Apple, Samsung, Xiaomi, Withings ... these are the companies investing the health market with smart watches that can record an ECG (electrocardiogram). A “revolution in cardiology”, according to Professor Pierre Bordachar, head of the cardiac stimulation and defibrillation department at the Bordeaux University Hospital and Education Director at the IHU Liryc. He is excited about the idea that millions of people will have access to their ECG in real time.

This investment in health care of large international companies is very good news, a catalyst for innovation. Moreover, these companies have chosen electrophysiology, highly symbolic for life and death, to enter the health care market.

How does it work ?

In practical terms, the watches measure the electrical current that the heart generates to prepare itself for contraction. They do so thanks to two electrodes, one under the watch, in contact with the wrist, and a second on top of the watch. They record one lead, a single "point of view" of electrical activity, which allows them to detect atrial fibrillation.

If the watches detect a problem, they display a warning message suggesting atrial fibrillation, and inviting to quickly see a specialist. Atrial fibrillation is the most common arrhythmia, characterized by an irregular and ineffective contraction of the atria, and it promotes the formation of blood clots.

Challenges for the profession

According to Professor Bordachar, it is vital now to prepare - cardiologists, medical and paramedical teams, teachers, students, researchers - for far-reaching changes in practice.

First, from a technical point of view, the watches only record a single lead, versus twelve for the usual medical devices. The point raised by Professor Bordachar here, is therefore to know precisely what can be detected with the recording of a single lead and what can be missed. Indeed, in an ECG, it is the plurality of points of view of the same electrical activity, provided by the 12 leads, that allows a medical observation.

In a second step, access to these data by the public, supposedly non-expert, requires training. It is not only a question of a training for the users of the watch to understand it, but also the entire medical profession, specialist and non-specialist. Professor Bordachar, as Education Director at IHU Liryc, insists on the different training stages: for the future generations of cardiologists, general practitioners, paramedics, etc. The idea is that everyone should be able to understand the data to be able to support patients with their health needs.

Finally, these watches open up endless possibilities in terms of research. The watches automatically monitor the owner's heart rate every two hours and without special intervention. We can see here the richness of these data to better understand the heart and its electrical activity. Associated with telemedicine data, it is an opportunity to multiply the viewpoints.
 

A study at the Bordeaux University Hospital to get ready

Many companies will enter this market in the near future. Professor Bordachar's team is already taking actions, by carrying out an independent study.
This study includes 250 patients, with very diverse and more or less rare cardiac pathologies, equipped with a smart watch.
Patients also receive standard clinical examinations, such as the famous 12-lead ECG.
The signals recorded by the watches are blindly analyzed by cardiologists, who try to make a diagnosis from them.
The goal here is to find out what kind of information the watch reveals and what is missing in the diagnosis.

In a nutshell, smart watches measuring the ECG are already revolutionizing clinical practices.
The constant development of this connected health solution ileads to many new possibilities, such as an artificial intelligence capable of establishing an initial diagnosis on the watch in the future.
Finally, the media attention generated by this innovation raises public awareness of heart rhythm disorders. It is worth repeating that heart rhythm diseases are a real public health issue, with 33.5 million people affected by atrial fibrillation alone.