Garmin appears to have included ECG functionality within their recently released Venu 2 Plus smartwatch, albeit without acknowledging its existence or including the feature at launch. This is notable because there’s currently no Garmin wearable with ECG functionality on it, well, at least officially anyway. Still, Garmin’s shift towards medical devices and specifically ECG functionality wouldn’t necessarily be a surprise. Last spring, Garmin quietly began a clinical trial (2021) to test ECG-related features “derived from a Garmin wrist-worn, consumer device”.
The presence of ECG diagnostics hardware and diagnostics app on the Venu 2 Plus, combined with Garmin’s clinical trials testing, indicates the company is clearly working towards a goal of launching ECG functionality in their wearables. Of course, the timing of that is still unknown – as well as whether or not the Venu 2 Plus will *ever* officially gain ECG functionality.
When the company launched the Venu 2 Plus this past January, its core new features were a speaker/microphone, with calling-related functions. Omitted from that list, was any mention of ECG functionality – or even future ECG functionality. The fact that we’re seeing it now is largely due to a seemingly accidental act that left it in the diagnostic menus on units that were produced prior to February. Garmin has since removed that diagnostic menu in a firmware update, though it’s highly doubtful they’ve removed the actual ECG hardware.
At present Garmin doesn’t officially acknowledge its existence in the unit (more on that later in the post), but does acknowledge the clinical study. Of course, it kinda has to acknowledge that since it’s listed under their name on the US Government website. But again, we’ll circle back to that later in the post.
First Look at Garmin’s ECG:
The ability to see the ECG function is hardly a finished product. To be clear – everything you see in this post is the hardware test/diagnostics menu within the watch. This menu is normally reserved for Garmin technicians to troubleshoot various features. It includes diagnostic pages for sensors, accelerometers, NFC functionality, WiFi, Bluetooth, GPS, displays, etc… Generally speaking, if you’re using that menu – something has gone wrong and you’re trying to determine whether the hardware is the cause. It’s available on every Garmin watch and has been for probably a decade now.
However, what’s not been there is a new ECG diagnostic page. That was accidentally discovered by a user on the Garmin Forums back in early February. However, their experience there was short-lived, without any further documentation or photos. When they went back to access that feature later in the day, it was no longer there. That’s because, by that point, the watch had updated its firmware to the most recent version, which meant the option went away (it appears firmware version 8.05 in late January removed it – prior to the Garmin Forum post).
You see, Garmin, like most companies, manufactures hardware well before products start shipping to you. Apple, GoPro, and countless others do the same. It allows them to stockpile hardware while they finalize the software. This is often 2-4 months ahead of release. When these units are made, they need some sort of software on them so that when you unbox them for the first time, they’ll pair up to your phone and get updated to the current firmware. Ironically, I just posted about this concept a few days ago.
Given my existing Venu 2 Plus had long since updated to the most recent production firmware and removed the feature, I did what any normal person would do – I ordered another new Venu 2 Plus off of Amazon, and it arrived the next day. I then opened it up and without pairing to anything, went into the diagnostics menu. It showed the factory-made firmware version of 6.05 – so plenty old to still contain the feature. And sure enough, just two taps through the menu pages later was the ECG diagnostic menu:
Now to reiterate again, this isn’t meant to be a pretty display of your ECG. It’s a hardware diagnostic test screen, so it’s displaying the core data that Garmin needs to troubleshoot/test the ECG hardware itself. Undoubtedly, the normal end-user feature would be prettier and have pretty red ECG lines, warnings, usage instructions, and more. Why red lines? Because obviously, it has to be red. Any other color means it’s clearly fake.
The way the ECG app works is that you place your opposite thumb and index finger on the bezel, and within about 1-2 seconds it’ll start reading your ECG – taking a few more seconds to stabilize. The moment you remove your fingers from the bezel, it stops. This is essentially the same as how other companies have implemented it. With some companies (like Apple), you touch the digital crown instead, but the concept is the same. By using your opposite wrist/hand, you complete the required electrical circuit.
Playing around with hand position appears to relatively easily impact accuracy, as does playing around with one finger versus two fingers on the bezel. Certainly, this diagnostics software is likely 5-7 months old, and was never intended to do anything more than show raw sensor data. Just like all the other service menu pages do, for things like accelerometer, heart rate, Bluetooth, WiFi, GPS, and more.
Nonetheless, it’s clearly producing a valid-looking ECG. And given that Garmin completed a 568-person clinical trial last October with at least some Garmin-made ECG hardware, it’s likely by this point Garmin knows what they’re doing here. Here’s a look at how that ECG wave pattern looks compared to an Apple Watch Series 7, worn back to back (one after another):
Now normally, most watches that feature ECG functionality also allow you to record the ECG trace and then export the results to send to a doctor. They also typically monitor/check for certain conditions, like atrial fibrillation, which is an irregular heartbeat pattern. They NEVER check for whether a heart attack is occurring.
However, given this is in the diagnostics menu and not the normal feature, we don’t get that here. Undoubtedly, that’d be in any normal ECG feature down the road (because it’d be pointless without it), so we’ll have to see on that – if and when Garmin makes a feature out of this. And in fact, in Garmin’s clinical trials they even outline what features they’re trying to complete. So, let’s dig into that.
The Clinical Trials Study:
Last Spring Garmin recruited for a US clinical trial. As by law, any clinical trial in the US that’s done on people must be registered and listed publicly on the ClinicalTrials.gov database/website. That government organization isn’t quite the FDA, but has loose ties to it. It’s those clinical trials that are then used as the basis for submission to regulatory agencies like the FDA (in the US), or other medical regulatory bodies around the world. Garmin’s submission is here.
