New Apple Watch 4 for 2018 Rumors and Facts

Apparently you just touch the face of the watch while the app is running and it takes its measurements between the face and the watch back.

Not exactly. The circuit is not the watch face but the top of the crown button and the connection under the watch. The ECG monitor is the equivalent of ONLY the "Lead 1" in a clinical EKG system. Lead 1 is the connections between the upper arm or shoulders, left and right. The clinical EKG uses 3 Lead configuration where a third connection is the left leg and even up to 12 measurements with additional leads to the chest. The AW4 will only measure 1. But that one is adequate to let you know if there is a problem, just that one absent the others can't diagnose what the problem is.

Note that a "Lead" in an ECG is not how many wires, but how many circuits are monitored. It takes a minimum of 2 wires to monitor each circuit of "Lead" Also, some wires can contain a + and - dual connection such as in a pacemaker lead so electrically it functions like 2 wires of a clinical EKG.
 
It is indeed the crown. I was confusing what it should be with what it is and that should be something with a relatively large surface area (something the crown cannot provide) according to the books. Cornell University did considerable research on what constitutes good dry-skin contact and the result was that a relatively large electrode reduces the noise factor.

I wonder what happens if they get rid of the crown (something there has been much discussion about).

The point is that the ECG that the watch features isn't particularly exciting other than measuring (with relatively high noise) a path between your right hand and your left wrist (or vice versa). Exercise equipment uses a similar technique to measure heart rate.

I've had couple of EKGs and neither of them included electrodes on arms or hands. Then again, I'm not a 1%er (the percentage of people that are statistically likely to have AFib)... yet.
 
I don't know what the statistical pattern is that predisposes people to have AFib. But for a lay person, that is not something to bank on.

As for the crown, it has been modified in the AW4 to eliminate the push button switch. It now is only a capacitive touch switch and a rotating dial with heptactic feedback. The one thing I would never do is make a claim that I know better how to innovate these devices than Apple. They have often proved the "experts" wrong on what they can do. There was a time after the first AW0 was introduced that making a watch that small could never include a self contained cell phone yet AW3 proved them wrong.

I often said I didn't know how Apple would ever do an ECG because of the electrode placement. Yet they took an occam's razor approach and brought the right finger across to the watch and completed the circuit. Brilliant! As for noise reduction- that technology has been around for a decade now. I think this device system to work they already addressed that issue.

As for your EKG that didn't include Lead 1. It is likely you just didn't understand the purpose of the leads the tech connected. Lead one just has to measure across the upper chest. When I had mine on Tuesday, the tech connected it on the upper breast muscle just below the collar bone. When I had my surgery in June, they connected Lead one across the back over my shoulder blades. An EKG can have as many as 12 circuits depending on what they are looking for. The main thing for lead 1 circuit is to measure across the heart in the upper chest. It can include the arms and wrist and hands. I do agree it seems likely the signal quality would drop with dry skin. You might recall the tech used gel on the electrodes for a better connection. AW4 and other consumer devices don't use that.
 
I'm hoping to get a copy of my ECG on Tuesday and look forward to comparing it to the AW4. But I understand it won't be active until later in the year so my next scheduled ECG will be in December so maybe have to wait.

As for 98% accurate, I would need to know as compared to what standard. For my interest, I'm just happy there is a way to detect a problem that I can then call the doctor and have it checked out. That's how everyone should view these things. If I were a cardiologist, I'm sure I would be using it the same way. When I was a teenager nobody could read a BP except a trained medical Professional. When I went to Corpsman school in the Army it took the class lots of practice to read a BP with a pressure gauge and a stethoscope. I was not perfect but fair at reading it as I just never had much practice. Today, I have a Qardio cuff that works with the iphone app and I can get very accurate BP every time as compared to my 4 physicals a year by a nurse and my cardiologist. Technology is great! It's why we are living longer if we heed the warnings.
 
I don't know what the statistical pattern is that predisposes people to have AFib. But for a lay person, that is not something to bank on.
There's no formula for predisposition, just a percentage for how many are thought to be afflicted. Like X-rays and other diagnostic tools in the hands of a lay person, a little knowledge can be dangerous and may lead to faulty self-diagnosis.
I think this device system to work they already addressed that issue.
Believing that Apple can consistently thwart the laws of physics is dangerous. They may bend them, but they cannot break them.
I do agree it seems likely the signal quality would drop with dry skin. You might recall the tech used gel on the electrodes for a better connection. AW4 and other consumer devices don't use that.
The Cornell study was pretty specific about what's involved and Apple has been working with them but that doesn't change the results of the study. I liken this to the $30 endoscopes that you can buy online. You're saving a lot of money on hardware but that certainly doesn't prepare you to interpret the results of what you see.
 
I think too many are overthinking this ECG on the AW4. It is NOT for a diagnosis, it is at most a possible early warning device but more likely, just another tool to take to the doctor with your concerns. I talked to my cardiologist and he thinks it is a fine tool even if not refined or accurate enough in and of itself.
 
I think too many are overthinking this ECG on the AW4. It is NOT for a diagnosis, it is at most a possible early warning device but more likely, just another tool to take to the doctor with your concerns. I talked to my cardiologist and he thinks it is a fine tool even if not refined or accurate enough in and of itself.

Agreed. Only downside is for the hypochondriac, who will see stuff that isn't there. :)

Meanwhile, I am really looking forward to this new watch. Not running the beta software on my AW3, so the new WatchOS looks very nice. Ready to have a bit different watch face, which for me is always focused on activity and accountability.
 
