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Garmin ECG Feature Is Now Live: Here’s how it works!

As of today, Garmin has released ECG functionality for the Venu 2 Plus watch, for users in the United States. This is Garmin’s first watch to have ECG, following both clinical trials, and subsequent FDA approval, which they were granted last week (more on all that down below). The on-watch ECG functionality will detect and classify atrial fibrillation (aka AFib), as well as a normal sinus rhythm.

On your Venu 2 Plus you can open the ECG app at any time, touch the bezel with your other hand’s fingers, and then wait about 30 seconds for the ECG to complete. After which you’ll get your results as well as the ability to save/export the report via the app, such as to send the PDF to a doctor.

Garmin is essentially the last major smartwatch maker to join the ECG fray. This follows Apple, Samsung, Fitbit, and others who have received FDA approval for their ECG app implementations. For the most part though, what you see on these devices is all very similar, largely owing to the process by which these devices are certified. Still, there are some differences, such as Apple having irregular rhythm notifications (albeit non-continual), whereas Garmin does not. Still, for those needing to do quick spot checks for ECG, this is a huge step forward.

Watch & User Requirements:

In order to get the ECG app working, you’ll need to have a Garmin Venu 2 Plus watch. Garmin has confirmed that that is currently the only in-market watch they have that has the hardware inside to perform ECGs. That hardware has essentially two major components: A wire connected to the bezel (inside the watch), and a connected (internally) metal ring (electrode) around the outside of the optical HR sensor. This is then further surrounded by an isolation/insulating ring between the metal sensor (electrode) and backplate. Those two components allow the watch to ‘complete the circuit’ when measuring an ECG, and currently only the Venu 2 Plus hardware has this.

While you cannot see the wire connected to the antenna internally, you can actually see the thin insulating strip around the outside of the electrode sensor on the Venu 2 Plus:

Now compared to that not being present on an Epix seen below (or any other watch, simply flip yours over):

The next bit is that you must be in the US, physically, when first activating the ECG app. This is due to regulatory requirements, and the onboarding process happens via your phone with Garmin Connect Mobile (Garmin’s smartphone companion app). During that process, it uses both GPS+WiFi to validate that you’re physically in the US. You can however do subsequent ECGs outside the US after completing your initial activation (more on this in a second).

Finally, you must have the latest version of Garmin Connect Mobile and the Venu 2 Plus firmware. These versions are:

Garmin Connect Mobile (iOS/Android): At least version 4.62
Garmin Venu 2 Plus Firmware: At least version 11.21

This Garmin Connect Mobile version went live this past weekend, as did the Garmin Venu 2 Plus firmware version. So if you haven’t upgraded yet, do that now. Finally, if you’re reading this in the seconds after I hit publish (at 7:00AM US Eastern Time), then Garmin also says there may be a very slight delay of an hour or so till the feature shows up as live for everyone.

Got it? Good, let’s get rolling.

How it works:

Garmin-ECG-Overview

First up is activating the ECG functionality on your (compatible) watch. That requires Garmin Connect Mobile (the smartphone app), to do initial activation. That’s because Garmin verifies you’re physically in the US using your phone’s GPS+WiFi signals. This activation is only required the first time, and any subsequent usage can occur outside the US.

If it’s part of the setup of a new watch, it’ll be one of the tasks you complete (akin to WiFi setup). Whereas if it’s for an existing watch you’ll get prodded to consider setting it up. From there, it’ll give you a quick overview of what an ECG is, and what it is not. For example, it does not detect heart attacks. This is part of the FDA approval terms because it’s considered an over-the-counter medical device. As such, the user must be able to figure out everything purely from the step-by-step device instructions. Meaning, it assumes a doctor/pharmacist didn’t talk to you at all. It also validates you’re 22 years of age or older.

You can also access this via the Devices menu, and confirm the existing setup steps that are present:

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Once that’s done, it’s activated on your watch.

You can now go onto your watch into the ‘Apps’ list. This is the same place you’d go to start a Run/Bike/etc. Scroll far enough and you’ll eventually see ECG in the list:

vlcsnap-2023-01-23-23h25m50s483 vlcsnap-2023-01-23-23h25m55s506

Then, rest your arm and wrist on a table, and place your other thumb and index finger on the metal ring/bezel. Do ensure whatever wrist you set up in Garmin Connect Mobile is the same wrist you’re wearing it on here.

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Finally, the ECG starts and you’ll wait 30 seconds. As you wait you’ll see the waveform displayed in real-time, as well as your heart rate and a count-down. If you move too much or otherwise do something unexplainable, it’ll prompt a failure message.

vlcsnap-2023-01-23-23h26m49s365

Once it’s done, you’ll immediately get your result. This happens entirely locally to the watch, and there is no connectivity required at this time. Within the results you can scroll left/right along the waveform, as well as select any symptoms you might have had.

vlcsnap-2023-01-23-23h26m57s981

These logged symptoms and full results are then saved with that specific ECG result to both the watch as well as Garmin Connect (mobile and platform):

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Meanwhile, back on Garmin Connect Mobile, you can see the full results of your ECG (and historical ones), as well as export out a PDF of the ECG to give to a doctor (or, you know, social media). Here’s an example of a PDF export:

PDF-ExportResult

And it’s as simple as that. In fact, by design, it’s supposed to be simple. That’s somewhat the entire purpose of this being a regulated over-the-counter medical device, it’s supposed to be hard (if not impossible) to screw up. Speaking of which, let’s quickly dive into some FDA bits.

