Finding the right smartwatch with ECG capability can feel like wading through a swamp of specs and marketing claims. I’ve tested dozens of these devices in real fitness scenarios—running, cycling, lifting, sleeping, you name it—and this guide cuts through the noise to help you pick what’s actually worth your money.
ECG tech in smartwatches has moved beyond the gimmick stage. These devices measure your heart’s electrical activity directly, which is fundamentally different from the optical sensors that just estimate your pulse by watching blood flow under your skin.
For active people, this matters. During hard workouts, ECG can catch irregular rhythms that regular heart rate monitors miss. Athletes pushing high training loads benefit from knowing their heart is handling the stress okay. And for anyone concerned about atrial fibrillation—a condition affecting millions that often goes unnoticed—ECG provides a simple way to check in.
The FDA has cleared ECG features on major smartwatches, which lends them some credibility. But it’s worth being clear: these are screening tools, not diagnostic devices. They can flag potential issues worth mentioning to your doctor, but they won’t replace a proper medical exam.
Apple Watch Series 9 is the one everyone else tries to beat. Apple got to the ECG wearable market early, and it shows.
The ECG app uses electrodes built into the Digital Crown and the watch case back. Touch the Crown with your finger, and it completes a circuit through your heart. The app classifies results as sinus rhythm (normal), atrial fibrillation, low heart rate, or inconclusive.
The ecosystem integration is what makes Apple shine. The Health app stores your readings over time, and you can export them to share with your doctor. Apple Health connects with most fitness apps and healthcare systems, so data moves around easily.
The Series 9 also includes the Precision Stack sensor—three LEDs and six photodiodes for better heart rate tracking during workouts. Temperature sensing tracks ovulation and can flag potential illness.
At $399, it’s not cheap. But you get reliable ECG, solid fitness tracking, and the most polished implementation available. If you have an iPhone, this is the one to beat.
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Samsung’s Galaxy Watch 6 delivers ECG at a lower price, making it the smart pick for Android users who want reliable heart monitoring without spending Apple money.
The Galaxy Watch 6 uses Samsung’s BioActive sensor, which combines optical heart rate, ECG, and bioelectrical impedance analysis in one module. Beyond ECG, this means blood pressure monitoring (where local regulations allow) and body composition tracking.
The ECG process is similar to Apple—you touch the watch buttons to complete the circuit. Results classify as normal sinus rhythm, atrial fibrillation, or inconclusive. Samsung has FDA clearance and CE marking for European markets.
Sleep tracking uses AI to analyze patterns and give detailed insights. Automatic workout detection covers over 100 exercise types with post-workout summaries. The rotating bezel is a nice touch for navigation without covering the screen.
At around $299, you’re getting a lot of watch for the money.
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Garmin dominates the fitness-focused smartwatch space, and the Venu 3 brings ECG to their lineup for the first time. If workout tracking matters more than smart features, this is worth a look.
The Venu 3’s ECG sensor detects atrial fibrillation, with results stored in Garmin Connect. It’s newer to Garmin’s ecosystem, so less battle-tested than Apple or Samsung, but functional.
Where Garmin really delivers is workout metrics. Over 30 preloaded sports apps cover running, cycling, golf, pickleball—whatever you’re into. Training features include VO2 max, recovery time, and training readiness scores that tell you whether to push hard or take it easy.
Battery life is the real win here: up to 14 days in smartwatch mode, up to 26 hours in GPS mode. Most competitors die after a day or two. This is the watch for athletes who forget to charge or go on multi-day adventures.
At around $449, it’s pricey. But serious athletes will appreciate the training analytics depth.
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Fitbit basically invented consumer heart rate tracking, and the Sense 2 brings ECG at the lowest price among FDA-cleared devices.
The Sense 2 has Fitbit’s most advanced sensor suite: ECG, continuous SpO2, and cEDA for stress detection. The ECG app needs you to hold fingers on the watch corners for 30 seconds, then classifies the result.
The health features go beyond ECG. cEDA detects electrodermal activity changes that may indicate stress. Built-in GPS tracks outdoor runs without your phone. Sleep tracking is Fitbit’s strength—detailed sleep stages, sleep score, and sleep profile insights.
At around $249, it’s the cheapest way to get FDA-cleared ECG. The catch: you need Fitbit Premium for full sleep analysis and some advanced health metrics.
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The Pixel Watch 2 refines the original with better design, better battery, and improved health sensors—the premium Android option for ECG.
