Cath Lab Activation With Smartwatch’s Electrocardiogram Tracings

J INVASIVE CARDIOL 2023;35(7):E392-E393

Key words: acute coronary syndrome, smartwatch, tele-consultation, digital

A 67-year-old man with a history of smoking, hyperlipidemia, and hypertension complained of central chest pain radiating to his left arm for 2 hours and contacted the attending cardiologist. Based on medical history and symptom description, the physician urged him to undergo a complete cardiac evaluation to rule in or out an acute coronary syndrome. Interestingly, the patient insisted on sending digitally for tele-consultation a lead-I tracing recorded by his Samsung Galaxy Watch 4 (Samsung Electronics) worn on his left wrist.

Τo increase diagnostic potential, he was instructed to place the smartwatch onto the 4th intercostal space (ICS) left of the sternum touching the crown with his right index finger and then repeat on the 5th ICS along the midclavicular line (Figure 1A). By this manipulation, precordial leads V2 and V4 were reproduced successively and an anterior ST-elevation myocardial infarction was depicted (Figure 1B). The patient bypassed the emergency department (ED) triage and headed directly to the cath lab. In-hospital electrocardiogram leads I, V2, and V4 demonstrated notable correlation with patient’s self-recordings (Figures 1B and 1C). Coronary angiography revealed a left anterior descending artery occlusion, which was successfully stented (Figures 1D and 1E).

Prompt diagnosis of acute chest pain is critical to avoid adverse outcomes. Still, a non-negligible number of patients hesitate to present to the ED immediately after symptom onset. This phenomenon was significantly boosted in the COVID-19 era.

Smartwatches have been FDA-cleared for rhythm detection but ST-T deviation recognition is also feasible. These gadgets record the voltage difference between the positive sensor embedded in the back and the negative sensor integrated in the crown, thus reproducing bipolar leads similar to Einthoven’s I, II, III, or Wilson’s precordial V1-V6 with suitable placing manipulation (Figure 1A).

The ability to self-register electrocardiograms for tele-consultation limits patient indecisiveness, shortens door-to-balloon time, and contributes to timely intervention.

Affiliations and Disclosures

From the Cardiology Department, Trikala Hospital, Trikala, Thessaly, Greece.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted January 6, 2023.

Address for correspondence:  Dimitrios Karelas, MD, MSc, R. Feraiou 13, 43100, Karditsa, Greece. Email: dim.f.karelas@gmail.com.