Clinical Trials, FDA Approval, Other Regions:

It’s worthwhile to take a brief detour to touch on the clinical trials and FDA approval for the ECG App. You may remember about a year ago I detailed out where Garmin stood on clinical trials for their ECG app. The cool part about this is that all of it’s public. The tests, the facilities involved, user counts, and even test protocol. Of course, that assumes said company files all of this under their actual company name. Garmin being Garmin, they did. Apple? Less so – using shell companies to hide that Apple was actually working on it. Of course, Apple was first on the market in the watch form factor, so hiding their work was important from a competitive side.

Without getting too into the weeds, Garmin 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. As such, in order to account for these participants dropping out in later phases of the study, you sometimes have to increase the number as time goes on. You’d expect to see some increase between the projected number and the final number. Next month, the FDA will publish Garmin’s full summary, which will give us even more details in a final report form.

The key thing to understand though is that Garmin isn’t certifying the Venu 2 Plus as a medical device. Rather, they’re certifying the “ECG App” running atop the Venu 2 Plus, and specifically, they’re proving to the FDA that it was “substantially equivalent” to an existing FDA-cleared device. In this specific case, Garmin was proving substantial equivalence to Apple’s implementation.

Within that, Garmin is only focused on ECG performance. So things like PulseOx (SpO2 sensing), or heart rate during sport, or sleep detection, or any other Garmin health feature – those aren’t being vetted here. It’s purely the ECG feature and specifically within that the detection and classification of atrial fibrillation and a normal sinus rhythm. That’s it.

To do that, Garmin had to basically pass three separate bars/chunks:

1) Clinical Performance: Looking at their clinical trial data, did it meet the FDA’s threshold?
2) Human Factors: Can a normal everyday human with no preexisting knowledge use the device properly using just the instructions shown in the app and on-device. Given it’s an over-the-counter device, this is important.
3) Technical Performance: Does the algorithm meet various requirements for thermal safety, electromagnetic interference, arrhythmia performance, and more.

This entire process, from an official clinical trials standpoint, started all the way back in April 2021 (nearly two years ago). Of course, that’s just when they submitted their first formal paperwork that’s public, not when the engineering and preparations started. All of this concluded about 10 days ago when Garmin received their final FDA approval:

Garmin-USFDAApproval

And even though Garmin only received this approval 10 days ago, they’ve been ready for quite some time to hit the ‘Go’ button on toggling this to live for users. This is akin to what we actually saw from both Fitbit and Apple, who received approval and then lit it up for users within days of that approval happening.

Going Forward:

vlcsnap-2023-01-23-23h24m14s137

Which of course brings us to the next logical question – what do the timelines look like for other countries? Well, that’s messier. Garmin’s official statement is as follows:

“Garmin intends to continue to expand its portfolio of products supporting the ECG App and launch it in new regions in-line with necessary regulatory approval.”

Now, where it goes from here is substantially more complex. Some countries will take the FDA clearance more or less as-is, allowing for relatively rapid transfer and approval. However, others require starting much of that paperwork process again.

For example, I asked whether or not there were plans for Europe/EU and Garmin would only confirm that there “is a plan”, but couldn’t say anything more specific. They did however note that a new EU regulation that came into effect in 2021 marked a pretty significant shift in the certification approach, making it more thorough than previous, and also extending the timelines too. Here’s a quick article that explains the differences and impacts. Obviously, I’d expect Garmin is already quite a ways into that process, but it’s still…well…a process (just as it was for Apple, Samsung, and others).

The good news though is that like Apple and others, this doesn’t stop Garmin from releasing new watches with ECG hardware, that’s simply turned on by region as approval happens. And that’s also true of the Venu 2 Plus. Someday down the road if/when Garmin gets EU (or any other country) approval, toggling that region on is a relatively trivial affair for watches that have the right hardware already.

As for future hardware, I’d expect there will be a baseline point sometime this year when essentially all future Garmin watches from a given price level have ECG. After all, it’s on relatively inexpensive competitor devices from both Fitbit and Samsung. And even the Venu 2 Plus itself is only at the lower end of the mid-range Garmin pricing these days, with far more expensive units above it that would certainly be logical candidates for ECG inclusion in new hardware variants.

With that, thanks for reading!

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117 Comments

  1. CHris

    Ray, isn’t the strip in quesiton is the one surrounding the HR sensor? It would be logical for the piece that makes the reading, be in deep contact with the skin? (and the color of the metal used VENU actually suggest that is the case.)

    • That’s the piece they confirmed in the call I had. 🤷

    • Chris

      I figured that out. Seeing what is happening in Garmin forum I am not surprised. This part looks more like an “isolation” between the ECG part and the rest of the back cover. I may be wrong here, but I am just wondering. Thanks for the response :)

    • Ok, got confirmation that indeed that was the isolation ring. The same net impact in terms of “other watches don’t have it, thus how you can easily tell” sort of thing, but wanted to get more clarification there.

    • Jesper

      You really ought to edit/augment the YT video. These days, I’m too lazy to read all this, so I just watch the vid from the couch. And it still tell the opposite story about the ring… That precious ring…

    • Sadly, there’s no method to edit YT videos after the fact (short of removing entire sections). Again, in some areas, I can only go with what I’m told. We had a call, discussed the ring in-depth, and everything.

      I wish i could edit it, obviously. I edited the post here the second I had confirmation/correction from Gamrin.

      At the end of the day though, the end-resultant is no different – without that ring on another Garmin watch, there’s no connectivity happening.

  2. Jared

    Thankfully I have no practical use for this but it’s pretty crazy this will not be coming to the current iterations of the Marq/Epix/Fenix and it’s on the Venu. Particularly since the Marq Gen 2 just launched in October.

    • Ryan M.

      I’m not shocked. Can’t imagine they would want to go through adding the hardware to all devices until the FDA approval came through.