In Garmin’s case, they began the study last March 31st, 2021, and then concluded the response period on October 4th, 2021. That means that during that timeframe they were actively gathering data from real-world humans. Then last month (February 2022), they filed an update to the study indicating they did indeed conclude data collection last fall, as well as the final number of participants.
In Garmin’s case, they had initially filed the trials to include 460 participants, however, by the end, they had included 568 participants. In talking to various industry folks, that’s pretty normal, as participants that were initially included are occasionally removed from the study later on. That can be because the individual might not have met the criteria (more on that in a second) upon further inspection, or perhaps there were protocol errors in their sample. You’d expect to see some increase between the projected number and the final number.
The study’s purpose was, in their own words:
“to confirm the Garmin ECG (electrocardiogram) software algorithm can detect and classify atrial fibrillation and normal sinus rhythm on single lead ECG data derived from a Garmin wrist-worn, consumer device. The study will also confirm the software’s ability to create a Lead I ECG that is clinically equivalent to a reference device. The Garmin ECG software is not a diagnostic system and is intended for informational purposes only.”
In other words, they wanted to:
A) Validate the accuracy of the ECG data itself
B) Validate the accuracy of their software identifying atrial fibrillation and a normal sinus rhythm
Basically, they were aiming to have the same baseline validation and features that Apple, Samsung, and others do.
In order to do this, as the study outlines, they recruited through their partner research/medical organizations two different groups of people. Those with known AFib (atrial fibrillation), and those with a normal sinus rhythm. And they did this across 6 different sites in the US. It’s this two-group recruitment that can lead to differences in the final projected number, when for example someone says they have AFib, but upon doing a reference ECG with a doctor during the trial, they actually don’t. Thus, additional participants have to be identified.
The study’s execution was done by six different sites, though some of them are part of the same organization.
A) Hope Research Institute (Phoenix, AZ)
B) MedStar Washington Hospital Center (Washington DC)
C) HealthEast (St. Paul, MN)
D) Northwell Health North Shore University Hospital (Manhasset, NY)
E) Northwell Health Lenox Hill Hospital (New York, NY)
F) MedStar Health Cardiac Electrophysiology at Fairfax (Fairfax, VA)
Garmin themselves of course commissioned the study, and in particular, their health division. I thought it was notable that the application actually listed the names and titles of the Garmin people in charge of it. That itself wasn’t notable, but rather the fact that Garmin now actually has someone with a job title of “Clinical Research Manager” was interesting (and her background at other organizations over the past decade is super interesting in microbiology R&D as well as managing other clinical trials and research). This makes sense, given that Garmin needs to have people with experience in those fields. Other names listed on the study also have experience in these areas.
The initial study documents do outline their exact protocol for each test participant:
In a nutshell, the study collects data from a reference device, then collects data from a Garmin watch. Then they’re looking to understand whether or not the software correctly predicts the rhythm classification (AFib or normal). They’re also looking at secondary outcomes that validate that the pretty graph that you see is actually medical-worthy and that a doctor looking at it can correctly identify the rhythm classification. Finally, they’re looking to ensure that the R-Wave (the spike within the pretty graph) matches that of their reference device.
At this point, Garmin has until later in the year to submit the final results of that study to the government. At present they haven’t uploaded that, which is normal. Most tech companies in this ECG space don’t typically upload those final results until they gain FDA approval.
Still, the fact that they updated the official file though on February 3rd, 2022, clearly indicates things aren’t dead here. Looking at the timeframe for the study, it was a bit longer than Apple’s was for their study (keep in mind Apple did this in 2018, pre-covid, which undoubtedly would have slowed down many aspects of this). Both companies had about the same number of people in the study, and the same number of sites (in fact, even sharing some sites/organizations).
Keep in mind though, the conclusion of the data-gathering phase back in October (for Garmin) is merely one step in a long road to FDA certification. In Apple’s case, their FDA certification took about 5-6 months after their study “primary completion date”. And again, it’s hard to reiterate the impact of COVID on delays to all processes here in 2022 versus 2018.
Going Forward:
That ultimately gets to the big question: Is an ECG feature coming to Garmin watches, or the Venu 2 Plus specifically? Well, it’d certainly seem that Garmin has been lining up their ducks for that to occur. Between the medical study last summer, the recent study filing document updates, and now the hardware clearly being inside the Venu 2 Plus – these are strong indicators.
But there are also reasons why it may never appear in the Venu 2 Plus. First, it’s entirely plausible that the ECG components, or design of such, that Garmin put in the Venu 2 Plus didn’t meet their quality or accuracy levels for ECG. While that seems unlikely at that point, it’s certainly a scenario.
The ECG function here is classified as a medical device (under the FDA’s Software as a Medical Device program), so it required approval by the FDA and similar organizations. Additionally, it typically requires that on a per-country basis. Some countries have their own bodies (e.g. the US), some have a central certifying body shared between countries (like in the EU), and some countries will simply follow certification by the US or EU. As we saw with Apple, Samsung, and others – those were a staged rollout, country by country. And some countries never received it, because the burden of getting medical device approval in a given country may not have been worth the effort for the number of devices in that country.
