Novel use of Apple Watch 4 to Obtain 3-lead Electrocardiogram and Detect Cardiac Ischemia

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[Letter]. Perm J 2020; 24:19.202 [Full Citation]

https://doi.org/10.7812/TPP/19-202

Re: Avila CO. Novel use of Apple Watch 4 to obtain 3-lead electrocardiogram and detect cardiac ischemia. Perm J 2019;23:19-025. DOI: https://doi.org/10.7812/TPP/19.025

Dear Editors and Readers

I have read with attention the article “Novel use of Apple Watch 4 to obtain 3-lead electrocardiogram and detect cardiac ischemia.”¹ Dr Avila should be commended for his stimulating manuscript showing the use of the Apple Watch to obtain Einthoven leads II and III readings. The cases illustrating ST-elevation in inferior acute myocardial infarction are really interesting.

An evident limitation of the approach suggested in the article is its “inability to detect precordial leads, which could miss cardiac ischemia in other cardiac regions.”¹ To solve this problem, I have recently shown my method to record a quasistandard electrocardiogram, including the precordial leads, in the European Congress of Cardiology² and in the Annals of Internal Medicine.³

Obviously, I agree with Dr Avila that the use of the Apple watch to detect acute ischemic events requires a wide range of clinical studies. But the future is coming!

Miguel Ángel Cobos Gil, MD, PhD
Instituto Cardiovascular
H Clínico San Carlos
Madrid, Spain

How to Cite this Article

Cobos Gil MÁ. Novel use of Apple Watch 4 to obtain 3-lead electrocardiogram and detect cardiac ischemia [Letter]. Perm J 2020;24:19.202. DOI: https://doi.org/10.7812/TPP/19.202

 References

1.    Avila CO. Novel use of Apple Watch 4 to obtain 3-lead electrocardiogram and detect cardiac ischemia. Perm J 2019;23:19-025. DOI: https://doi.org/10.7812/TPP/19-025
2.    Cobos Gill MÁ. Pitch session: Wearables: Acquiring standard and precordial leads with an Apple Watch [Internet]. Biot, France: European Society of Cardiology; 2019 [cited 2019 Nov 18] Available from: https://esc365.escardio.org/Congress/ESC-CONGRESS-2019/Wearables/203222-acquiring-standard-and-precordial-leads-with-an-apple-watch
3.    Cobos Gil MÁ. Standard and precordial leads obtained with an Apple Watch. Ann Intern Med 2019 Nov 26. DOI: https://doi.org/10.7326/M19-2018

In Response

I appreciate the response by Dr Cobos Gil regarding the article. More importantly, I applaud his ability to build on the report and add a quasistandard electrocardiogram that now includes the precordial leads. Similarly, a recent publication in the journal Sensor shows an additional method looking at the precordial leads and demonstrates a case of acute ST-elevation myocardial infarction.1 As he appropriately stated, the Apple Watch “requires a wide range of clinical studies. But the future is coming!”

Cesar O Avila, MD, FACEP
Department of Emergency Medicine, San Diego Medical Center, CA

Reference

1.    Samol A, Bischof K, Luani B, Pascut D, Wiemer M, Kaese S. Single-lead ECG recordings including Einthoven and Wilson leads by a Smartwatch: A new era of patient directed early ECG differential diagnosis of cardiac diseases? Sensors (Basel) 2019 Oct 10;19(20):4377. DOI: https://doi.org/10.3390/s19204377