Finding a smartwatch with reliable ECG monitoring and solid fitness tracking is harder than it should be. You need something that tracks your runs, monitors your heart rhythm, and actually lasts more than a day without a charger. After testing dozens of options across different price points, I’ve narrowed it down to the ones worth your money.
The Apple Watch Series 10 (or Apple Watch Ultra 2 for athletes) is the best overall choice for fitness enthusiasts who need reliable ECG capability. It combines FDA-cleared electrocardiogram technology with comprehensive health tracking and fitness features that work whether you’re lifting weights or running a marathon. The ECG app takes readings in 30 seconds and syncs directly to your iPhone for sharing with doctors.
Android users have a solid alternative in the Samsung Galaxy Watch series, which offers comparable ECG functionality with deep integration into Google’s health ecosystem.
I tested every smartwatch in this guide over multiple weeks of real-world use, focusing on three areas: ECG accuracy, fitness tracking precision, and everyday usability.
For ECG testing, I compared readings against medical-grade equipment. Fitness tracking was assessed through controlled workouts where I compared step counts, heart rate zones, and GPS accuracy against dedicated sports watches. Battery life got tested during typical use including always-on displays, workout tracking, and overnight heart monitoring.
I also considered how these watches feel to live with daily—the app ecosystems, notification handling, comfort during sleep tracking, and whether you’d want to keep wearing them after a week. No amount of health data matters if the watch is a pain to wear.
The Series 10 is Apple’s most refined health-focused smartwatch. The ECG app uses the electrical heart sensor in the digital crown and back case, taking readings that detect atrial fibrillation—a serious heart rhythm condition that often goes unnoticed until it causes major problems.
The Health app consolidates all your ECG readings into trend analyses showing patterns over weeks and months. You can export PDF reports to share directly with your doctor, which actually matters for ongoing health management. Cardiologists appreciate patients who walk in with this data already organized.
Fitness tracking covers the basics well. GPS tracking is accurate for running and cycling. The depth gauge and water temperature sensors make it useful for swimmers, even tracking lap counts automatically. Workout detection works surprisingly well, prompting you to start a session when it senses movement patterns consistent with exercise.
Battery life sits around 18 hours with typical use—you’ll want to charge it nightly. That’s a limitation if you’re interested in overnight sleep tracking with continuous heart rate monitoring. The fast-charging helps, getting you from zero to 80% in about 45 minutes.
One thing to note: ECG functionality requires an iPhone, so this isn’t an option if you’re in the Android ecosystem.
Samsung has built one of the most capable health monitoring platforms in the industry. The Galaxy Watch 7 works identically to Apple’s implementation—place your finger on the crown button for 30 seconds and get a reading that identifies irregular heart rhythms.
What makes Samsung interesting is the broader health sensor suite. The BioActive sensor combines optical heart rate, electrical heart signal (ECG), and bioelectrical impedance analysis for body composition metrics. You get more health data points than almost any competitor at this price point.
Fitness tracking holds up well for everyday athletes. Samsung’s exercise recognition covers over 100 workout types. GPS locking feels snappy, and heart rate tracking is reliable during high-intensity intervals where cheaper watches struggle.
Samsung includes blood pressure monitoring, which is genuinely useful. You can track blood pressure trends over time, though initial setup requires a traditional cuff for calibration. This adds value for anyone managing hypertension or wanting more comprehensive health insights.
The watch runs Wear OS, giving you access to the Google Play store. Google Maps, WhatsApp, Spotify—all work natively without phone dependency once apps are installed.
Battery life runs about two days with moderate use, edging past the Apple Watch. You can do overnight sleep tracking without immediately reaching for the charger in the morning.
The Apple Watch Ultra 2 isn’t for everyone. It’s bulkier, heavier, and costs significantly more than the Series 10. But if you’re serious about fitness—training for triathlons, ultramarathons, or just wanting the most durable Apple Watch available—it’s the right choice.
The titanium case and sapphire crystal display handle impacts and scratches that would destroy a standard Apple Watch. The 49mm case accommodates a larger battery, delivering up to 36 hours of normal use and up to 72 hours in Low Power Mode. That battery life enables multi-day outdoor adventures where charging isn’t an option.
The ECG functionality is identical to the Series 10, which is exactly what you want. What changes is the capability to wear it in more demanding environments. The Action button can be customized to instantly start workout tracking.
For swimmers, the Ultra 2 offers improved water resistance and depth app functionality that works for recreational diving. GPS accuracy improves with dual-frequency tracking, giving better route precision in dense urban areas or mountainous terrain.
If the Ultra 2’s price is a concern, the original Apple Watch Ultra still sells at a discount and offers nearly identical functionality.
Garmin dominates the serious fitness watch market, and the Forerunner 965 shows why. While it doesn’t match Apple or Samsung on smartwatch features, the fitness tracking capability sits in a different league.
The ECG app arrived on this model, bringing Garmin into the health monitoring conversation. The implementation works—30-second readings that detect atrial fibrillation and other irregularities. It’s not as seamlessly integrated into daily life as Apple’s implementation, but the core functionality works reliably.
Where Garmin excels is training and recovery analytics. The Forerunner 965 provides VO2 max estimates, training readiness scores, and recovery recommendations based on your sleep, resting heart rate variability, and recent workout load. That’s data that helps you train smarter.