So, armed with all this curiosity, I simply asked Garmin. Here’s what Mary Woodbury, Garmin’s PR lead for their Wellness products/division (which the Venu series falls under) had to say:
“Garmin has conducted a clinical trial to assess the capability of our smartwatches to accurately detect the presence of AFib. The details of the study can be found on clinicaltrials.gov”
Which..is all they would say. They would not provide any comment regarding the existence of ECG features in the device itself – only confirming the clinical trial that existed. Their lack of comment would be in line with US FDA regulations that prohibit companies from discussing medical devices until FDA approval has been granted. In the case of Apple for example – they waited until they had actual approval from the FDA before announcing that ECG functionality would be coming to watches (even though there was another gap between the announcement of existence and implementation on consumers’ wrists). Whereas Withings, a French company, did not initially seek US FDA approval and thus pre-announced a year prior to the actual availability of the feature.
Remember, as advanced as Garmin is within the sports tech realm, they are a tremendously fiscal and legally conservative company. They virtually never pre-announce features. And in the last few years, they’ve shifted to not announcing products until they can ship immediately (versus announcing something coming in a few months). Them even acknowledging the existence of the ECG feature of this would land them in hot water with the FDA. Undoubtedly, a lot of four-letter words occurred in Kansas back in January when they realized this diagnostics menu was left in there.
However, in this case, their acknowledgment isn’t really necessary. They’ve acknowledged the clinical trial to detect AFib with an ECG in a Garmin wearable, and they’ve accidentally demonstrated that the Venu 2 Plus has capable hardware. The only things left to know are when and where. When will Garmin announce it, and to which country will it be available? Of course, there’s still the “if” factor. It’s entirely plausible that Garmin doesn’t request/receive FDA approval for this iteration. Thus, we may never see ECG on the Venu 2 Plus and certainly, I wouldn’t buy the Venu 2 Plus with that as a reason, since no promise (or even hint) has ever been made in that realm.
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I don’t see any evidence that it’s secretly in the Fenix/Epix units.
Garmin has often started various wellness features within the Vivoactive/Venu lineup, and those were expanded upwards to Fenix/Forerunner/etc product lines. Whether or not Garmin ends up ever releasing a Venu 2 Plus ECG feature, or expands it beyond that remains to be seen.
Certainly though, if we look at the long game (years), I imagine it’ll largely become a baseline feature for Garmin, just like PulseOx or others.
Now I’m looking closely at the change from through bolts on the Fenix 6 to offset bolts on the Fenix 7. On the 6 it looks like the front and back of the case would be directly electrically connected by these bolts. While it’s nice to extend the metal bezel out onto the lugs it seems just as likely that they moved for electrical reasons to allow electronics to be wired in between the two. I just checked and both are electrically connected but it’s possible that the 7 can measure voltage/current/resistance between them.
as I remember the Venu 2 Plus has also a SS backcover – this in addition with the crown could represent the electrodes needed for ECG – and no other Garmin watch I saw was equipped with such
My Venu 2 cannot read correct heart rate so how do Garmin think this will work. They are just turning out useless data in the hope nobody notices. Garmin should fix existing issues which users have been complaing about for over 1 year.
But if they get validated studies and FDA approval then that’s a good argument that they can measure HR accurately. I’ve always told people not to be too concerned with exact numbers from your watch. It’s not a medical device I tell them. Might have to alter my wording soon.
It’s the optical HR sensors that have trouble. ECG is done electrically, not optically. That’s why you have to touch the bezel with your other hand and complete the electrical circuit. This is similar to traditional HR straps.
Current heart rate monitoring and ECG use completely different hardware. Heart rate measures light reflectivity changes induced by blood flowing through very fine veins while ECG measures small voltages between two different parts of your body (one wrist and the fingers on the opposite hand). In my opinion, ECG is actually simpler to do from a hardware standpoint. The reason is has not been implemented first is probably because of the relative inconvenience of having to place one hand on the watch to take a sample which in many cases will require interrupting what you are doing, whereas heart rate can be monitored continuously, even while you sleep, without you even being aware of it.
All smart watch vendors have difficulty providing reliable heart rate monitoring under all circumstances and for all skin conditions. I believe ECG has the potential of having less variability. The difficulty of ECG is that in order to get FDA approval, it has to meet very strict standards.
Sure Garmin (or another) could make a non medical approved health band which you wear on your other wrist or ankle to measure the differences real time continuously or samples every x minutes of testing to achieve the same results. Just need to remove the “noise” from the real data
Echoing what others are saying. If it’s no more accurate or useful than PulseOx, which is only useful to drain your battery at amazingly horrific rates, please Garmin, leave it off.
Other than for those who have a condition like Afib .. which is estimated to be about 0.51% of the population, I just don’t get the fascination with ECG on a watch. I have had on my Apple Watch for years and tried it once and never used it again.
I think that if I had a condition that required me to take an accurate ECG, I would probably invest in something that would be a bit more accurate than a watch.
Again, I know some have benefited from it, but for the vast majority, it really isn’t useful.
A higher number of folks see afib. Research is showing PAC to be occurring at a higher rate than previously thought. Folks are going to use these devices and seek diagnosis. The known population will jump. It’s already happening due to the Apple device.
