Many readers have asked what the skeptical cardiologist thinks about a unique and interesting addition to the personal cardiovascular monitoring space that offers long-term ECG monitoring to individuals without a prescription.
One reader, George Hody, MD, turns out to have considerable experience with the Wellue Heart Health Monitor, therefore I asked him if he’d be willing to provide a review of it. The article he wrote contains a very detailed description. It is so detailed that I have put the bulk of it in a linked PDF.
As he points out, for decades cardiologists have utilized long-term ECG monitors to identify and track abnormal heart rhythms. Initially, these “Holter” monitors were bulky and worn for 24 or 48 hours. Now, smaller, less obtrusive, patch-type monitors are available which can record 2 to 4 weeks of ECG data. These are expensive and not available for personal consumer use.
Small, hand-held or wrist-watch ECG devices have been available for a decade. As I pointed out here, in my practice the Kardia ECG devices have substantially reduced the amount of long term ECG monitoring that I prescribe.
This Wellue review suggests capabilities that will expand personal ECG monitoring to longer durations.
As a retired physician, when I noticed some extra heartbeats on my Apple Watch electrocardiogram (ECG), I visited my own family doctor who prescribed a “Holter” continuous ECG recorder. I was told it would take a week for me to receive it by mail, then I was to wear it for two weeks, mail it back, and getting the result would be another two weeks. Meanwhile, I would have to rely on 30-second ECG’s from my Apple watch. I complied with my doctor’s order and waited for the “official” Holter monitor but at the same time, I went to the internet to search for a quicker solution. I found something very useful. It was a single-channel, continuous, 24 hour ECG recorder branded Wellue.
This is a review of the “The Wellue Heart Health Monitor and ECG Tracker,” intended for home use, model ER1. It is made in China by Shenzhen Viatom Technology Co.,Ltd. The same company makes a bewildering array of similar products under different brands, for example, “CheckMe” which sells in Canada and Australia. A feature of one version of the ER1 is the capability to upload ECG data to a company server which returns an “artificial intelligence analysis” of your ECG record. There are also models intended mainly for monitoring exercise. While these are lower cost (typically $70), recordings are limited to 30 minutes and AI analysis is not available.
I bought the Wellue ER1 on Amazon for $239 however Amazon is not currently (April 2023) selling the device. It can still be purchased directly from the Wellue USA representative at getwellue.com and also on eBay. A similar-looking Livenpace ECG monitor appears almost identical to the Wellue, is made by the same company and the instruction manual is essentially the same. I obtained one on eBay. I was able to record with it and to get an AI analysis, but could not get the mobile app to work. I recommend only the Wellue branded, USA product and make sure it includes the AI analysis service.
“Holter” monitors were first developed in the 1940’s by Norman Holter, to make continuous recordings of electrocardiograms, first via radio transmission to magnetic tape recorders and large computers, but now, they are available, much improved, on tiny digital devices boasting large capacity memory chips. Holter monitors are now tiny, lightweight devices you can adhere or strap to your chest where they can barely be felt.
[Figure 1] Early Holter Device in the inventor’s backpack.
(public domain image from Wikipedia )
The Wellue ECG recorder is not FDA-approved and is represented as a “non-medical” health device. Nonetheless, it performs continuous, single-channel ECG recordings for up to 24 hours. The recording can be uploaded to the manufacturer’s website for “AI” (artificial intelligence) analysis. The downloaded AI report can be printed or sent out as a PDF file. The status of the recorder can be determined from a single flashing LED on the device. But an app, available for phones and tablets, has multiple useful functions including monitoring the recorder’s battery, the current length of the recording, and the app can display a live ECG tracing in real-time (telemetry). The app also records up to 30 minutes for rapid viewing without needing to upload the recording and wait for the AI analysis.
The Wellue system is suitable for monitoring heart activity under a variety of different circumstances. These include primarily arrhythmia detection and evaluation. In addition, the device records heart rate and heart rate variability. It can be used during exercise, sleep, and periods of stress. Other uses for the Wellue recorder include post-heart surgery home monitoring, evaluation of new medication effects (for example beta-blockers), atrial fibrillation detection and management, pregnancy monitoring and maybe for stress-reducing biofeedback.
Ideally, the Wellue ECG recorder is used with the guidance of a medical professional, particularly if it reports abnormalities. However, it’s important to note that some doctors may be hesitant to interpret results from an unapproved device. They may prefer to prescribe an FDA-approved, medical-grade Holter monitor which has been reviewed by specialists. But it’s worth noting that a single test with the approved monitors can be more expensive than purchasing a Wellue recorder and medical-grade Holter monitors don’t provide real-time displays for the user. Additionally, it may take up to a month to receive results, causing a delay in diagnosis.
