How to use the Irregular Heart Rhythm notification feature on Apple Watch

irregular heart rhythm notification on Apple Watch

Apple Watch is a great device for monitoring your health and fitness. With alerts, notifications, and the ECG app, your watch can provide you with important information concerning your heart health.

The Apple Watch has two heart rate features that can help to detect irregular heart rate rhythms. The ECG App and the Irregular Rhythm notification feature.

The Irregular Rhythm notification feature checks your heart rhythms and sends a notification if an irregular heart rhythm is detected. This feature is available to all Apple Watch users with a Series 1 or later in over 100 countries!

The ECG app is specific to the Apple Watch Series 4, Series 5, and Series 6 and allows you to perform ECG tests using your apple watch. The electrocardiogram (ECG) app is disabled on the SE.

With the ECG app, you can take an ECG recording at any time or following an irregular heart rhythm notification. 

An ECG, short for an electrocardiogram, is a way of measuring the timings and strength of electrical signals that make up your heartbeat. Your doctor can identify problems in your heart’s rhythm and any irregularities by reading an ECG.

What is the Apple Irregular Heart Rate Rhythm feature used for? sample of an irregular heart rhythm using Apple Watch ECG app

The irregular heart rate feature on the Apple Watch checks for unusually high or low heart rates and uneven heartbeats. Times when your heart is out of its normal and usual rhythm. 

You may experience no symptoms, or you might feel like your heart is racing or slowing down, skips a beat, adds a beat, or flutters between beats. 

These could be signs of a serious underlying condition like atrial fibrillation (Afib) or another heart issue.

While this feature helps identify irregularities in your heart rate, it is not a diagnostic tool or a substitute for medical care. If you receive a notification, it’s a call to action to further discuss with your doctor or healthcare provider. 

When is an irregular heart rate rhythm notification produced?

If your heart rhythm fluctuates from your norm and your heart beats too fast or too slow while sedentary (you appear to have been inactive for 10 minutes), you receive a notification.

  • You receive an alert when an irregular heart rate is found five times (or more) within 48 hours.
  • If five out of six sequential readings are classified as irregular within a 48-hour period, you are notified of the potential irregular rhythm. 
  • If two readings are classified as not irregular before the threshold is reached, the cycle is reset, and the collection of readings returns to the baseline rate of every two hours.

How often does the irregular rhythm notification look for an irregular rhythm? man wearing Apple Watch

The irregular heart rate rhythm notification feature does not constantly look for an irregular heart rate. 

Additionally, your Apple Watch only looks for irregular rhythms at rest; it does not look for abnormalities during exercise. This means the number of readings collected each day and the time between these readings vary depending on how active you are that day. 

Because your watch isn’t constantly monitoring your heart rhythm, it cannot detect all instances of irregular heart rhythm.

Who should use the irregular rhythm notification feature?

This feature is also only recommended for users 22 years and older with no prior history of AFib.  

The FDA has granted De Novo classification (classified as a low- to moderate-risk device ) for these users.

How do I use the Irregular Rhythm notification feature?

Before using the irregular notification feature, you need to:

  • Complete the onboarding in the Health app on your paired iPhone to learn how to use this feature and receive education regarding AFib. 
  • Make sure that notifications are available in your country or region. 
  • Update your iPhone to the latest version of iOS and Apple Watch to the latest version of watchOS.

To enable irregular notifications:

  1. On your iPhone, open the Health app.
  2. Tap the Browse tab and choose the Heart category. Heart information in iPhone's Health app
  3. Then toggle on Irregular Rhythm under Heart Rate Notifications. iPhone Health app irregular heart rhythm

Once you turn on this notfication, you can choose to turn irregular rhythm notifications on or off in the Apple Watch app on your iPhone or your watch in the Settings app. 