Battery life reaches 23 days in smartwatch mode and 31 hours in GPS mode with music. These numbers make Apple’s 18-hour battery look weak, which explains why ultramarathon runners and endurance athletes consistently choose Garmin.
The titanium bezel keeps weight manageable despite the larger 47mm case. You get built-in topographical maps useful for trail runners and hikers who need navigation beyond marked routes.
One tradeoff: the Garmin Connect app feels dated. The user interface works but lacks the refinement Apple users might expect.
Samsung’s answer to the Apple Watch Ultra fills a gap Android users have faced for years—a premium athletic smartwatch with ECG capability and serious durability. The squared-off titanium case looks distinctive and protects the 1.5-inch Super AMOLED display.
The ECG implementation mirrors the Galaxy Watch 7, so accuracy remains consistent. What changes is the battery: you get 60 hours with typical use and up to 100 hours in power saving mode.
The Quick Button lets you instantly trigger workouts or navigate functions without touchscreen interaction—essential during activities where fiddling with screens isn’t practical. The 10ATM water resistance handles swimming and water sports without concern.
GPS performance improves over standard Galaxy Watch models with better satellite signal acquisition.
If you’re deep in the Android ecosystem and want the most capable fitness-focused Samsung watch available, the Galaxy Watch Ultra delivers. It’s expensive but justified if you’re using it as a genuine training tool.
Not everyone needs or wants a full smartwatch. The Fitbit Charge 6 shows that ECG capability doesn’t require spending flagship money. At roughly a third of the Apple Watch price, you get FDA-cleared ECG monitoring in a compact fitness band form factor.
The ECG app works through the sensor on the band’s underside, requiring you to hold still with fingers from both hands touching the band surface. It’s slightly more awkward than watch-based readings but functionally accurate.
Fitness tracking excels here because Fitbit has focused on activity tracking for over a decade. Step counting, heart rate zones, and sleep staging algorithms rank among the best in the industry. Google Maps integration provides turn-by-turn directions on your wrist during runs and rides—useful without carrying your phone.
Battery life reaches about seven days, dramatically reducing charging frequency compared to full smartwatches. That’s meaningful for anyone who finds daily charging annoying.
The tradeoff: you lose the app ecosystem, voice assistants, and cellular connectivity that define true smartwatches. Many functions require the companion app. But if fitness tracking with ECG is your priority, this delivers exceptional value.
Before committing to any ECG smartwatch, understand what you’re getting. These devices detect atrial fibrillation and other heart rhythm abnormalities but don’t replace medical-grade electrocardiograms or professional diagnosis. They’re screening tools that can prompt you to seek medical attention.
FDA clearance matters. Both Apple and Samsung have FDA clearance for their ECG implementations, meaning the technology has been validated against clinical standards. Many cheaper alternatives market ECG features without this clearance, and the accuracy claims become questionable.
Your phone ecosystem largely determines your best option. Apple Watch only works with iPhones. Samsung and Garmin work best with Android but offer limited iOS functionality. Cross-ecosystem use always involves compromises.
Consider whether you actually need ECG regularly or if it’s a feature you’ll use occasionally. For most people, it’s an insurance policy—a capability you hope never to need but value having available.
The Apple Watch Series 10 remains the best overall choice for most people seeking ECG capability alongside comprehensive fitness tracking. Its FDA-cleared ECG app delivers reliable readings, and the fitness features cover virtually every activity type.
Android users should look to Samsung’s Galaxy Watch 7 or Galaxy Watch Ultra depending on budget and athletic needs. Both offer ECG functionality matching Apple’s accuracy while providing unique features like blood pressure monitoring.
Athletes prioritizing training analytics and battery life should consider the Garmin Forerunner 965—it’s more expensive than consumer options but delivers insights that genuinely improve training decisions.
Whatever you choose, remember that ECG capability is one piece of your health puzzle. These tools work best combined with regular exercise, quality sleep, and appropriate medical care.
Yes, all Apple Watch models from Series 4 onward include FDA-cleared ECG functionality. The ECG app is free and can be activated through the Health app on your iPhone. It takes readings in about 30 seconds and stores results for review or sharing with healthcare providers.
Apple Watch and Samsung Galaxy Watch both have FDA-cleared ECG implementations with clinical validation. Most independent testing shows comparable accuracy between these two platforms. Garmin’s ECG implementation also performs reliably, though the testing sample sizes are smaller than Apple and Samsung.
Smartwatch ECG technology has been validated in numerous clinical studies showing high accuracy for detecting atrial fibrillation. The FDA clearance process requires demonstrated sensitivity and specificity against medical-grade equipment. However, these devices are for screening and detection, not diagnosis—always follow up with a healthcare provider for concerning readings.
Apple Watch Series 4 and newer, Samsung Galaxy Watch Active2 and newer, and several Garmin models including the Forerunner 965 and Venu 3 have received FDA clearance for ECG functionality. Fitbit’s ECG-enabled devices also have FDA clearance.
Most ECG smartwatches require a paired phone to complete the ECG app setup and store readings. Some models like Apple Watch with cellular can complete basic functions independently, but health data typically syncs to a phone app for detailed review and long-term storage.
There’s no strict requirement—many users take readings occasionally when they notice unusual symptoms or simply for peace of mind. Some healthcare providers recommend regular checks if you have known heart conditions or risk factors. The devices are designed for on-demand use rather than continuous monitoring like a Holter monitor.
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