    • DaveS

      I’m surprised. They knew they were working on it and would likely get it. Doesn’t sound like the hw change was super expensive. Cost something? Yes. But would have been great for the epix and other new models to be capable. I think it’s a miss unfortunately.

    • Ryan M.

      I just don’t know if garmin is in the position to make hardware changes that cost something on the premise of likely getting approval. While it might be a selling point going forward, it’s not generating any extra revenue on the devices they sold.

    • Dave Cochrane

      You may be surprised. My Dad was a little unwell over Xmas and after I put my Apple Watch on him and ran the ECG app, it confirmed he was in AF (atrial fibrillation). My wife is a doctor, and confirmed the trace from the PDF. Dad spent the following day in the hospital having a series of tests and is now on blood thinners – we may have headed off a stroke.

    • spinnekopje

      Nice story, but also without ecg app on the apple watch your dad would have been going to hospital and probably had the same tests..
      While it would be nice to have such a feature, I won’t rely on it for deciding whether or not to go to hospital.

    • Dave

      No, he wouldn’t. My wife’s a consultant anaesthetist and said that had I not decided on a whim to check his pulse and then ECG after he was dizzy from standing up at the table (hardly unusual, but he’s in his 80s and I live on the other side of the planet from him and want him to stick around) then it probably wouldn’t have been diagnosed until he had a significant TIA or a full stroke. She suspected he had probably had AF for a while, as is common in many patients who later present with other issues. I actually wrote to Apple about it, and got a very nice email back from Tim Cook (or whoever he has writing these replies)! What you do or don’t do is entirely up to you.

    • Kai

      A couple days before New Year I noticed a strangely high heartbeat and feeling odd after a workout. My Apple Watch also diagnosed AFib.
      I went to the ER immediately since my doctor was on holiday and the diagnosis unfortunately was correct.

      I spend two days in hospital for tests and treatment. Eventually, they managed to correct the arrhythmic heartbeat via drugs.

      But the AFib might come back and require further treatment, for that reason I’m happy to have ECG on my Venu 2 Plus since its my daily driver.

    • Will

      Great story, wishing your Dad well. I’m on the opposite side of the globe to my Dad and I know how you feel.

    • Dave

      Thanks Will. The guilt never really goes away, does it?

    • TJ

      Quite impressed, that from the other side of the planet, you were able to place your Apple Watch on him. Apple really has surpassed itself…
      Quite sad to hear of his condition, and a little disappointed that without the watch, you wouldn’t have taken him to hospital, particularly as your wife had an inkling.
      As someone, who is also a London based Anaesthetist, I would have taken his pulse, and quickly noted his irregular rhythm. all with two fingers, that cost me nought. 😳😉

    • Dave

      Amazingly enough, she wasn’t in the room at the time – and as you know, many people get a bit dizzy when they stand up a little too quickly. Not really sure what you’re hoping to achieve with the snide comment; NHS grinding you down a bit too much? 111 were very helpful and we had him in the next morning for what turned out to be a long day of a full ECG, bloods and a chest film.

    • TJ

      Just wanted to know how you put your Apple Watch on him, from the other side of the world.

    • Craig

      What a great time to be alive with these types of advancements.

    • Neil Jones

      @TJ – I think most readers are probably using common sense to infer that he was with his father at Christmas, despite him normally living on the other side of the world. It certainly only took me a couple of seconds to come to that conclusion rather than feel the need to publicly call him out.

    • Mike

      Watches are full of “gimicky” features. This is one that could actually save lives. Based on your posts, you clearly know little to nothing about a-fib, but thanks for sharing your valuable insights.

  3. Si Adams

    Thanks so for me it will have to wait until my next Watch purchase but for an idiot like me is there a reason they cannot achieve this with any of their watches in conjunction with one of their chest straps?

  4. John (Resident Troll)

    FDA hand out approvals very quick nowadays,

  5. Belmont

    I’d be interested to see if this ever comes to the Instinct. Presumably, they would need a redesign to incorporate the metal components.

  6. Edwin

    They should have added it to their HRM or BPM products. Watches are replaced every few years and will need to be recertified around the world so more expensive to users. Plus one more thing that can break or cause a leak. An ECG on their BPM would encourage more sales of Garmin products. I actually delayed buying the BPM because it didn’t have ECG/EKG yet.

    • Sam J

      The point is that they have certified the software, NOT the hardware. The same software running on different hardware will not require recertification.

    • Edwin

      Latest leaks suggest FR 265 and 965 will be $150 more than the 255 and 955. The pics do show a new metal contact on the back so ECG will raise prices. I already don’t have a need for music and will have to think hard about whether a $700 FR 965 makes sense. Hopefully, the 955 is not phased out and a BPM with ECG is eventually released.

    • TJ

      The irony though, is all that one has to do, is take your own pulse. If it’s beating irregularly, which is obvious, it’s highly likely that you have a conduction issue, and should see a doctor.

  7. Fred

    They should now make ECG app work using Garmin HRM chest straps.

    I believe an HRM is better for that single lead ECG reading than watch finger touching. Because in laboratory tests the electrodes are attached to the chest.

    • Duncan Tindall

      “Garmin has confirmed that that is currently the only in-market WATCH they have that has the hardware inside to perform ECGs.” And as noted above in article and comments then it’s the app that’s certified not the watch…..

      As such I suspect that there is nothing above that says that in 3 months (or less) you’d not be able to do this on any watch able to use the latest IQ store apps, if you have a HRM-pro. With the assumption that anyone with a top end watch and interested in ECG would be highly likely to be in the same sample of population as having a HRM-pro strap. Or at least be willing to buy one if ECG is important.

