performed the ECG evaluations. Rhythms were categorized as normal sinus rhythm and abnormal rhythms, while ECG findings were classified based on the presence or absence of abnormalities. AW and 12-lead ECG outputs were compared using the McNemar test. Predictive performance analyses were also conducted for subgroups. Bland-Altman analysis employing absolute mean differences and concordance correlation coefficients was utilized to evaluate heart rate agreement between devices.

The study involved 721 patients. Analysis of ECG rhythms and abnormal findings in lead-I revealed that AW’s efficacy in distinguishing between normal and abnormal rhythms was comparable to standard ECGs (P = 0.52). However, a significant difference was noted between AW and standard ECGs in identifying abnormal findings in lead-I (P < 0.05). Bland-Altman analysis for heart rate assessment demonstrated an absolute mean difference of 0.81 ± 6.12 bpm (r = 0.94). Strong agreement was observed in 658 out of 700 (94%) heart rate measurements.

The findings suggested that the AW holds promise in detecting cardiac rhythms beyond AF. ECG tracings obtained from the AW could aid in assessing cardiac rhythms before the arrival of patients in the ED. Nevertheless, further research with a larger patient cohort, particularly for specific diagnoses, is imperative.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000615