There may only be a rate of 0.51% of, i presume, the general population, but in older athletes, older in both age and training years it is higher. I am 67 and have cycle trained/raced for over 30yrs and have at least 15 friends of similar profile who have this condition; luckily, i don’t
Just a small point–the R wave doesn’t refer to the whole pretty graph but to a specific part of it. In the pics above, it’s the big upwards spike. In atrial fibrillation they’d be randomly spaced. As others point out this measured in a totally different way than the optical heart rate sensor. Theoretically for each R wave on the EKG you get one beat on the optical sensor (although perhaps not at exactly the same time). Agree that although it’s cool to be able to get an EKG on your wrist, the utility of this seems limited, especially for the more expensive watches geared towards healthy endurance athletes. More of a marketing and keep-up-with-Apple thing.
And yes, I agree that for the vast majority of the population (likely far in excess of 95%), this functionality has little practical day-to-day purpose except for fun geekery.
However, it was fascinating to see just how many people in the Fenix 7/Epix/Venu 2 reviews were upset that the device lacked ECG functionality. As always, there is a tiny segment of the population where this can be beneficial (and in fact, hugely beneficial) – but it is indeed small.
Ultimately, this is as you noted, a keeping up with the Joneses type situation.
Read the book “Haywire heart”! Endurance athletes, especially those who do ultramarathon, triathlon, biathlon and cycling have a higher chance of getting Afib when they are in their fifties (and older). I myself am an example of that.
My Afib started at 56, thanks to the OHR of my Garmin watch it was easy to spot (suddenly a very high stress level). But an ECG-function would have been nice then.
I think a lot people are complaining about no ECG on Garmin devices just because some of the competitors have it and Garmin not. They don´t know, if they will use it, but others have it and Garmin not… So they must have it. Just my 2cents.
That might be true if your population is the existing users of Garmin multisport watches. It also might be true that a small percentage of the overall population has AFib. But I would contend that a very large percentage of the general population has high blood pressure or other factors that mean they should be screened for AFib. Whether or not it’s a good idea to send a bunch of people to their doctors because their Garmin told them they have AFib is another question. Having more data is always a good thing in my mind and hopefully Garmin’s health division (in cooperation with Apple and others?) will be able to provide some useful insights into AFib or other conditions they might be able to detect.
I am not a doctor so don’t quote me on the medical details but the general idea is that I’m guessing the average age of Garmin users is getting older (especially for $1000+ watches) and even though they’re probably more healthy than the general population there are a lot more than 5% of them that are still susceptible to problems that hopefully will be detected by a Garmin someday soon.
And sorry for the long post but I do have a friend who was in excellent shape and had AFib, pretty much ignored it, and had a stroke that through a lot of luck, willpower, a rock to bang with, and a life flight in a helicopter doesn’t seem to have caused any lasting damage. So if you’re over 50 consider getting screened for it and pay attention to it if you are diagnosed with it.
And I question if that is really needed if people are even somewhat diligent about your health. You should be seeing a doctor for a check-up at least once a year, especially as you get older. And no, not due to being a worry wort, but just to make sure.
ECG is really not a one off for people like myself who suffer from A Fib. It’s the main reason I switched to an Apple Watch to be able to get timely ECGs at appropriate times.
that poor guy who discovered this by accident and asked about it in the garmin venu forum is owed an apology there. he was absolutely crucified because he had no “proof”
It’s okay, I don’t take internet comments to heart! I did wish I had taken a picture but didn’t expect it to disappear an hour later when the watch auto updated. The internet is a cruel mistress! It’s just great the DC found the comment and took the time to investigate!!
Why can’t they release a HRV stat? Is the optical unreliable? I would rather have such instead of ECG. I’m able to perceive my PAC and PVC. I want data that is useful. I can guess at my HRV based on the day’s readings..
As an ECG novice, are there laws/incentives for Garmin to get FDA approval instead of just launching the feature “as-is” and improving it with software over time?
As far as I know, other metrics like cadence or swim stroke detection don’t require FDA approval. Is there something that makes ECG “more important” than these other metrics?
Apple & Withings ECG offerings have FDA approval so from a marketing standpoint they would either want to get the same certification or skip the feature entirely.
Since that type of measurement was traditionally performed in a medical setting consumers will naturally assume it has the relevance and accuracy of a medical test.
If nothing else, internally they want to keep their capability level as high as their competition even if they don’t immediately sell product with the capability. Like Apple, they have enough money to explore things and don’t especially require the outputs to immediately generate profits.
Well, you can’t die from an abnormal swim stroke. If you could, I’d be long since dead ::-). But seriously, I personally have some minor abnormalities in my ECG rhythm and it might be nice especially if I could upload or print something out to show my doc from time to time. Sort of a real-world stress test result.
Well, you can’t die from an abnormal swim stroke. If you could, I’d be long since dead ::-). But seriously, I personally have some minor abnormalities in my ECG rhythm and it might be nice especially if I could upload or print something out to show my doc from time to time. Sort of a real-world stress test result.
Hi, yes, Garmin cannot market this feature in the US without Pre-Market Approval (PMA) from the FDA. It’s called a 510k clearance (named after the submission form).
Apple actually got the clearance long before they enabled the functionality in the software in their Apple 4 watch. Their developers had a deadline to be able to announce it by the time their big product release show came around, and if you know Apple…
Funny thing about Apple, they hold patents in many spaces you wouldn’t think they would. Years ago I wrote up a utility patent on a ‘bike bus’ combining both battery and CAN-like data transfer (think Shimano DI2), but Apple actually beat me to filing (by mere months). Coincidentally I had also written up a patent back then for overlaying ANT+ data on video (think Virb) but never filed it.
Anyway Garmin, get your butts in gear and get this going!
I hope this comes to the EPIX watch. It’s the single thing I miss about my Apple Watch 7 although as Ray mentioned in a review it is something you use lots at the start and then less and less.