      Be interested if @Ray can correct any errors in my statement above, noting that of course that wouldn’t confirm they were or are doing that, just that there’s nothing technically or legally stopping that outcome.

      Frustration is I’ve a 1 week trip to the US in 2 weeks time, so would be awesome if they could get this out by then so I can activate before returning to NZ when this may get approved sometime late 2056.

    • Paul S.

      I read somewhere that an actually useful ECG requires 3 electrodes. (That’s why you have to touch the crown of an Apple Watch in order to take an ECG.). The HRM-Pro (I have one) seems to have only 2 electrodes.

      If you have the kind of heart problem that requires you to take regular ECG measurements, you probably already have some kind of medical grade device to do that. I put my HRM-Pro on before doing an activity, you can’t take an ECG during the activity, and I take it off soon afterwards. The window of time for me to take an ECG with an HRM-Pro would be pretty small. (And I’ve had an Apple Watch that can take ECG’s for years, and I rarely do it.) So I’d guess the market for an HRM-Pro that can take an ECG is pretty small, and I doubt Garmin would be interested.

    • Yeah, chest ECG is funky territory. I need to do some digging there to see what the FDA-certified landscape looks like for chest ECG.

      For example, there’s Frontier as a chest strap, and they often tout ECG – but they aren’t FDA (or EU) certified. And, even if it is scientifically accurate (and could stand up to clinical trials), it’s not clear to me what’s different hardware-wise between that and something like a general HRM strap from Garmin.

      And then there’s the Polar straps, to which Polar has also touted ECG and validity in a study (which, to be clear, is not clinical trials). But in that case, that was about doctors using the data, not about a consumer using the data (thus, the doctor understands it). link to polar.com

    • e HALL

      FF works. Was able to show cardiologist HR drops on long rides that never happened on lab stress tests. Bradycardia only happened after about 60 min at or near FTP. Pacemaker solves.

  8. J

    Very disappointing to see that top premium models are left out. So much that I would return the epix watch in exchange for something else..

    • JR

      This is a pretty gimmicky feature. It has no training or general health utility, and it’s not something that you need to track on a daily basis. I suppose the best use case is that everyone plays with it once, and some very small percentage of people who wouldn’t have gotten a cardiac screening otherwise learn that they have afib. But if you’re getting regular physicals, you’re going to know if you have afib.

    • Ryan M.

      Why?

      Besides not buying a product based on a promise of a feature to arrive later, there has never been anything saying that x watch was going to receive ECG functionality. I used it on my AW7 when I wore that, but only because it was there.

  9. Stephen Smith

    While disappointing that it didn’t come to Garmin’s premium watches this generation, I’d argue that a Kardia 6L device is excellent if you are worried about strange heart rhythms. Their ecosystem will allow you to send an EKG strip to a licensed cardiologist for review for a nominal fee. With Covid having caused many strange heart issues, having a cardiologist interpret things is probably the smartest path you can take to not fall into the Dr. Google pit.

    • Koen

      Mostly agree on this, I was having some very sporadic short burst of irregular heartrhythm issues. Since there was no possibility to simply trigger these with various tests in hospital, the cardiologist actually suggested to buy a Kardia 6L and then send him the EKG strip via pdf once I was able to capture one.
      After many months, I finally was able to capture one; which then confirmed the cardiologists initial diagnosis.
      Now the “mostly agree” part is regarding the actual use of this Kardia 6L. Since my bursts were only very short most of the time (<30sec's), I had trouble to take an EKG the first 2 times since it already stopped once I had my phone/Kardia out and connected.
      For this scenario, a very quick measurement option, like just touching the watch would have really helped me to maybe capture an earlier event. Furthermore, I typically don't run with a phone so this was also somewhat annoying to take the Kardia and phone with me all the time. Now that I have a diagnosis I no longer worry about it. However until the capture succeeded, I could see a major advantage if it would have been available on my Epix2 as well.

  10. Bill M

    The HRM chest traps use the very electrical signal that the ECG function uses, would be a very nice way to add this feature to current devices which don’t have the ECG hardware on board.

  11. Andy

    Isn’t the blueish thingy arrow is pointing most likely an insulating ring?

  12. Thanks for the review and update. Pretty cool the things that they are making available to help. If I ever have known heart issues, this may make the case of getting 1 Garmin over another.

    • Benedikt

      They are only catching up to their main competitor in the lifestyle watch market: Apple.
      Nothing new or innovative here.

  13. Testy

    So, if you are outside the EU you could, on theory, use an app such as Private Location on Android, to lead the watch to believe you are in the US? Once you do that you can continue using the ECG

  14. Matej

    Will you comapare measurement to Aplle and Samsung wtches and maybe others too?

  15. Toronto Runner

    Great video too bad it’s only on the Venu 2 Plus!! TBH don’t see a lot of use for ECG anyways!! BUT … I was hoping with the updated Garmin Connect app would be an overhauled Physio Trueup. That’s the big feature that I think many would be excited for and was introduced in the Fenix Alpha before the holidays with HRV syncing. I am waiting for the day that I can wear a Vivosmart 5 during the day on my right wrist and a regular watch on my left wrist and do activities with my 955 and have it all sync beautifully to give an accurate training readiness score in the morning!!!

    Any update Ray??

  16. Felicia

    My Venu 2 plus upgraded to the latest software version, and then I walked thru the setup in the mobile app, did my first ECG.
    I agree it is kind of gimicky, and I’m surprised/not surprised that it is on the Venu 2 plus as opposed to any of the other high end watches. It feels like it is directly motivated by trying to be an Apple Watch competitor/repacement. I don’t have an iPhone, so and Apple Watch has never been an option for me (but I’m the kind of person who would definitely have one if I did have an iPhone), so I’m pretty excited and happy with this and the Venu 2 plus overall.

