Garmin ECG App

Plain English: The wearer rests a thumb and finger on the watch’s metal ring for 30 seconds while the watch records the heart’s electrical signals. The app then reports either a normal rhythm or signs of atrial fibrillation, an irregular heart rhythm, or says the recording could not be classified. A normal result covers only that recording, and it is not a diagnosis.

In practice: This feature seems next to useless. It can only attempt to catch an AFib event manually, as it is happening. It is not a passive, background feature.

Quick answers

Which Garmin watches have the ECG App?
Apart from the original Venu 2 Plus, the ECG App needs a watch with Garmin’s Elevate Gen 5 optical sensor, and the watch must be used in a country where Garmin has enabled the app. Garmin’s ECG App page lists the current watches and countries.

Is the Garmin ECG App accurate?
In Garmin’s own FDA submission, the app identified atrial fibrillation with 99.5% sensitivity and normal sinus rhythm with 100% specificity, counting only recordings it could classify. These figures come from Garmin’s validation study rather than a peer-reviewed paper, and no independent study of the Garmin ECG App was found.

How do I set up the ECG App on a Garmin watch?
Setup runs through the Garmin Connect app, which walks through the Instructions for Use before the app appears in the watch’s Apps and Activities menu. If the setup prompt is missing, check the watch software, the Garmin Connect version, the region and that the account has Permanent Two-Step Verification switched on, and allow up to 24 hours.

Does Garmin check for AFib automatically?
No. The ECG App only records when the wearer starts it and holds a finger on the watch, and Garmin does not passively scan for atrial fibrillation in the background. It is not intended for continuous monitoring.

ECG App – a deep dive

When the ECG App is actually useful

The app is only useful for people with frequent, continuous events. Those people should not attempt to rely on a smartwatch, especially when the number of inconclusive readings is over 10%.

Introduction

The Garmin ECG App records an electrocardiogram (ECG, also written EKG in the US) from the wrist. Garmin describes it this way: “Available on compatible smartwatches, the ECG app allows you to record your heart rhythm and check for signs of atrial fibrillation (AFib) or normal sinus rhythm.” Garmin says the recording is similar to a Lead I ECG.

Garmin announced the app on 24 January 2023 for Venu 2 Plus in the US, calling it “Garmin’s first FDA-cleared smartwatch feature”. In the EU it is a Class IIa medical device under the Medical Device Regulation. Its limitation is that it only works on demand: a 30-second recording catches the heart rhythm at that moment, so an intermittent irregular rhythm can come and go between checks. The result is not a diagnosis, and anyone with symptoms should see a doctor whatever the watch says.

What the ECG App result actually means

Each recording ends with one of four results. Sinus rhythm means the heart beat in a normal, regular pattern, and Garmin stresses that this only applies to that specific recording. AFib means the app found signs of atrial fibrillation. A high or low heart rate result appears because the app has a working range: “If your heart rate is over 120 beats per minute (bpm) or under 50 bpm, the ECG app cannot check for AFib heart rhythms.” Inconclusive means the app could not classify the trace, which Garmin puts down to movement, poor contact, a weak signal, a heart rate between 100 and 120 bpm without AFib, a pacemaker or implanted defibrillator, or other heart conditions. Garmin publishes no score or norm; each result classifies one recording.

How Garmin’s ECG App works

Garmin states that the watch’s sensors record the heart’s electrical signals while the wearer holds a thumb and index finger on the metal ring around the watch face, with the back of the watch against the wrist. The app analyses the trace for heart rate and signs of AFib. Garmin describes these contact points but does not describe the circuit. The most plausible reading is that the ring and the caseback act as the two electrodes of a single-lead circuit running across both arms.

Garmin does not publish the classification algorithm, so how it separates AFib from sinus rhythm is unknown. Results appear on the watch and in Garmin Connect, where a recording can be exported as a PDF.

What affects the reading

Garmin’s recording advice centres on contact and stillness. It advises resting the arm on a table, wearing the watch snug on the correct wrist, keeping the skin and the ring clean and dry, and staying away from electronics. Movement during the 30 seconds and poor contact are the causes Garmin names first for an inconclusive result.

The 50 to 120 bpm range sets the other limit, so a recording straight after training, or from a very fit athlete with a low resting heart rate, may come back as a heart rate result rather than a rhythm. Garmin lists people under 22, people with a known arrhythmia other than AFib, people with a pacemaker, ICD or other implanted electronics, and pregnant women among those the app is not intended for.

How accurate is the Garmin ECG App

The only accuracy figures come from Garmin’s own FDA 510(k) submission (K221774), cleared in a letter dated 12 January 2023. In a study of approximately 590 subjects, the app identified AFib with 99.5% sensitivity and sinus rhythm with 100% specificity, counting only the recordings it could classify. A further 11.5% of recordings were inconclusive. Garmin’s Instructions for Use also report the figures across all recordings, including inconclusive ones: the app returned an AFib result for 86.5% of people with AFib and a sinus rhythm result for 91.1% of people in sinus rhythm.