  1. Open the Apple Watch app and tap the My Watch tab or go to your watch’s Settings app.
  2. Choose Heart. Heart rate notifications in Apple Watch Settings app
  3. Choose Irregular Rhythm and toggle it on or off. irregular heart rhythm notification on Apple Watch
  4. Scroll down further to adjust your threshold bpm (beats per minute) for High and Low heart rate notifications. Tap each to adjust if required. High and Low heart rate notifications settings on Apple Watch

View all your heart rate notifications, along with the date, time, and heart rate, in the Health app on your iPhone. 

What should I do when I receive an Irregular Rhythm Notification on my Apple Watch? irregular heart rate and rhythm notification on Apple Watch

It can be scary when your Apple Watch sends you irregular rhythm notifications. However, when you see a notification or alert, it does not automatically mean you have Afib or another heart condition.

Let your doctor or healthcare team know that you have received this notification from your watch and follow it up with them.

If you are experiencing chest pain or a medical emergency, please get in touch with emergency services immediately. 

Wearables, like the Apple Watch, play a supportive role in maintaining and managing your health. They are not a substitute for medical care.  

How do I view my irregular rhythm notification data?

You can view a list of the irregular rhythm notifications in the Health app on your iPhone.

  1. Open the Health app on iPhone.
  2. Tap the Browse tab > Heart.
  3. Scroll down and tap Irregular rhythm notification. find your previous notifications for irregular heart rhythm in Apple Health app
  4. Tap Show All Data to see your historical data. Show all recorded data for Apple Watch irregular heart rate notifications

Irregular Rhythm notifications not working or not available?

  • Check if your country and your Apple Watch model support this feature.  Learn what countries currently support irregular rhythm notifications.
  • If your Apple Watch was set up using Family Setup, your watch does not allow access to irregular heart rhythm notifications and these other health features: ECG, Cycle Tracking, Sleep, and Blood Oxygen (Sp02.)
  • Make sure Location Services is turned on in your paired iPhone’s Privacy settings and that ‘Health’ is turned on under Location Services.

How do I install and set up the ECG App?

If you receive an irregular heart rhythm notification, it’s a good idea to take an ECG with your Apple Watch to get a closer look. 

Not all Apple Watches include this feature–find this app on Series 4 and above, excluding the SE or any Apple Watch set up with family setup.

The ECG app is installed when you first set up the ECG app in the Health app. It’s important to note that the ECG app isn’t available in every country or region–check if it’s available in your region here.

Follow these steps to set up the ECG app:

  1. Open the Health app on your iPhone and follow the onscreen steps. If you don’t see a prompt to set up, tap the Browse tab > Heart > Electrocardiograms (ECG)–you only find this one Apple Watches that support ECG.
  2. Choose Set Up ECG App. Set up ECG app in iPhone Health App for use on Apple Watch
  3. Follow the on-screen steps to complete the setup.

After you complete the setup, open the ECG app on your Apple Watch and take an ECG by holding your finger against the watch’s digital crown (you don’t need to push the button.) place finger on Apple Watch digital crown to get an ECG recording

If you don’t see the app on your Apple Watch

  1. Open the Watch App on your iPhone. 
  2. Scroll down and tap Heart. 
  3. Look for the ECG section and tap Install to install the ECG app. Apple Watch iPhone Watch app install ECG app

If you don’t see the INSTALL button, see this article: Is your Apple Watch ECG App Missing? Here is how to get it back.

How do I take an ECG? take an ECG using Apple Watch

You may want to take an ECG if you’re feeling symptoms such as a rapid or skipped heartbeat or when you receive an irregular rhythm notification.

The ECG app records your heartbeat and its rhythm using your watch’s electrical heart sensor.

To take an ECG on your Apple Watch, you need to:

  1. Make sure that your Apple Watch is snug and on the wrist.
  2. Open the ECG app on your Apple Watch. ECG app on Apple Watch home screen
  3. Rest your arms on a table or in your lap. 
  4. With the hand opposite your watch, hold your finger on the Digital Crown. You don’t need to press the Digital Crown during the session. 
  5. Wait. The recording takes 30 seconds, and you see a countdown on your watch.
  6. At the end of the recording, you receive a classification. EGG app classification following taking an ECG on Apple watch
  7. Tap Add Symptoms and choose your symptoms. ECG symptom checker on Apple Watch
  8. Select Save to note any symptoms.
  9. Tap Done.