I’m really glad you posted this. I’ve been debating which new watch to get, or if it’s even worth replacing my FR645M since there’s no added functionality that means anything to me. I’m no longer a runner and I have my Edge 1030+ for cycling. Anyway, this potential breakthrough feature is worth waiting for IMO so I’m going to stop obsessing about which watch to get and just wait to see what eventually comes next.
I think someone mentioned it but a-fib and endurance sports go hand in hand, especially as you age. I’ve been watching this functionality closely for years now, and waiting for Garmin to make progress. Why? Because I’m in their ecosystem, mainly, and because I have a-fib that first arrived on an epic bike ride.
Apple has many stories of viable a-fib detection. I don’t have an Apple watch, and it makes no sense for me to buy one. The other FDA-cleared (not “approved”) device I’m aware of is Kardia Mobile, with a steep monthly subscription. My last smartwatch was a Garmin and my next will be too – not that I love them to pieces…
Ultimately I want to track daily hydration, weight, BP, and hydration trends using Connect. I have Strava too but Connect blows its doors off, and I think it’s much better than the Apple, Google, Samsung, and Under Armour platforms. But I have a 5X and can upload none of those, despite being ConnectIQ and FIT savvy! It also lacks the Garmin Pay feature my Vivoactive 3 has, and on EU trips I really miss that. I mainly use my watch for kitesurfing and windsurfing, which the Fenix 7 says it has built-in, but price-wise only the regular Fenix 6 is coming into range for me… the 7’s not worth $700 to me, sorry.
I’ll wait with baited breath. Currently I track real-time HR (with a Polar HRM10) religiously and try hard to manage effort and hydration. Sometimes I feel like I’m in a-fib and have to ask my nurse wife to feel my chest and give me her opinion. I met her during my first cardioversion over a decade ago (and had three others since), so needless to say I’d rather have a device that I can double-check it with and not have her get freaked out, since on my last cardioversion my heart actually stopped for a short time.
So while I agree it’s a “me-too” feature in some folks’ view, it’s also highly anticipated for others.
BTW, I’ve compared the HR reading of Garmin’s optical sensor to the HRM-10 while getting an ECG on a 12-lead Siemens device, and the optical was way off – and it only gets worse as your effort level goes up.
My interest is primarily road cycling as a long-since retired Cat. 2 roadie. I’m on this page specifically because today my cardiologist suggested a smartwatch and having read DCRM for a long time knew I’d get honest discussion of tech stuff. I’m also retired from a heavily technical IT career that started before there was a WWW, so certainly not averse to this stuff. Currently I’ve very satisfied with a Garmin Edge 500. I like to get my money’s worth out of a product.
I know this is a bit old, but a couple comments got under my skin a bit and I wanted to address them, and that has to do with who would want ECG capabilities. And there were several comments I thought were kind of naive, I assume from younger readers (I’m 63).
I don’t think Garmin would be going to the trouble of trying to make this work simply for the bling factor, and I have no doubt some kind of study was also done to see if there was demand to make the investment worthwhile for them. That’s fundamental business stuff, and I’m an utter fool when it comes to business.
It only took a couple seconds of search engine love to find this article on WebMD titled: “Athletes Face Twice the Odds for A-Fib” which covers a study performed by the British Journal of Sports Medicine (7/2021) where they found:
~~~~~~~~~~~~~
“Athletes have a significantly greater likelihood of developing atrial fibrillation compared with non-athlete controls,” Jamie O’Driscoll, of the School of Psychology and Life Sciences at Canterbury Christ Church University in England, and colleagues reported.
“Younger aged athletes have a greater relative risk of atrial fibrillation compared with older athletes; however, exercise dose parameters, including training and competition history, as well as potential gender differences for the risk of atrial fibrillation requires future research,” the authors concluded in a journal news release.
The analysis also showed that athletes younger than 55 had about a four times higher risk of a-fib than those 55 and older. Those older athletes were 76% more likely to have the condition than non-athletes.
~~~~~~~~~~~~~
They also note that endurance athletes have a lesser chance of developing A-Fib.
The article concludes saying “studies have also suggested there is a point at which increasing levels of exercise are associated with heart issues, including a-fib.”
I think maybe the younger athletes are somewhat divorced from the world of older athletes (I know I used to be) but here’s evidence that being young and fit is not the panacea against heart disease some would think. Every race car driver knows his car and engine intimately. Every athlete should show the same concern for their heart and get checked up by a sports cardiologist (if you can find one…a sad story for another time). I can name a half dozen high level endurance athletes of “middle age” who dropped dead from undetected heart ailments. I’d start with a guy named Jim Fixx.
Afib detection is mainly geeky. Someone I know who is extremely prone to Afib wore a heart nonitor for a month and it picked up Afib once for a few minutes. That means the chance of a random check, even every day, detecting Afib is very small. If Afib is continuous it will likely lead to a stroke. I know someone that happened to. His speech was slurred, and he did not realize his injury. Maybe continuous Afib without any sign is rare or it is not. If it was common, cardiologists would be fitting their patients with continuous monitors a lot more often.
I’m sure it can be done, but at least on the Apple Watch ECG has to be done while motionless. So putting it in a FIT file might be useful, but you’re not going to be able to record ECG while doing an activity.
I’m (currently) primarily interested in capturing ECG from the Polar H10 during workouts. E.g. for doing post-workout analysis of RR-interval artifacts.
