Novel Use of Apple Watch 4 to Obtain 3-Lead Electrocardiogram and Detect Cardiac Ischemia

Abstract

Background: Early recognition and treatment of ST-elevation myocardial infarction (STEMI) results in better outcomes. Objectives: To describe a novel technique using the Apple Watch 4 (Apple Inc, Cupertino, CA) to obtain a 3-lead electrocardiogram (ECG) and confirm the watch's feasibility to detect cardiac ischemia in selective cases with a particular injury pattern. Methods: Two male patients in the Emergency Department had STEMI apparent on their ECGs. These findings were compared with those from the Apple Watch 4, whose positioning was adjusted for 3-lead ECG. Results: The patients' real-time, watch-based, 3-lead ECG tracings matched the traditional ECGs demonstrating STEMI, confirming the potential ability of this device to uncover myocardial ischemia. In each patient, cardiac catheterization revealed severe, 100% occlusion of the right coronary artery. Conclusion: The Apple Watch 4 could lead to earlier detection of acute coronary artery disease, but sensitivity and specificity remain unknown.