Accuracy of the Apple Watch single-lead ECG recordings in pre-term neonates

Abstract

Introduction: Telemedicine gained an increasing use throughout the last years. Lifestyle tools like the Apple watch seem to have an increasing spread even in remote areas and underdeveloped regions. The increasing availability of these tools offers the chance to use the health care functions of these devices to improve provision of professional medical care. First data on the use of the Apple Watch as a remote monitoring device in children have been reported, showing good acceptability and usability of the Apple Watch for symptom monitoring in children. This study aimed to evaluate the accuracy of the Apple Watch iECG in comparison to a standard 12-lead ECG in pre-term babies. Methods: In this prospective, single-arm study, consecutive preterm neonates hospitalised in Leipzig University Hospital neonatal ICU were eligible. A 12-lead ECG and an iECG using Apple Watch 4 were performed. iECG and 12-lead ECG measurements were performed by a paediatric cardiologist. Cardiac rhythm was classified and amplitudes and timing intervals were analysed for comparability. Results: Fifty preterm neonates, gestational week (23–36 weeks), and body weight (0.65–3.09 kg) were enrolled. Overall good quality and excellent correlation of the Apple Watch generated iECG in comparison to the standard 12-lead ECG could be demonstrated (p < 0.001). When interpreted by a paediatric cardiologist, a correct rhythm classification could be done in 100% of cases. Conclusion: The Apple Watch iECG seems to be a valuable tool to record an ECG comparable to lead I of the standard 12-lead ECG even in pre-term neonates. With a widespread availability and excellent connectivity, the Apple Watch iECG function may provide practitioners with a tool to send an iECG for interpretation to a paediatric cardiac specialist.

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“…Inconsistent availability of device specific dashboards due to University firewalls may inhibit the ability to assess data in real-time. Lastly, none of these technologies were assessed in this study against their gold-standard counterparts, so no assessment of data accuracy or reliability can be made, though previous studies in the literature have supported the use of both KM and AW6 in the pediatric population 8 , 9 , 10 , 11 , 12 .…”

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“…Gropler et al [11] studied the Kardia device in pediatric patients with and without a known cardiac history and found that it produced accurate ECGs when comparing manual over-read of rhythm and interval measurements by two pediatric electrophysiologists to consecutively obtained 12-lead ECGs. Similar studies have been done with the Apple Watch 4 in neonates and healthy adults [12,13]. Recently, Kobel et al [14] published their work focused on the utility of the Apple Watch series 4 ECG (iECG) in pediatric patients (ages 0-16 years) and showed excellent correlation (K>0.7, p<0.01) in all ECG interval measurements between the AW ECG and standard 12 lead ECG with reliable AW ECG rhythm interpretation in 95% of cases.…”

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“…59 Numerous studies have tested and are testing the reliability, accuracy, and usability of this and other smartwatches in various settings. [60][61][62][63] Smart devices were not developed with patient monitoring in mind. However, differences in manufacturing scale and technology adoption trends mean that medical devices tend to adopt consumer hardware and technologies over time.…”