Garmin controls the FIT SDK, so if they are looking at ECG, I’m hoping that ECG will show up in the FIT SDK.
Possibly if Garmin is looking at ECG they may also add it to their heart rate monitors (Dual, Pro etc).
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Any hints at this feature coming to high-end Fēnix / Epix lines?
I don’t see any evidence that it’s secretly in the Fenix/Epix units.
Garmin has often started various wellness features within the Vivoactive/Venu lineup, and those were expanded upwards to Fenix/Forerunner/etc product lines. Whether or not Garmin ends up ever releasing a Venu 2 Plus ECG feature, or expands it beyond that remains to be seen.
Certainly though, if we look at the long game (years), I imagine it’ll largely become a baseline feature for Garmin, just like PulseOx or others.
Thank you!
I wondered if the hardware may be visible but I understand the electrodes are in the watch crown itself.
Have you seen any product breakdowns (à la iFixit) of the Venu 2 Plus and the new F7/E2 that may reveal about similar sensors in the latest watches?
Just curious (and looking for even more reasons to upgrade frankly 😇).
Now I’m looking closely at the change from through bolts on the Fenix 6 to offset bolts on the Fenix 7. On the 6 it looks like the front and back of the case would be directly electrically connected by these bolts. While it’s nice to extend the metal bezel out onto the lugs it seems just as likely that they moved for electrical reasons to allow electronics to be wired in between the two. I just checked and both are electrically connected but it’s possible that the 7 can measure voltage/current/resistance between them.
Yeah, I’m reasonably certain the Venu 2 Plus is the only Garmin unit in the market that has the correct hardware under the covers.
as I remember the Venu 2 Plus has also a SS backcover – this in addition with the crown could represent the electrodes needed for ECG – and no other Garmin watch I saw was equipped with such
My Venu 2 cannot read correct heart rate so how do Garmin think this will work. They are just turning out useless data in the hope nobody notices. Garmin should fix existing issues which users have been complaing about for over 1 year.
But if they get validated studies and FDA approval then that’s a good argument that they can measure HR accurately. I’ve always told people not to be too concerned with exact numbers from your watch. It’s not a medical device I tell them. Might have to alter my wording soon.
It’s the optical HR sensors that have trouble. ECG is done electrically, not optically. That’s why you have to touch the bezel with your other hand and complete the electrical circuit. This is similar to traditional HR straps.
Current heart rate monitoring and ECG use completely different hardware. Heart rate measures light reflectivity changes induced by blood flowing through very fine veins while ECG measures small voltages between two different parts of your body (one wrist and the fingers on the opposite hand). In my opinion, ECG is actually simpler to do from a hardware standpoint. The reason is has not been implemented first is probably because of the relative inconvenience of having to place one hand on the watch to take a sample which in many cases will require interrupting what you are doing, whereas heart rate can be monitored continuously, even while you sleep, without you even being aware of it.
All smart watch vendors have difficulty providing reliable heart rate monitoring under all circumstances and for all skin conditions. I believe ECG has the potential of having less variability. The difficulty of ECG is that in order to get FDA approval, it has to meet very strict standards.
Sure Garmin (or another) could make a non medical approved health band which you wear on your other wrist or ankle to measure the differences real time continuously or samples every x minutes of testing to achieve the same results. Just need to remove the “noise” from the real data
Would be great if my 745 has the hardware necessary for this.
I have a 945. This feature coming to the Fenix 7 would mean an immediate upgrade for me.
Echoing what others are saying. If it’s no more accurate or useful than PulseOx, which is only useful to drain your battery at amazingly horrific rates, please Garmin, leave it off.
Other than for those who have a condition like Afib .. which is estimated to be about 0.51% of the population, I just don’t get the fascination with ECG on a watch. I have had on my Apple Watch for years and tried it once and never used it again.
I think that if I had a condition that required me to take an accurate ECG, I would probably invest in something that would be a bit more accurate than a watch.
Again, I know some have benefited from it, but for the vast majority, it really isn’t useful.
A higher number of folks see afib. Research is showing PAC to be occurring at a higher rate than previously thought. Folks are going to use these devices and seek diagnosis. The known population will jump. It’s already happening due to the Apple device.
There may only be a rate of 0.51% of, i presume, the general population, but in older athletes, older in both age and training years it is higher. I am 67 and have cycle trained/raced for over 30yrs and have at least 15 friends of similar profile who have this condition; luckily, i don’t
I’m embarrassed that I didn’t know what ECG was an acronym for.
Just a small point–the R wave doesn’t refer to the whole pretty graph but to a specific part of it. In the pics above, it’s the big upwards spike. In atrial fibrillation they’d be randomly spaced. As others point out this measured in a totally different way than the optical heart rate sensor. Theoretically for each R wave on the EKG you get one beat on the optical sensor (although perhaps not at exactly the same time). Agree that although it’s cool to be able to get an EKG on your wrist, the utility of this seems limited, especially for the more expensive watches geared towards healthy endurance athletes. More of a marketing and keep-up-with-Apple thing.
Thanks!
And yes, I agree that for the vast majority of the population (likely far in excess of 95%), this functionality has little practical day-to-day purpose except for fun geekery.
However, it was fascinating to see just how many people in the Fenix 7/Epix/Venu 2 reviews were upset that the device lacked ECG functionality. As always, there is a tiny segment of the population where this can be beneficial (and in fact, hugely beneficial) – but it is indeed small.
Ultimately, this is as you noted, a keeping up with the Joneses type situation.
