17 Sep 2019


The Chapter of Cardiologists, College of Physicians Singapore and the Academy of Medicine Singapore welcome the release of the ECG app on the Apple watch on 23 July 2019.  We would like to provide the following advice to primary care physicians:




The Apple Watch ECG App is a single channel electrocardiogram similar to a Lead I ECG.  The ECG App is able to determine if atrial fibrillation or sinus rhythm is present.  It is not recommended to be used by patients with known atrial fibrillation (AF) or other heart rhythm abnormalities.


The Apple Watch ECG App is meant to supplement and not to replace traditional methods of diagnosis of atrial fibrillation.  In addition, the ECG app is not intended to be for use by people under 22 years old.  The ECG app cannot diagnose heart attacks.


Regarding ECG function and irregular heart rhythm detection function


1. If your patient presents with:
       a. An alert for irregular heart rhythm and/or
       b. An Apple Watch ECG tracing showing atrial fibrillation,


Please perform a 12-lead electrocardiogram (ECG).  If the 12-lead ECG shows atrial fibrillation, then a diagnosis is made and you may manage the patient according to established guidelines.


2. If the 12-lead ECG as performed above shows normal sinus rhythm, you may consider referring the patient to a cardiologist for further evaluation and/or testing.  Given the limited experience of this technology to guide therapy, we do not recommend commencing anticoagulation for these patients. Confirmatory diagnosis on a 12 lead ECG or on Holter monitoring is required prior to initiation of such treatment.



For any enquiries, please contact:
Email: cps@ams.edu.sg



Drs Yeo Khung Keong, Lim Toon Wei, Yeo Tee Joo, Ching Chi Keong, David Foo, Terrance Chua and Ong Hean Yee, on behalf of the Chapter of Cardiologists; College of Physicians, Singapore; Academy of Medicine, Singapore; and Singapore Cardiac Society.



Please click here to view the Advisory in pdf format.