How do I view my ECG readings or share them with my doctor or health provider?

You can find the irregular rhythm data and ECG readings in the Health app on your iPhone.

  1. Open the Health app on your iPhone.
  2. Tap the Browse tab at the bottom of the screen—select Heart.
  3. Find Electrocardiogram (ECG) and tap the ECG reading you wish to view.
  4. Scroll down for more information.
  5. To share with your doctor, healthcare provider, or caregiver, tap Export a PDF for Your Doctor.ECG details in Apple Health app from Apple Watch ECG app

If you’re using iOS 15+, you can also share data with your healthcare provider using the new Sharing tab in Apple Health. Apple Health app share health data with doctor

This health sharing feature only works for doctors and providers that are part of Apple’s Health Records and Sharing.

If your doctor or healthcare provider is not part of Apple’s Health Records and Sharing yet, you can still export your health data as a spreadsheet or take screenshots of the particular health data you want to share.

To export Apple Health data as a spreadsheet:

  1. Open the Health app and choose the Summary tab at the bottom. Apple Health Summary and account profile
  2. Tap on your initial or photo on the top right.
  3. Then scroll down to the bottom and choose Export All Health Data. Apple exports the data as an XML file.Apple Health app export all health data to a spreadsheet

How do I set up high and low heart rate notifications?

If your heart rate remains above or below a chosen beats per minute (BPM) while you appear to have been inactive for a period of 10 minutes, your Apple Watch can notify you.

These notifications are available only on Apple Watch Series 1 or later for ages 13 and up.

You can turn on heart rate notifications when you first open the Heart Rate app on your Apple Watch or at any time later from your iPhone:

To turn on high and low heart rate notifications on your Apple Watch, you need to:

  1. Open the Apple Watch app on your iPhone and select the My Watch tab or choose Settings on Apple Watch.
  2. Choose Heart. high and low heart rate settings on Apple Watch
  3. Tap High Heart Rate, then choose a threshold BPM. Tap Low Heart Rate, then choose a threshold BPM. thresholds for high and low heart rate on Apple Watch

Can I turn off irregular heart rhythm notifications without impacting other heart monitoring or vise-versa?

Yes, you can turn off the Irregular Rhythm notification without having to turn off notifications for High and Low Heart rates. 

Similarly, you can turn off high or low notifications (or both) without impacting irregular heart rhythm.

There is a separate on/off setting for each of these heart rate monitoring features.

How Apple Watch measures your heart rate and irregular heart rhythm rate

The optical heart sensor in Apple Watch uses what is known as photoplethysmography (PPG). Apple Watch uses green LED lights paired with light-sensitive photodiodes to detect the amount of blood flowing through your wrist at any given moment. 

By flashing its LED lights hundreds of times per second, Apple Watch can calculate your heart rate. The optical heart sensor supports a range of 30–210 beats per minute. 

The optical heart sensor can also use infrared light. This mode is what Apple Watch uses when it measures your heart rate in the background and generates irregular heart rhythm notifications. 

How does the irregular rhythm notification feature identify irregular rhythms? 

PPG signals combined with an algorithm are used to identify an irregular pulse suggestive of Afib ( available with OS 5.1.2 or later, Apple Watch Series 1 and later).

Which models of Apple watch have the ECG App?

Apple Watch Series 4 and above supports ECG. However, the ECG app is not supported on Apple Watch SE and is disabled on any Apple Watch that doesn’t pair with its own iPhone and is set up via Apple’s family setup.

How does the ECG App generate an ECG?

It uses a PPG-based algorithm and electrical heart sensor that enables the generation and analysis of an ECG when combined with the ECG app.

The ECG app can generate an electrocardiogram (ECG) and classify the rhythm as sinus rhythm (normal rhythm), Afib, high or low heart rate, or inconclusive.