  17. fieldwalker

    Based on what you’ve show here, it will show a heart attack and other cardiac issues that appear on the ECG.

    It’s giving quite nice looking rhythm strip and depending on your level of ECG interpretation you’d be able to do anything with it you can do with a regular rhythm strip.

    Read a book on ECGs and you can have good insight on interpretation yourself.

    • TJ

      It’s not able to asses for a myocardial infarction, as that require at least a 5 lead ecg, with reference, negative and positive electrodes. The important electrodes in a 5 or 12 lead, is the leads (place of electrode)placement, adjacent to the walls of the heart, in particular the anterior, posterior and lateral aspects.

  18. Elliott

    Thanks DC! Pulled my Venu 2 Plus off the shelf today to get this setup here in the USA – worked without a hitch. Question – since you know a lot more about Garmin devices and seem to have some better connection to them than us mere mortals, ha – do you know if they have any plans to continue the Venu 2 Plus ability experience by opening up the HRV Status on this watch? Having the new ECG feature plus the HRV Status, which is available on virtually all over v4 sensor Garmin watches, would make for a much more complete experience.

  19. Indy Jonze

    ah garmin. we were just complaining in the V2+ review a few weeks ago how it’s outrageous that it doesn’t have HRV status and how that feature would probably never come to the watch as garmin seemingly treats this line with disdain, and WHAM! ECG for you (but STILL no HRV). lol you have to laugh…

    • Elliott

      Great minds think alike… This is exactly what I was asking about above. Did not know if DC had any insight on this issue or not.

    • Indy Jonze

      what happened here is that the ECG feature was already in the watch and they were just waiting for FCC blessing. so theoretically it was ready to go when this thing came out last january. software and hardware were already in the watch and it was just hidden (and discovered by a user in the garmin forum by mistake back in march). HRV status is something completely different and would require brand new investment from their engineering team to develop. if i’ve learned anything over the years about garmin, this is not going to happen. i hope i’m wrong, but i doubt it

    • inSyt

      HRV status will just require a copy and paste from Epix 2 code.

    • Ryan M.

      If it were as simple as copy/pasting code then the bugs in the Beta firmware for the 955 just getting features from Fenix wouldn’t exist.

  20. DocDan

    Well, trying to enable the new ECG feature on my Venu 2 Plus this evening ultimately resulted in the watch hard-resetting itself and now it won’t pair with my iPhone 13 Pro (iOS 16.3). Just wonderful… I guess if I wanted a seamless experience, I should have bought an Apple Watch instead. It’s a good thing that Garmin doesn’t make medical equipment.

    As an aside, from that ECG trace you’d be able to see arrhythmias other than just Afib… you’d just need to know what they look like, since I imagine the watch/app won’t perform automated interpretation of them.

  21. Alan

    Thanks for the update. I happen to have a Venu2 plus but live in New Zealand. It won’t let me update because it says NZ isn’t covered. Do you happen to have any info on when it will be available in other countries?

    • Michael Reich

      Hi I am in Australia and managed to get it work the Android GPS spoofing app Location Manager. Requires you to access advance settings and temporarily chsnge two settings. This is explained by the App.

  22. Barry Atlas

    To add to the 2 presumed Docs mentioning this, it appears this is a rhythm strip. Qualified personnel can interpret this, not just for A Fib, but for any other abnormal rhythms, extra or dropped heart beats , significant lack of oxygen to the heart (precursor to or actual heart attack), etc etc. Pretty cool!

  23. TeresaM

    UK – Can do this with the Withings ScanWatch, found it very useful. Alerted me to one AFib event.
    I have an irregular heartbeat, getting ECG readings on my Venu 2 Plus would be great.

  24. Paul

    As someone in the EU is it possible to trick my garmin to thinking it’s a US watch so I can access this feature now?

    • Kai-Uwe Markeli

      On an Android Device it is possible to acctivate the ECG App in Europe. I just did it for mine in Germany:

      Clear cache and data of Garmin Connect app.

      Changed location in my Garmin Profile to US via the Garmin website.

      Enabled VPN and set location to USA.

      Enabled fake GPS and set it to USA as well.

      Opened Garmin Connect and logged in.

      Tapped the watch and added the ECG option.

  25. Ray, just in case if it matters for privacy: the PDF export screenshot shows date of birth in the upper right corner.

  26. I recently had an AF episode. I discovered that my older non-ECG-app-capable Garmin watch can actually show AF as high stress in the Stress app. Because the stress app records rapid variations in heart rate it shows very high-stress levels when AF is present because the watch thinks the HR is bouncing up and down. After I had the cardioversion treatment my stress levels immediately went back to normal blue.

    • Merten

      Hi Chris,
      I can confirm your observation. I had the same observations and verified them with a mobile device with three electrodes called “KardiaMobile 6L”
      Regards, Merten

    • Michael Reich

      Hmm I am puzzled. I thought low HRV was a sign of depression and stress. One would naively think that large variations in heart rate would indicate low stress. Maybe the standard relationship is only applicable to those who do not normally have any AF related instability?

      Paradoxically my lowest stress measurements over the last year corresponded to the first couple of days of Covid. Go figure.

  27. Stm

    Some may write it off as a gimmick. My Apple Watch ecg actually discovered that I was getting frequent heart PVCs, like 10+ per minute. As an active 40 something, this was news to me. After exporting and showing my watch ecgs to my Dr, I went in for a full work up and my Dr confirmed the problem and am now getting treatment.