A couple years ago my cardiologist was using old fashion BP measurements. I finally questioned the art of BP vs the electronic for accuracy. He started documenting my log on the iphone that used the Qardio BP cuff after a year they updated and now all BP is using a medical electronic device same as used in the hospitals. They finally recognized that data collection consistency was more important than relying on art, skill, and experience but continuing to accept without question wide discrepancies in the BP data.

While I don't believe the AW4 ECG is a device that will compete with medical devices, I think as more people begin to use health monitoring in their wearables, more lives will be saved and life spans will increase. Self diagnosis is a fools game, but a warning by a standardized device will receive more respect than a temporary dizzy spell, momentary blackout, or even a small pain in the chest.
 
Been reading up on the new AW4 health monitors. There are some cardiologists who worry that too many young people will be developing hypochondria over false positives as a result of the availability of the AW4 capability. Other cardiologists see the AW4 features as a good thing for two reasons. 1. it will benefit mostly older folks who can have AFIB and bradycardia and not know it until they suffer a stroke. There are no symptoms of AFIB in most cases. Even 30 day cardiac monitors often miss the time when AFIB occurs as so many patients may only suffer 3-4 times a year. All too often the first sign a patient has AFIB is after they suffer a stroke. 2. The false positives could trigger many unnecessary calls to the ER by people receiving the warning and not knowing what to do.

Test data for the FDA approval was found as follows:
Apple Watch wants to monitor your heart’s health — and cardiologists say it could make you worry instead

Apple submitted to the FDA a study that included 588 individuals, according to an agency spokesperson. The ECG feature positively identified 98.3% of individuals with atrial fibrillation, and correctly identified 99.6% of the individuals that didn’t have atrial fibrillation, the spokesperson said; about nine out of 10 of the ECG recordings could be interpreted by a cardiologist.

Results for the other watch feature found that of 226 participants for whom the watch indicated irregular rhythm, about 41.6% were determined, when tracked for an average of six days, to have atrial fibrillation as measured by an ambulatory cardiac monitor. When atrial-fibrillation notifications were seen on the watch during the monitoring period, the proportion of individuals who had the same reading on the cardiac monitor was 78.9%, according to the FDA.
 
There are some cardiologists who worry that too many young people will be developing hypochondria over false positives as a result of the availability of the AW4 capability.
As the article that I linked to suggested, while they trotted out a principal of the AHA at the announcement, perhaps the AHA isn't entirely on board with the whole of Apple's offering.

My first boss diagnosed himself with heart problems as he often had chest pains but just before he died, he found out it was esophageal cancer as a result of acid reflux. With the proliferation of medical information and diagnostic tools that have become available in the last few years, the average person (and many above average persons) still aren't all that good at self-diagnosis. The key, as you've noted, is to work with your doctor and provide them with all the information you can.
 
You know, even doctors can make mistakes in diagnosis. Personal story-

For a year I was suffering from dizzy spells that hit me once or twice a month. It got to the point I stopped driving by choice. Then one day I was working in Savannah shooting testimonials for an infomercial for a chiropractor and I blacked out for about 5 seconds. An hour later it happened again. The doctor said that's it, I'm calling 911 and we're done here. My assistant took care of the camera equipment as the ambulance rushed me to the ER. They did all sorts of tests for the next 24 hours and released me finding nothing wrong. They referred me to a neurologist. He did an EEG and prescribed a medication for epilepsy. I went back for several visits and he still came to the same conclusion and assumed that since I had no more dizziness spells the drug was working. Then I had another blackout 5 months after the Savannah incident and 4 months on his epilepsy medication. I reported it to him and he said: well, then, go see a cardiologist. I did, took the stress tests and other tests. Told me I was in perfect heart health. Said my stamina was that of a 25 yr old Marine profile. That was in my cave diving days so I was indeed very fit. Cardiologist said to stay on the epilepsy meds and start taking fish oil daily. In September I suffered a cardiac arrest and my wife was the first responder who saved my life. Finally, the doctors in the hospital figured out my atrial node that makes the heart beat was intermittent and would just stop at times. They also did a heart cath and said I would be a candidate for bypass surgery in 5-10 years and recommended I should do it now rather than after a major heart attack in my 60's. So bypass surgery and an ICD pacemaker and I am back in business. Oh, the epilepsy drug was determined a mistaken diagnosis of the EEG by 3 other neurologists in the hospital. Later my original neurologist was sued by several patients for the same thing and lost his license. He died a few months after that of a heart attack. Karma?
 
If only our Manufacturer had provided better diagnostic reporting…
I think a bigger part of the problem lies with our diagnosticians. That said, a good ophthalmologist can tell you if you've got arterial problems by looking at the veins in your eyes before they show up on most diagnostics.

Then again, my home blood pressure cuff (sphygmomanometer) seems to be much more consistent than the wrist band versions that they use at the clinic.
 
Those wrist band cuffs were never that accurate. I have one here and it frequently registers "error" A real time waster. I've only seen the commercial forearm ones in drug stores.

my home blood pressure cuff (sphygmomanometer) seems to be much more consistent
I haven't seen one of those since corpsman school in the Army back in the 60's. It was a big deal when they replaced the mercury column with an actual pressure gauge. :)
 
I downloaded the new software to my Watch last night. I decided not to wear a external heart rate monitor and use only the Watch sensors. To my surprise I had very similar cals burned and heart rate with same workouts with the external. I looked at the graphs and saw very few drop outs with tennis and strength training. It was nice going the whole day without wearing chest strap. I’ll give it a week or so and view the results and see how they compare. Something has changed how the optical heart rate sensor works now with the update. I will cancel my AW4 if things hold up as is.
I do notice now with the update I’m down to around 50% battery compared to around 75% before update with 12 hours use.
 

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