Read the book “Haywire heart”! Endurance athletes, especially those who do ultramarathon, triathlon, biathlon and cycling have a higher chance of getting Afib when they are in their fifties (and older). I myself am an example of that.
My Afib started at 56, thanks to the OHR of my Garmin watch it was easy to spot (suddenly a very high stress level). But an ECG-function would have been nice then.
I think a lot people are complaining about no ECG on Garmin devices just because some of the competitors have it and Garmin not. They don´t know, if they will use it, but others have it and Garmin not… So they must have it. Just my 2cents.
That might be true if your population is the existing users of Garmin multisport watches. It also might be true that a small percentage of the overall population has AFib. But I would contend that a very large percentage of the general population has high blood pressure or other factors that mean they should be screened for AFib. Whether or not it’s a good idea to send a bunch of people to their doctors because their Garmin told them they have AFib is another question. Having more data is always a good thing in my mind and hopefully Garmin’s health division (in cooperation with Apple and others?) will be able to provide some useful insights into AFib or other conditions they might be able to detect.
I am not a doctor so don’t quote me on the medical details but the general idea is that I’m guessing the average age of Garmin users is getting older (especially for $1000+ watches) and even though they’re probably more healthy than the general population there are a lot more than 5% of them that are still susceptible to problems that hopefully will be detected by a Garmin someday soon.
And sorry for the long post but I do have a friend who was in excellent shape and had AFib, pretty much ignored it, and had a stroke that through a lot of luck, willpower, a rock to bang with, and a life flight in a helicopter doesn’t seem to have caused any lasting damage. So if you’re over 50 consider getting screened for it and pay attention to it if you are diagnosed with it.
It’s still really a one off use for most people.
And I question if that is really needed if people are even somewhat diligent about your health. You should be seeing a doctor for a check-up at least once a year, especially as you get older. And no, not due to being a worry wort, but just to make sure.
ECG is really not a one off for people like myself who suffer from A Fib. It’s the main reason I switched to an Apple Watch to be able to get timely ECGs at appropriate times.
It’s funny. I really want this feature now, even though for my usage it’s about as useful as sp02. That’s to see it’s utterly pointless in my case. 🤣
that poor guy who discovered this by accident and asked about it in the garmin venu forum is owed an apology there. he was absolutely crucified because he had no “proof”
It’s okay, I don’t take internet comments to heart! I did wish I had taken a picture but didn’t expect it to disappear an hour later when the watch auto updated. The internet is a cruel mistress! It’s just great the DC found the comment and took the time to investigate!!
Why can’t they release a HRV stat? Is the optical unreliable? I would rather have such instead of ECG. I’m able to perceive my PAC and PVC. I want data that is useful. I can guess at my HRV based on the day’s readings..
As an ECG novice, are there laws/incentives for Garmin to get FDA approval instead of just launching the feature “as-is” and improving it with software over time?
As far as I know, other metrics like cadence or swim stroke detection don’t require FDA approval. Is there something that makes ECG “more important” than these other metrics?
Apple & Withings ECG offerings have FDA approval so from a marketing standpoint they would either want to get the same certification or skip the feature entirely.
Since that type of measurement was traditionally performed in a medical setting consumers will naturally assume it has the relevance and accuracy of a medical test.
If nothing else, internally they want to keep their capability level as high as their competition even if they don’t immediately sell product with the capability. Like Apple, they have enough money to explore things and don’t especially require the outputs to immediately generate profits.
Well, you can’t die from an abnormal swim stroke. If you could, I’d be long since dead ::-). But seriously, I personally have some minor abnormalities in my ECG rhythm and it might be nice especially if I could upload or print something out to show my doc from time to time. Sort of a real-world stress test result.
Well, you can’t die from an abnormal swim stroke. If you could, I’d be long since dead ::-). But seriously, I personally have some minor abnormalities in my ECG rhythm and it might be nice especially if I could upload or print something out to show my doc from time to time. Sort of a real-world stress test result.
Hi, yes, Garmin cannot market this feature in the US without Pre-Market Approval (PMA) from the FDA. It’s called a 510k clearance (named after the submission form).
Apple actually got the clearance long before they enabled the functionality in the software in their Apple 4 watch. Their developers had a deadline to be able to announce it by the time their big product release show came around, and if you know Apple…
Funny thing about Apple, they hold patents in many spaces you wouldn’t think they would. Years ago I wrote up a utility patent on a ‘bike bus’ combining both battery and CAN-like data transfer (think Shimano DI2), but Apple actually beat me to filing (by mere months). Coincidentally I had also written up a patent back then for overlaying ANT+ data on video (think Virb) but never filed it.
Anyway Garmin, get your butts in gear and get this going!
I want my, I want my, I want my ECG . . . Any chance of Epix2 getting this?
Your official gateway to all Clinical Trials with these devices (Apple, Garmin): clinicaltrials.gov
Happy reading.
Any chance the other newer watches like the Epix have this built in also?
I hope this comes to the EPIX watch. It’s the single thing I miss about my Apple Watch 7 although as Ray mentioned in a review it is something you use lots at the start and then less and less.
I’m really glad you posted this. I’ve been debating which new watch to get, or if it’s even worth replacing my FR645M since there’s no added functionality that means anything to me. I’m no longer a runner and I have my Edge 1030+ for cycling. Anyway, this potential breakthrough feature is worth waiting for IMO so I’m going to stop obsessing about which watch to get and just wait to see what eventually comes next.
