AI system
- System
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Apple Watch ECG app (single lead-I recording; its rhythm classifier is not mentioned in the report)
- Model
-
Not assessed
- Release
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Not assessed
- Application developer
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Apple - Role
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Not assessed
- Configuration
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Not assessed
- Inputs and outputs
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Not assessed
- Autonomy
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Not assessed
- Workflow
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A wearer who records a watch ECG right after exercise and looks at the waveform, not only the rhythm label. A cardiologist willing to investigate a watch trace in an asymptomatic patient. Exercise testing, CT, angiography and perfusion imaging to confirm and grade the disease.
- Human oversight
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Not assessed
- Relation to AI
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The watch recorded a 30-second lead-I trace at the wearer's initiative. The report gives no classification result from the app. The negative T-wave was noticed by the patient and interpreted by cardiologists, who ordered the exercise test, imaging and surgery. No machine-learning output contributed to the finding as described. The single source is an independent peer-reviewed case report. No maker material was used.
- AI contribution
-
The watch recorded a 30-second lead-I trace at the wearer's initiative. The report gives no classification result from the app. The negative T-wave was noticed by the patient and interpreted by cardiologists, who ordered the exercise test, imaging and surgery. No machine-learning output contributed to the finding as described. The single source is an independent peer-reviewed case report. No maker material was used.
Benefits
- Outcome identifiers
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Not assessed
- Benefit
-
he received four bypass grafts; recovery was uneventful
- Category
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Improved Physical Health
- Status
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Not assessed
- Beneficiary groups
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People.
- Beneficiaries
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Not assessed
- Reach
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Not assessed
- Distribution and access
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Not assessed
- Duration
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Not assessed
- Expected?
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No
- Costs and harms
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Not assessed
Measurement
- Studies
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Not assessed
- Study design
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Not assessed
- Measurement
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Not assessed
- Setting and sample
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Not assessed
- Measures
-
he received four bypass grafts; recovery was uneventful
- Comparison
-
the cardiologist's resting 12-lead ECG and physical examination
- Results
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Reference: A standard ECG was completely normal, as was physical examination. Result: he noticed immediately after exercise, a negative T-wave that became more prominent in ∼7 min, then slowly returned back to a normal positive T-wave after 22 min.
- Additional value from AI
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Not assessed
- Limitations
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Not assessed
- Denominators
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Not assessed
- Materials for replication
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Not assessed
Money
- Kind of value
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Not assessed
- Amount
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Not assessed
- Currency and prices
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Not assessed
- Period and unit
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Not assessed
- Realization
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Not assessed
- Recipients and payers
-
Not assessed
- Gross or net
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Not assessed
- Included costs
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Not assessed
- Comparison
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Not assessed
- Method
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Not assessed
- Return and payback
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Not assessed
People and places
- Participants
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Developer:
Apple. - Jurisdictions
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Benefit: Amsterdam, the
Netherlands. Developer: 
United States. - Ownership and control
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Not assessed
- Dependencies
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Not assessed
- Cross-border connections
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Not assessed
- Geopolitical implications
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Not assessed
Follow-up
- Conditions for replication
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The lead-I trace reproduces T-wave changes faithfully, which the authors say appeared accurate though frequency characteristics are undocumented. Ischemia that shows in lead I, which the authors call not ideal for the purpose. Tolerance of false positives and investigation cascades, which the authors flag as unstudied.
- Replication attempts
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Not assessed
- Later findings
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The paper's own 11-week postoperative exercise ECG (normal) is part of the first report; nothing published later about the patient was found.
- Availability
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Not assessed
- Institutional decision
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Not assessed
- Grounds
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Not assessed
- Action and result
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Not assessed
- Success criterion
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Not assessed
Evidence
- Source numbers
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AIBD-0301-source-0001–0004
- Citations
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Numbered references below.
- Language
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Not assessed
- Source relationships
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Independent
- Original evidence
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Not assessed
- Access and versions
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Not assessed
- Supported findings
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Not assessed
- Evidence links
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Not assessed
- Evidence strength
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Not assessed
- Missing evidence
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Not assessed
Grades
- Assessed benefits
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People.
- Depth
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People: 3.
- Reasons
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People: Silent, extensive, reversible ischemia from three-vessel disease was found and treated with quadruple bypass in an asymptomatic man. The authors' learning point is that such ischemia can end in exercise-induced sudden death. The counterfactual is not established.
- Observed or intended
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Not assessed
- Rubric
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Not assessed
- Assessor and date
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Not assessed
- Alternative assessments
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Not assessed
- Fill
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Independently studied
Entry details
- Kind
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Not assessed
- Related entries
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Not assessed
- Field
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Healthcare (cardiology). Consumer wearables.
- Purpose
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The ECG app is built to record a single-lead ECG and classify atrial fibrillation. Using the trace to spot exercise-induced ischemia is, as the authors say, not endorsed by Apple.
- Dates
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Date basis unassessed: 2024 (precision unassessed). Updated: 21 October 2026.
- Stage
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Not assessed
- Version
-
SHA-256: 7f02698d60bc…
References
- Other identifiers
-
Not assessed
- Category mappings
-
Not assessed
- Brief
-
Not assessed
- Revisions
-
5 revisions. Latest: 21 October 2026.
Sources
-
Case report Independent author
Koster RW, de Winter RJ, Verberne HJ, Spijkerboer AM, Chamuleau SA (2024). Severe silent ischaemia detected with an Apple Watch in the home setting: a case report. European Heart Journal - Case Reports 8(2):ytae043 (PMC10872691).
The use for detecting myocardial ischaemia is not endorsed by Apple but is documented in this case.
he noticed immediately after exercise, a negative T-wave that became more prominent in ∼7 min, then slowly returned back to a normal positive T-wave after 22 min
Coronary bypass surgery was performed with four bypasses on all coronary arteries involved
Extensive exercise-induced reversible myocardial ischaemia may remain asymptomatic and can result in exercise-induced sudden death.