  28. Mile

    A lot of trolls saying this is an unnecessary feature and challenging those who claim they discovered they had a-fib thanks to their apple watch. Those trolls likely have no first hand experience and decide if they don’t need it then nobody does.

    Reality is that there are many people who suffer from a-fib who do not “feel” it and are unaware they have it or when it occurs. This puts those individuals, of all ages, at risk of stroke.

    Unlike most features on smart watches, this is one that can actually save lives.

    It is sad that Garmin did not equip their latest, high end models to support this.

    • TJ

      I am one of those you have remarked on, and just because we have an opinion that differs from yours, does not place us in the trolls category. I have a medical degree, and 7 years of anaesthetic training, and 18 years of practice as a consultant anaesthetist, so yes, I am qualified to talk on this subject. I also, fortnightly, in private, work with a cardiologist, who performs AF ablation, to treat said condition.
      Sadly few people who have AF are unaware of it, as the irregular heart beat, also gives you the feeling of palpitations.
      This feature, whether on an Apple Watch, or any other device, is no different to placing two fingers on your pulse. AF is categorised by an irregular heart beat, whereby the atrial impulse is irregular and chaotic, and causes the turbulence to blood flow, which can result in a stroke. If you were exercising with AF, you’d know it.

  29. Peter

    I’ve been using Withings ECG feature in the EU for a few years now. I have suffered several heart attacks despite being an endurance athlete, so my cardiologist recommended it to me for peace of mind. That said, the utility of a single-point ECG is somewhat questionable at this moment.

    Here’s why I say it: If you have a history of heart issues, as I do, you are HYPER SENSITIVE to how you are feeling. I would not need a watch to tell me I’m having problems. And they won’t indicate if you having a myocardial infarction, i.e. heart attack. Just A-fib, which may or may not be a problem. Most anecdotal stories have the victim feeling “not right.” You don’t need a watch to tell you that — what it could do, I guess, is give you a better reason to get your a** to the emergency room, which is hardly nothing.

    This article sums up the relatively current thinking: link to nytimes.com

    My overall take is that this is a steppingstone technology to where smartwatches might be able to detect other health issues. Not sure exactly what those could be, but I guess more tech is better than less — and I wouldn’t tell anyone NOT to get an ECG-enabled watch, but just to be very clear on what they can an cannot do.

  30. Michael Reich

    The ECG function has clarified an issue that I have had with the optical HRM.

    I have had atrial fibrillation for several years, and I am due for a second ablation in a months time. My resting heart rate has signs of bradycardia typically below 50 despite my lack of overall fitness (i stopped doing 10k steps when I caught Covid for the first time 6 weeks ago).

    Where this gets more interesting is when I wear the watch in the shower. I am aware of the Venu’s IP rating for swimming. I notice in the shower that my HR often becomes irregular with readings below 40 bpm for up to a minute or two and then returns to 70 or 80 bpm. This happens more often than not.

    Interestingly, the ECG function surprisingly works well in the shower, showing clean QRS signals. When switching to the ECG setting during one of these apparent plunges in HR, the ECG showed no plunge but regular 80 bpm pulses.
    This morning, I belatedly took my old Vivoactive 4 watch and put it on my other wrist. Needless to say, it didn’t show the plunge while my Venu2 plus did!

    I know this is flagging a particularly marginal case, but it does suggest that Venu2 plus HRM does have issues which may contribute to some unreliability when sweating during vigorous exercise.

    As my cardiologist said, these devices are two edge swords. They can be useful on occasions to alert for unusual low or high HR but also can unnecessarily provoke anxiety for neurotic individuals like myself.

    However in the past, I have used the Kardia device to record an episode of AF . The recordings when read by my cardiologist suggested bigeminy AF and allowed her to dispense with the requirement for 48 hour Houlter monitoring, which may or may not pick up an episode.

    Finally, a bit of feedback to Garmin. As a retired physicist who has experience in signal processing, a possible suspect for the abnormally low heart rate measurements may be aliasing of the signal. Maybe a little more low pass filtering is required? Hopefully this tradeoff will not drastically reduce the responsivety to changes in HR during exercise.

    • TJ

      One difference between the measurement of heart rate through the optical sensor, and ecg through the conductive mechanism, is that the sensor is simply picking up blood flow to the extremity, whereas the ecg is picking up the electrical current emitted from the heart’s impulses.

      In healthcare, we sometimes see (critically ill) patients with something called electro-mechanical disassociation. Electromechanical dissociation implies organised electrical depolarisation of the heart without synchronous myocardial fibre shortening and, therefore, without cardiac output.

  31. Roger Harper

    The D2 Air X10 has the same hardware as the Venu 2 Plus (exactly the same layout on the bottom of mine as shown on your Venu 2 plus images, and the exact same bezel), could you ask your contacts at Garmin if this will get the ECG app too?

  32. DocDan

    I finally got the ECG feature up and running on my Venu 2 Plus. Essentially I had to start from scratch, in that my watch had reset itself so it needed to be set up from an “out of the box” state, and I also had to create a new a Garmin Connect account.

    Basically, as others have mentioned, the ECG feature is a single lead ECG rhythm strip. That can be useful to diagnose arrhythmias, e.g. Afib, PVCs, SVTs, and heart blocks. You’d also see self-limiting runs of Vtach if you happened to catch it at the precise moment they occurred. For that matter, you’d see sustained Vfib/Vtach, but of course you’d be down and in need of CPR and defibrillation, so you wouldn’t be able to operate the watch. ;) Not useful for ischemic ST-T changes per se, although you may possibly see some gross morphological changes during an MI, such as so-called “tombstone” T waves.