The Pixel Watch 2 uses Fitbit health technology (Google acquired Fitbit) and delivers FDA-cleared ECG with atrial fibrillation detection. Readings store in the Fitbit app for easy access and sharing.
A continuous skin temperature sensor sets it apart—useful for tracking ovulation and understanding your body’s patterns. This is something competitors don’t offer.
Google ecosystem integration is seamless for Android users: Google Assistant, Maps, and Wallet work natively, while Fitbit handles fitness tracking. Fall Detection and Safety Check add peace of mind.
At $349, it’s mid-range pricing with a solid feature mix for Android users who want Fitbit’s fitness expertise plus Google’s smarts.
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Testing ECG smartwatches means evaluating both the medical-grade features and everyday usability. Our methodology covers multiple angles.
We verify ECG accuracy by comparing readings to medical-grade equipment. We test ECG at rest, during light activity, and in recovery to understand performance across different states.
Fitness tracking accuracy gets serious attention. We compare heart rate during various exercises against chest strap monitors (the gold standard). We also check GPS accuracy and automatic workout detection responsiveness.
Battery life testing uses real-world usage: always-on display, notifications, workouts, sleep tracking. We note charging speed and whether fast charging is supported.
Finally, we assess the overall experience—how easy taking an ECG is, how quickly results appear, and how well data integrates with other platforms. The best ECG smartwatch is one you’ll actually use.
| Feature | Apple Watch Series 9 | Samsung Galaxy Watch 6 | Garmin Venu 3 | Fitbit Sense 2 | Pixel Watch 2 |
|---|---|---|---|---|---|
| Starting Price | $399 | $299 | $449 | $249 | $349 |
| ECG FDA Cleared | Yes | Yes | Yes | Yes | Yes |
| Battery Life | 18 hours | 40 hours | 14 days | 6+ days | 24 hours |
| GPS | Yes | Yes | Yes | Yes | Yes |
| Water Resistance | 50m | 50m | 5 ATM | 5 ATM | 5 ATM |
| Sleep Tracking | Yes | Yes | Yes | Yes | Yes |
| Blood Pressure | No | Yes (select markets) | No | No | No |
| Temperature Sensor | Yes | No | No | No | Yes |
| Mobile Payments | Apple Pay | Samsung Pay | Garmin Pay | Fitbit Pay | Google Pay |
Apple Watch Series 9 currently tops accuracy comparisons in independent tests. Samsung Galaxy Watch 6 and Google Pixel Watch 2 (using Fitbit tech) perform nearly as well—all three are FDA-cleared for AFib detection. Garmin’s ECG is newer and works fine but has less clinical validation data available.
ECG is worth it if you have specific health concerns, family history of heart problems, or want comprehensive health data. Athletes doing intense training benefit since ECG catches irregular rhythms optical sensors miss. If you’re generally healthy and want basic fitness tracking, ECG adds cost without much benefit.
No. ECG requires specific hardware sensors and FDA or CE clearance. Not all smartwatches have it, and some features may be unavailable in certain countries due to regulations.
ECG itself doesn’t require a subscription on most devices. The exception is Fitbit Sense 2, which needs Fitbit Premium ($9.99/month or $79.99/year) for full sleep analysis and advanced health metrics. Apple, Samsung, Garmin, and Google don’t require subscriptions for core ECG.
No. ECG features detect atrial fibrillation and arrhythmias, not heart attacks. If you have chest pain, shortness of breath, or potential heart attack symptoms, seek emergency care immediately—don’t wait for a consumer device.
No strict rule exists. Weekly readings or when you notice unusual symptoms creates helpful baseline data. If you have a heart condition, follow your doctor’s recommendations. Many users take readings in the morning or after workouts to understand their heart patterns.
Apple Watch Series 9 stays our top recommendation for most people. FDA-cleared accuracy, seamless ecosystem integration, and comprehensive fitness tracking make it the complete package. iPhone users won’t find anything better.
Android users have a harder choice. Samsung Galaxy Watch 6 gives the best value—ECG plus blood pressure monitoring at a lower price. If workout analytics and battery life matter most, Garmin Venu 3 is the athlete’s pick. Budget buyers get the most affordable FDA-cleared ECG with Fitbit Sense 2.
Whatever you choose, remember these are health tools, not medical devices. Share concerning readings with your doctor, use them as part of a broader wellness approach, and enjoy the peace of mind that comes from keeping tabs on your heart.
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