About Apple Smartwatch 6 ECG
Electrocardiogram, how it works
Before assessing the arrival of the Apple watch it is worth explaining what we are talking about, leaving the answer to the initial question to the reader. Electro-Cardio-Gram, ECG means to measure the electrical activity of the heart, from various “points of view”, called “derivations”. A derivation has its “point of view” in the ideal line that joins the two electric poles on which the electrodes are placed, who has ever done an ECG knows what I’m talking about, the wires to which you are connected.
Usually an ECG has twelve leads and from each one you get more detailed information about the condition of portions of the heart, or rather, exclusively of the electrical activity of those portions of the heart. The electrical activity is what causes the heart to contract and the heart must contract in a coordinated manner, first the atrium, then the ventricle which in turn must contract in a coordinated manner. The “initial electrical discharge” starts in the atrium, then passes to the ventricles and so the pump works efficiently and well synchronized.
ECG means “measurement of electrical activity”, the “points of view”, the twelve leads are seen virtually, with ultrasound, with CT, with MRI you can really see the heart, with the electrical activity you measure only the rhythm of the heartbeat, the synchronization of the electrical discharge and the “recharge”, called repolarization. Certainly the condition of the heart muscle can change the electrical activity but this does not always happen.
The limits of a professional medical EMG
We know that a normal electrocardiogram does not automatically mean a good function of the heart, we know that sometimes you need an electrocardiogram under stress, there are acute heart attacks with negative electrocardiogram, there are many alterations of “innocent” electrical activity and others very dangerous, as we have seen in recent cases, even of football players.
The (major) limits of Apple’s Ecg
What does Apple Watch do in all this scenario? It measures electrical activity in a single bypass, the D1 the one between the two arms and analyzes exclusively, as far as is known, the heart rate for 30 seconds, based on the electrical peak of the ventricle contraction, which is the highest peak, easy to be recognized. Ignore, as far as we know, all other electrical components.
Consequently, the associated APP evaluates the regularity of the peak and, if it is irregular in an “anarchic” way, not if it lacks a few beats every now and then, but if no regularity of the beat can be recognized, the data is interpreted as possible atrial fibrillation. Atrial fibrillation is a condition in which the atrium, like a conductor who has drunk too much, randomly moves the baton; as a result the orchestra members are unable to follow it and the rhythm has no regularity.
The risk of this condition, when it lasts for a long time, is the possibility that the blood in the atrium “stagnates” and a clot may form that could be pushed by the heart into the peripheral vessels, the first are those of the brain, causing a stroke.
So, to summarize: the ECG to a derivation of Apple Watch and similar devices does not assess “heart problems”, the risk of heart attack, the heart attack in progress, etc. etc., it assesses only one thing: the presence of a particular arrhythmia condition known as “atrial fibrillation” or better could detect it, because the correct evaluation of heart rate with ECG depends on many conditions: you have to stay still and calm, with arms and legs well supported, breathe in a relaxed way, do not have electrical interference around you from other devices and above all do not have tachycardias, extrasystoles (early beats, maybe in small groups). In all these cases the “automatic” diagnosis fails, with the response, different for each device, which generally says “electrocardiogram not evaluable”.
The medical value of Apple Watch
What is the medical value of all this? The physician can only begin to consider this data when it comes from devices certified for medical use. The list of certified medical devices can be found at the Ministry of Health and can be consulted publicly. Below is what appears when you search with the Apple keyword. I imagine it is APPLE INC US and an app is registered, without code and a “feature” the irregular rhythm notification, which is strangely defined ONLY in English. The detection device, APPLE Watch , does not seem to be present, but it could be just a matter of time, or bureaucratic problems.
Would I recommend Apple Watch to a patient with heart problems?
No, it does not automatically detect heart problems but only one type of heart rhythm irregularity, atrial fibrillation.
Would I recommend it to a patient with possible atrial fibrillation? No, there are dozens of devices certified for medical use that do it, they even enter the wallet and do it with all the smartphones on the market, many of them can also be easily placed on the chest and in case of disorders also allow to send the so-called “precordial” derivations detected on the chest, from V1 to V6 , much more interesting than the D1 . Finally, the price for certified devices to my knowledge ranges from about 100€ up to 250€, well below the cost of the APPLE watch and are tax deductible.
Would I use the data that the patient sends me? Yes, but only in case of emergency, in all other cases I would tell him to use something certified but I would be worried about the possibility of hypochondriac patients filling my mailbox with “unclassified” traces.All info : migliore smartwatch