    The utility of all of this depends on the wearer of the watch. For a young healthy individual, it’s probably more of a novelty, although clearly anyone can exhibit arrhythmias. For those individuals with heart conditions, it certainly can provide some measure of assurance or serve as an early detector of an arrhythmia, especially for paroxysmal events, e.g. going into Afib for five minutes with some vague symptoms constitutional symptoms and then retuning to sinus rhythm.

    That’s my professional assessment, being an attending anesthesiologist for 20+ years at a teaching institution. For those who think this level of ECG functionality is useless, the solution is simple: don’t use it.

  33. BWG

    Any idea whether the ECG function will be added to the Venu 2S? I thought it had the same sensors as the 2 Plus. In fact, on their website it is basically treated as the same product differentiate only by screen size.

    link to garmin.com

  34. steve jerry

    Curious, I had thought venu was on a fall update cycle, and expected to see Venu 3 this past fall. Instead, we get the ECG feature on the Venu + plus.

    Do you believe they are still on a fall cycle and their will be a Venu 3, or are added features, such as this, what is the ‘3’ model, and nothing more till the fall?

  35. L.S.

    Hallo DC Rainmaker,
    ich lese eure Berichte immer sehr gern. Hut ab, das ihr euch immer so damit beschäftigt. Was mir aber extrem unter den Nägeln brennt, wann kommt denn nun endlich mal die Venu 3 oder 3 plus. Es sickert ja absolut nix seitens garmin durch. Habe gedacht das sie gleich nach der forerunner 265 und 965 noch eine neue Venu bringen.

    • L.S.

      Noch etwas fällt mir ein! Könnte es nicht sein das die venu 2 plus deswegen den sensor mit dem metallring um den sensor hat weil sie einen lautsprecher besitzt und dieser eben bei allen anderen auch höherpreisigen modellen fehlt? Vielleicht können doch noch andere modelle in zukunft ekg( epix 2, fenix 7,…)

    • Thanks!

      Unfortunately, Garmin has confirmed those units don’t have the required hardware in it, either from a wiring standpoint, or the isolation ring.

    • L.S.

      Ok! Wissen sie schon was zwecks garmin venu 3 oder 3plus? Grüsse

    • wazza

      “Thanks!

      Unfortunately, Garmin has confirmed those units don’t have the required hardware in it, either from a wiring standpoint, or the isolation ring.”

      wonderful posts
      You must be getting tired of this topic. In AU I have found some retailers are saying that the fenix PRO 7 and Epix PRO gen 2( BUT NOT THE NON PRO versions !!) HAVE the hardware ( a new system without the ring ???) and will be capable of ECG “in the future with software upgrade AND after approval by the relevant authority…… Is it possible that GArmin is using a market to test the waters??? In this case the ASIAN/ AU market ( as we are out of Singapore). As you would expect Garmin pay no attention to my queries……… Also in AU HuwaEI ARE saying that their H WATCH 10 has the hardware for for ECG but they are not allowed to distribute the software until approved by ATAGI , the AU FDA……
      To be honest I would get the Venue 2 plus IF it had mapping……. but it doesnt…..mmmhh

      …………… cheers

    • This post was originally written months before the Epix/Fenix 7 Pro variants came out.

      Those Pro units use a new sensor package, which does include an isolation ring. At this time, Garmin has not rolled out any ECG features on those watches to production (or public beta). The ring on the Epix Pro/Fenix 7 Pro is very easily visible around the outside of the sensor before the lip of the metal back.

      The thing with ECG is that it does require that regulatory approval, at least, if you want to avoid regulatory fiasco’s. I would expect FDA first (US), followed by CE (EU). Given Garmin hasn’t unlocked CE yet for the Venu 2 Plus, I wouldn’t expect other markets till that is done.

      Some markets will essentially take an FDA/CE approval letter and just copy/paste it into their local regulatory approvals. But not all.

    • Mike

      I would not give much credence to anything a retailer states. I will hold of on upgrading my current Epix until Garmin has this functioning, not just announced.

      I also have a Huwei pro. It requires a bit of setup hacking, but ecg is working on that in the USA and does a nice job.

  36. honeybadger

    FR955 Solar user here

    As you said, 965 combines the best of both worlds. For me, if I wanna upgrade it or not comes down to battery life only. I honestly value battery life much higher than fancy screen and there are also benefits in the MIP display as it has been extensively discussed both here and in the yt in depth video comments

    So, it boils down to 1 question for me. How does solar enhanced battery life compare to 965?

    I do 10-13 workous per week, 4 of them being running outside with full GPS on. HR is on in all my workouts, and I’m charging only once either prior or after my long run on Sundays depending on the week which is really the sweet spot for me
    I image many multi-athletes fall in the same category so that would be a really interesting scenario to test!!

    As always, TY so much for your valuable reviews!

  37. Lynn Dettinger

    Hi,
    a few questions regarding Venu 2: Atrial fib and atrial flutter are different but does the ECG work for Atrial flutter?
    Venu2 doesn’t seem to include heart rate variability? Is that correct? If so, why not?
    Last question: Is the stress, sleep, recovery data accurate if I am not also recording calorie and hydration intake?

    thanks,
    Lynn

  38. Alex

    So, anyone managed to use ECG app in Europe (using iPhone), please?

  39. Kirk M Walter

    Ray – love your content. As an a 60+ cyclist who has occasionally experienced tachycardia during intense rides (usually also very negative in form during those events), I like the idea on onboard ECG via a Garmin watch. I’m not opposed to rolling with a Venue 2, but I’m curious as to your best guess when Garmin might roll out other ECG capable watches. Thanks!