How accurate is Apple’s irregular rhythm notification feature?

The Apple Heart Study (2017) of 419,297 participants aged over 22 years found a high correlation between irregular pulse-detection on Apple Watch and simultaneous irregular readings recorded with an electrocardiography patch. 

Each participant in the study had an Apple Watch (series 1, 2, or 3) and an iPhone. The most recent Apple Watch, which features a built-in ECG, wasn’t part of the study. 

Key findings from the study include:

  • Only 0.5 percent of participants received irregular pulse notifications.
  • Comparisons between irregular pulse detection on Apple Watch and simultaneous electrocardiography patch recordings showed the pulse detection algorithm has a 71 percent positive predictive value. 
  • Eighty-four percent of the time, participants who received irregular pulse notifications were found to be in atrial fibrillation at the time of the notification. 
  • One-third of the participants who received irregular pulse notifications and followed up by an ECG patch over a week later were found to have atrial fibrillation. 

In the study Accuracy of Apple Watch for Detection of Atrial Fibrillation by Dhruv et al. (2020) of 50 patients who had undergone cardiac surgery, the overall agreement between Apple watches 4 notification and telemetry was 61%.

The Apple watch series 4 notification correctly identified AF in 34 of 90 instances, giving a sensitivity of 41%, but an inconclusive rhythm was found in 31% of patients.

This study recommends that physicians exercise caution before taking action based on electrocardiographic diagnoses generated by this wrist-worn monitor. 

The patients in this study were known to have Afib, and the Apple watch irregular heart rate feature is not recommended for use for people with known Afib.   

How accurate is Apple’s ECG App? 

In 2018, Apple sponsored a two-part, multicenter clinical validation study to validate the ability of the ECG app to generate an ECG waveform similar to a Lead I ECG from a standard 12-Lead ECG and classify heart rhythms as either sinus rhythm or Afib. 

Apple tested the app on nearly 600 people, half of whom had atrial fibrillation and half who did not. 

When this study group used the watch, the result was inconclusive about 12% of the time. 

However, the rest of the time, the app was able to tell people accurately they did not have a-fib 99.6% of the time and accurately told them they did have a-fib 98% of the time, according to the study.

Summary

Apple Watch has two optional features that detect irregular heart rhythms: the Irregular Rhythm Notification Feature (available on Apple Watch Series 1 and later) and the ECG app (available on Apple Watch Series 4, Series 5, and Series 6).

The Irregular Rhythm Notification Feature opportunistically collects heart rhythm readings in the background and notifies you of the presence of an irregular heart rhythm. 

The ECG app allows you to generate an ECG reading whenever you wish and allows you to share the data with your doctor.

Overall, The Apple watch ECG App, and irregular heart rate feature provide acceptable reliability when generating an ECG and identifying Atrial fibrillation and other clinically relevant arrhythmias. 

I hope this article has helped you understand and access your Apple watch’s irregular heart rate rhythm feature and ECG App.

If you have any more questions or anything to add, please feel free to let us and everyone else know about it in the comments section down below!

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I have a first-class honors Physiotherapy degree and a second class honors Sports Science degree. I am also a certified Yoga teacher and Yoga therapist. Before completing my University education in the United Kingdom, I worked as a fitness instructor and athletics coach for many years. Since 2008 I have been practicing in the UK as a Chartered Physiotherapist, and traveling to European and World Cup tournaments with the Wales Masters field hockey team as their physiotherapist. I am passionate and actively involved in health and fitness and in the process of research and writing. I believe everyone should have access to the latest health and wellness research in simple, easy to understand language. In 2009 I published a research article ‘Is Yoga An Effective Treatment for Low Back Pain’ in the International Journal of Yoga Therapy. Currently, I am a freelance writer producing content relating to physiotherapy and health and wellness. I love anything animal! I have three rescued dogs and two parrots. I placed third lady in my city’s annual marathon (dressed as a bunny!) to raise funds for an animal welfare charity.

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