These figures come from Garmin’s own submission and have not been peer reviewed. Garmin registered the study as NCT04842123, which lists 568 people enrolled between March and October 2021 and has no posted results, and no independent study of the Garmin ECG App was found. The registry’s 568 differs from the FDA summary’s approximately 590, and Garmin has not explained the gap. Bumgarner and colleagues (2018) give useful context from an earlier single-lead smartwatch ECG band, the KardiaBand for Apple Watch: the automated reading reached 93% sensitivity and 84% specificity, and 57 of 169 recordings were uninterpretable, so a share of inconclusive results is a feature of the method rather than of Garmin alone. Optical AFib detection from the wrist is a separate technology, compared in Amazfit AFib detection beats older Garmins, not the ECG app.

Competitor equivalents

• Apple Watch has a single-lead ECG app for adults aged 22 and over, checks for AFib between 50 and 120 bpm in version 1 or 50 and 150 bpm in version 2, and was the predicate device for Garmin’s FDA clearance.
• Samsung offers ECG Monitor in the Samsung Health Monitor app, FDA-cleared to classify sinus rhythm or AFib and available in the US from 23 September 2020.
• Withings ScanWatch records a 30-second single-lead ECG that reports normal rhythm, AFib, or a low or high heart rate, with CE and FDA clearance.

Polar, COROS and Suunto offer no ECG feature.

Which Garmin devices support the ECG App

Apart from the original Venu 2 Plus, the ECG App needs a watch with the Elevate Gen 5 optical sensor, used in a country where Garmin has enabled the app, and Garmin’s supported devices and regions page lists each watch with its countries. As of November 2026 it lists Approach S72, D2 Air X15, D2 Mach 1 Pro, D2 Mach 2, D2 Mach 2 Pro, Enduro 3, Enduro 4, Epix Pro (Gen 2) including the Porsche Edition, Fenix 7 Pro, Fenix 8, Fenix 8 Pro, Fenix 9, Fenix 9 Pro, Forerunner 970, MARQ (Gen 3), Quatix 7 Pro, Quatix 8, Quatix 8 Pro, Tactix 7 AMOLED Edition, Tactix 8, Venu 2 Plus, Venu 3 and Venu 4. Venu 2 Plus, the launch watch, uses an older sensor and is limited to the US and several Asian markets. The app launched in the US in January 2023 and reached Australia and the EU on 15 January 2025, then the UK, Switzerland and New Zealand in April 2025. Garmin has since added more countries, including Saudi Arabia and the UAE in June 2026 and India in November 2026. Watches running beta firmware cannot set up the app.

Where to find the ECG App on Garmin

• Garmin Connect setup: More > Garmin Devices > the watch > Finish Set Up > Set Up ECG app, if the setup prompt has not appeared on its own.
• On the watch: the ECG App sits in the Apps and Activities menu once setup is complete.
• Garmin Connect mobile: each recording and its result, with the option to export it as a PDF.

Common problems and misreadings

When the setup prompt does not appear, Garmin’s checklist is the watch software, the Garmin Connect version, the region and Permanent Two-Step Verification on the account, and setup can take up to 24 hours to appear. See Quick answers above.

A run of inconclusive results usually means movement, poor contact or a heart rate outside the app’s range, so a recording taken during a cool-down can fail.

A sinus rhythm result is easy to over-read. It only covers the 30 seconds recorded, and the app checks only for AFib, which is why Garmin says it is not intended for people with a known arrhythmia other than AFib. Garmin does not check for AFib passively in the background, so the absence of a warning means nothing unless a recording was taken.

How to improve ECG App recordings

Heart rhythm is not a trainable metric, but recording quality improves by following Garmin’s advice: rest the arm on a table, wear the watch snug on the correct wrist, keep the skin and the ring clean and dry, and move away from electronics. The thumb and index finger stay on the metal ring, and the wearer stays still, for the full 30 seconds.

Scientific basis

Garmin International. Electrocardiogram Clinical Validation Study, ClinicalTrials.gov NCT04842123, 2021. Garmin’s own validation study, whose results appear only in FDA 510(k) K221774 and are the source of the accuracy figures above.

Bumgarner JM, Lambert CT, Hussein AA and colleagues. Journal of the American College of Cardiology, 2018. PMID 29535065. Showed that automated single-lead smartwatch ECG detects AFib well but leaves a large share of recordings unclassified, which puts Garmin’s inconclusive rate in context.

How the ECG App connects to other Garmin features

The ECG App records the heart’s electrical signals and was Garmin’s first FDA-cleared feature, whereas HRV Status and Pulse Ox are wellness metrics read by the optical sensor. A recording taken soon after hard training can land above 120 bpm, so knowing a realistic max heart rate and resting rate helps an athlete choose a moment when the app can check rhythm at all.