  40. Kevin D.

    A friend has the Apple watch and his Doctor is happy for him to submit his ECG data via Email ( this is in the UK )
    On the topic of heart health, I’m in my mid 70’s and have been a runner for 40+ years. It seems that over the recent years so many of the people I know with a long history of endurance sport, and particularly running, are now experiencing various heart related health issues and a couple of them have recently passed away due to heart problems. Of course, this may be survivorship bias due them living longer, but it has got me pondering.

  41. Carmine

    Yes Kevin D, I have been cycling for many years hoping that helps with keeping well and now find my self on beta blockers for atrial fib.

    A question DCR, I just purchased a 7x Pro which I use as my cycle computer as well. Given beta blockers are so pervasive for us in the more progressed age groups do you have any info if Garmin or others are going or planning to address this in their analytics. I know that I have already had to adjust my HR zones to compensate. Not sure how beta blockers affects other sensors.

  42. KaiM4k

    Hi, thanks for letting us know, that ECG is finally available for the Fenix 7 Pro.

    I can report, that it works for me in Germany following these steps for Android:

    My Garmin Account was still (from Venu 2 Plus times) set to US. You want to change your account to US before you begin. I just turned of Wifi on my Smartphone, revoked exact location for Garmin Connect, fired up a US VPN connection, and set a location in the USA via a fake location app (activate fake location app in developer settings)
    After that, I was able to activate ECG like Ray showed it. Don’t forget to turn fake location of and exact location for Connect on again when you are set up.

    I hope I could help some guys with that.

  43. kris

    Sorry Ray,

    This one was your downfall for me .. I’m locked into a stupid 2-step verification with account now after putting this junk on my watch.. I’ll read many, many, many comments before I listen from this point forward..

  44. Marian Aylmore

    Hello I’m looking for inline skating on this watch so that I can sync with Strava. Is this possible please? Have only been able to select cycling then change to Inline skating in the Strava app.

  45. Kenneth Moore

    Thanks as always Ray. Great content.

    Does anyone know if it’s possible to take an EGC reading while doing another activity?

    Let’s say you are doing an activity (run, bike, hike, whatever) and you want to stop and do a quick EGC just to see how things are going. Is this possible without stopping your activity?

    I notice you’re asked to “sit comfortably” before the ECG, so perhaps this is an intentional UI design decision to prevent bad readings while people are exercising.

  46. MIchael

    Bought one of these off Amazon, everything works or appears to work fine except for the ECG, constantly getting inconclusive. Tech support had us reload and update send pictures and videos still nothing they had us do fixed the inconclusive problem. Seem’s like a nice device. Going to see if Amazon will swap it out.

  47. okrunner

    Ray,
    Any word if Garmin will implement irregular heart beat detection similar to Fitbit and Apple? My doctor has recommended an Apple watch to monitor any irregular heart beats. I don’t have Afib but have some PAC arrhythmia. I would rather not go outside the Garmin ecosystem. My only other option seems to be to get a Fitbit Charge 6 and wear it along with my Garmin Fenix. Any other suggestions or knowledge of when or if Garmin will implement this. From my reading, Garmin clearly has the ability and hardware to do so but has not enabled it. Thanks for any help.

    • FrankB

      Hi Okrunner

      I am in Oz and did the workaround which you can google to get access to it.

    • okrunner

      FrankB
      Can you explain? Not sure what workaround you are referring to or how to find it.

    • Alex Mlawsky

      I too would be interested in the work around.

    • JKB

      I try to find an answer for exactly the same question. I want to stay in the Garmin Ecosystem.

      But the Apple Watch has the ability to warn about suspicious HR and ECG can confirm any abnormalities like AFib.

      Would be very interested if Fenix 7 Pro can detect Abnormal HR during sleep without ECG and prompt to perform ECG?

      Thanks for Help

    • No passive abnormal detection at all on Garmin currently.

      I believe the ‘workaround’ portion of the FrankB message above is simply referring to the general ECG access workaround on Garmin devices if outside the US. Cheers!

    • okrunner

      Thanks for the clarification, Ray. I went ahead with a Fitbit Charge 6 and wearing it with my Garmin Fenix. Takes a little getting used to but you are no stranger to wearing more than one device at a time. The Fitbit was on sale on Amazon for $139, so certainly the cheapest option for passive detection. Had it about four weeks and no alerts, so all seems good. Manual ECG’s are fine as well. I have a 6 lead Kardia Mobile that is more detailed and accurate than the Fitbit for a manual ECG. What ever was going on with my heart in February and early March seems to have stopped. As usual, the doctors cannot explain or diagnose, which is SOOO comforting. They gave me a complete release and have trained and ridden a couple 100 mile gravel races since and didn’t die. So that’s good. My personal opinion was it felt like COVID again, like I had in 2021, but two tests showed negative.
      Any chance Garmin will enable passive detection in the future? Has this come up in any discussions with them?

    • JKb

      I sent an E-mail to Garmin but the answer also didn’t really help:

      Our fenix 7 pro and the epix pro offers an abnormal heart rate alert. You would need to preform an ECG test intentionally as the device will not prompt you with the alert.

    • okrunner

      Yes. I agree that is not helpful as they are just referring to the high and low heart rate alarms which is very different from passive afib detection. Hopefully Ray can ask the right person over there in Overland Park and find out.

    • Yeah, generally speaking, they’re pretty thin with details on the medical device realm. Given passive Afib detection would fall into that, they won’t say much of anything till it’s certified.

      (And yes, that is indeed very different than just abnormal HR alerts high/low, which they’ve had for a long time.)

    • okrunner

      Ray,
      Thanks for the reply. I really appreciate your attentiveness to blog posts and responses. Here’s to hoping Garmin adds this some time.