I think someone mentioned it but a-fib and endurance sports go hand in hand, especially as you age. I’ve been watching this functionality closely for years now, and waiting for Garmin to make progress. Why? Because I’m in their ecosystem, mainly, and because I have a-fib that first arrived on an epic bike ride.
Apple has many stories of viable a-fib detection. I don’t have an Apple watch, and it makes no sense for me to buy one. The other FDA-cleared (not “approved”) device I’m aware of is Kardia Mobile, with a steep monthly subscription. My last smartwatch was a Garmin and my next will be too – not that I love them to pieces…
Ultimately I want to track daily hydration, weight, BP, and hydration trends using Connect. I have Strava too but Connect blows its doors off, and I think it’s much better than the Apple, Google, Samsung, and Under Armour platforms. But I have a 5X and can upload none of those, despite being ConnectIQ and FIT savvy! It also lacks the Garmin Pay feature my Vivoactive 3 has, and on EU trips I really miss that. I mainly use my watch for kitesurfing and windsurfing, which the Fenix 7 says it has built-in, but price-wise only the regular Fenix 6 is coming into range for me… the 7’s not worth $700 to me, sorry.
I’ll wait with baited breath. Currently I track real-time HR (with a Polar HRM10) religiously and try hard to manage effort and hydration. Sometimes I feel like I’m in a-fib and have to ask my nurse wife to feel my chest and give me her opinion. I met her during my first cardioversion over a decade ago (and had three others since), so needless to say I’d rather have a device that I can double-check it with and not have her get freaked out, since on my last cardioversion my heart actually stopped for a short time.
So while I agree it’s a “me-too” feature in some folks’ view, it’s also highly anticipated for others.
BTW, I’ve compared the HR reading of Garmin’s optical sensor to the HRM-10 while getting an ECG on a 12-lead Siemens device, and the optical was way off – and it only gets worse as your effort level goes up.
Why? What is the purpose of this? What utility does it have?
My interest is primarily road cycling as a long-since retired Cat. 2 roadie. I’m on this page specifically because today my cardiologist suggested a smartwatch and having read DCRM for a long time knew I’d get honest discussion of tech stuff. I’m also retired from a heavily technical IT career that started before there was a WWW, so certainly not averse to this stuff. Currently I’ve very satisfied with a Garmin Edge 500. I like to get my money’s worth out of a product.
I know this is a bit old, but a couple comments got under my skin a bit and I wanted to address them, and that has to do with who would want ECG capabilities. And there were several comments I thought were kind of naive, I assume from younger readers (I’m 63).
I don’t think Garmin would be going to the trouble of trying to make this work simply for the bling factor, and I have no doubt some kind of study was also done to see if there was demand to make the investment worthwhile for them. That’s fundamental business stuff, and I’m an utter fool when it comes to business.
It only took a couple seconds of search engine love to find this article on WebMD titled: “Athletes Face Twice the Odds for A-Fib” which covers a study performed by the British Journal of Sports Medicine (7/2021) where they found:
~~~~~~~~~~~~~
“Athletes have a significantly greater likelihood of developing atrial fibrillation compared with non-athlete controls,” Jamie O’Driscoll, of the School of Psychology and Life Sciences at Canterbury Christ Church University in England, and colleagues reported.
“Younger aged athletes have a greater relative risk of atrial fibrillation compared with older athletes; however, exercise dose parameters, including training and competition history, as well as potential gender differences for the risk of atrial fibrillation requires future research,” the authors concluded in a journal news release.
The analysis also showed that athletes younger than 55 had about a four times higher risk of a-fib than those 55 and older. Those older athletes were 76% more likely to have the condition than non-athletes.
~~~~~~~~~~~~~
They also note that endurance athletes have a lesser chance of developing A-Fib.
The article concludes saying “studies have also suggested there is a point at which increasing levels of exercise are associated with heart issues, including a-fib.”
I think maybe the younger athletes are somewhat divorced from the world of older athletes (I know I used to be) but here’s evidence that being young and fit is not the panacea against heart disease some would think. Every race car driver knows his car and engine intimately. Every athlete should show the same concern for their heart and get checked up by a sports cardiologist (if you can find one…a sad story for another time). I can name a half dozen high level endurance athletes of “middle age” who dropped dead from undetected heart ailments. I’d start with a guy named Jim Fixx.
Afib detection is mainly geeky. Someone I know who is extremely prone to Afib wore a heart nonitor for a month and it picked up Afib once for a few minutes. That means the chance of a random check, even every day, detecting Afib is very small. If Afib is continuous it will likely lead to a stroke. I know someone that happened to. His speech was slurred, and he did not realize his injury. Maybe continuous Afib without any sign is rare or it is not. If it was common, cardiologists would be fitting their patients with continuous monitors a lot more often.
Given that Polar and now Garmin are now producing units that can record ECG data, has anyone looked at adding ECG data to FIT files?
I’m sure it can be done, but at least on the Apple Watch ECG has to be done while motionless. So putting it in a FIT file might be useful, but you’re not going to be able to record ECG while doing an activity.
I’m (currently) primarily interested in capturing ECG from the Polar H10 during workouts. E.g. for doing post-workout analysis of RR-interval artifacts.
Garmin controls the FIT SDK, so if they are looking at ECG, I’m hoping that ECG will show up in the FIT SDK.
Possibly if Garmin is looking at ECG they may also add it to their heart rate monitors (Dual, Pro etc).
🤞🤞🤞
link to the5krunner.com