Agreement between ST-segment changes identified using a smartwatch ECG and standard ECGs, suggest smartwatch technology could be used for earlier detection of acute coronary syndromes (ACS), especially in high-risk patients, and possibly during major events when normal ECG technology is not available, according to new research presented at ESC Congress 2020 and published in JAMA Cardiology.

Researchers led by Carmen Anna Maria Spaccarotella, MD, et al., used a commercially available smartwatch to obtain multiple channel ECGs from 100 participants, 54 of whom had ST-elevation myocardial infarction, 27 of whom had non-ST-elevation myocardial infarction and 19 whom were identified as "healthy." The watch was placed in different body positions to obtain nine bipolar ECG tracings and the results were compared with a simultaneous standard 12-lead ECG.

Overall results showed agreement between the smartwatch and standard ECG for the identification of a normal ECG (Cohen κ coefficient, 0.90; 95% CI, 0.78-1.00), ST-segment elevation changes (Cohen κ coefficient, 0.88; 95% CI, 0.78-0.97), and non–ST-segment elevation changes (Cohen κ coefficient, 0.85; 95% CI, 0.74-0.96). In addition to detecting changes in ST-segment, researchers also noted the smartwatch was able to detect the localization of ST alterations.

Limitations to the study's findings include the inability to detect ST-segment abnormalities by simply wearing the smartwatch on the wrist. Rather, the watch needed to be removed and placed on "appropriate chest and abdomen locations." In addition, interpretation of the ECG generated by the smartwatch must still be done by a cardiologist. Lastly, control participants in the study were healthy, but not matched by age or sex with the ST segment participants.

While further studies and data analysis are needed, the researchers noted their findings do suggest the possibility that smartwatches could be used under specific circumstances, including pandemics or catastrophes, to recognize ST-segment changes and "be of clinical and social relevance in individuals with chest pain."

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Stable Ischemic Heart Disease, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Chronic Angina

Keywords: ESC Congress, ESC20, Arrhythmias, Cardiac, ST Elevation Myocardial Infarction, Acute Coronary Syndrome, Electrocardiography

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