Unboxing is straightforward but the package has a magnetically closed opening flap which lifts up and can be confusing. The following components are included:
- The recorder – appx 4 x 1 x 3/8 inches (Figures 2 & 3)
- An adjustable, elastic chest strap with clips
- A USB cord with a custom connector on one end
- An instruction manual which is clear but incomplete
- 5 trial sets of separate ECG clip electrodes with adhesive discs
(standard 3M red dot electrodes will also work)
- A USB flash drive containing the desktop software but not the phone app
[Figure 4] Additional items supplied, from left top clockwise: package of 5 sets of electrodes, chest strap, flash drive with Windows and Mac computer software, USB cord with clip. In this package, a spare cord was supplied. (Author photo)
Before the first use, a full charge is required, taking just over two hours. No charger is supplied with the recorder. When the battery isn’t mostly depleted, it only needs 0.25 Amps for charging, which most computer USB ports can handle. However, with my Windows desktop computer, I encountered an error message: “Excessive current required from USB port” when charging a battery which was completely drained. In addition, leaving the recorder connected to the computer to charge can cause problems with the operating system –more on this later. For these reasons, the use of a charger capable of delivering 1 Amp to a standard USB-A receptacle, such as phone chargers, Amazon and Google chargers, is recommended. Caution is needed to align the gold contacts in the USB charging cord clip with those on the ECG recorder. A pilot light on the recorder turns amber when charging and green when fully charged.
The instruction manual covers how to wear the device, charge and maintain it, and how to upload your recordings for the company’s AI analysis. It is rudimentary and the English is not perfect but it is useful. The company’s sales website has additional resources including FAQ’s, illustrations on how to wear
the device, a large number of credible but brief user reviews and some short Youtube videos. However, neither the site nor the information which came with the recorders I received had any instructions for the mobile phone app.
The ECG recorder is small and light and almost imperceptible to the user when worn. It is water-resistant to standard IP22 but it is not waterproof. IP22 specifies that gentle surface cleaning with liquids but not immersion or exposure to liquids under pressure is acceptable. Thus the recorder is not suitable for swimming or bathing but the manufacturer recommends wiping the recorder and the chest band with 70% alcohol for cleaning.
The Wellue recorder’s internal memory holds up to 10 recordings or a total of 30 hours. Once either limit is reached, the oldest record is overwritten. The device automatically stops recording and saves the ECG data after 24 hours. It also does the same if the leads lose electrical contact with the skin. The data-saving process is fail-safe—whether you reach the 24-hour limit or remove the leads before recording is complete, any data collected up to that point will be preserved in the recorder’s memory. A fresh, fully charged battery will last about 72 hours, good for a number of recordings. Because the Wellue recorder stays powered up at all times, it is possible that the lithium battery will wear out faster than usual, unless a low-voltage limiter circuit is included. There is no information about this in the manufacturer’s literature.
For the full review, click on the PDF belowtruncated-wellue-review
Overall, the Wellue 24-hour ECG recorder provides a unique device for recording one’s ECG with relative ease and low cost. I looked for similar products and the few that I found were larger, heavier, and more expensive. The recorder itself is light, compact, and virtually imperceptible when worn. It is compatible with any environments which are not excessively wet. It is relatively easy to set up and use although the instruction manual is brief and contains only the essential directions. A few of the menus and access to some functions could be clearer and more intuitive. The mobile app is very well written and has many useful functions including real-time telemetry. However, it is not entirely easy to use and I could not find any description or manual for it from the manufacturer.
When the AI computer program is active and the recorder is left plugged into a USB port, an unpredictable operating system and other computer errors can happen. The mobile app uses a lot of computing power and shortens battery life. The Bluetooth range is shorter than expected.
The AI interpretation is most reliable if it does not discover any abnormality. But it is subject to errors due to baseline drift and environmental electrical noise. If the electrodes are not in excellent contact with the skin, there will also be many spiky-looking artifacts and bizarre-looking waveforms. On occasion, the AI will mistake those for real extra beats or aberrant rhythms. For example, some artifacts in my records were mistaken variably for the very serious anomaly of ventricular tachycardia and also for couplets (adjacent pairs) of both premature atrial and premature ventricular contractions.
It’s important to note that AI analysis is not a substitute for a professional medical diagnosis. Any significant abnormalities in the ECG recording should be evaluated by a healthcare professional. This is not as easy as it might be because while the software will provide PDF files or printed pages, the search feature for anomalies is not easily transportable to another computer, particularly an institutional one. But if the program is installed on a laptop, then the laptop with the software, including the search feature, can be taken to a medical professional.
In my opinion, the usefulness, compactness and low cost of the Wellue ECG recorder far outweigh its problems. If the company continues to develop and improve this product, I have no doubts that its applications and ease of use will continually increase.
The skeptical cardiologist wants to emphasize that this review was written by a physician-user who has the capability of interpreting his own ECGs. Thus, when the Wellue AI diagnosed ventricular tachycardia he could recognize that it was being fooled by artifact. Such inaccuracies in my experience are common with non-FDA approved personal ECG monitors.
The rigorous testing, documented in the scientific literature of the AI algorithms of Alivecor’s Kardia and Apple’s Watch reassures me of their accuracy but is not apparent for other devices including the Wellue.
My reader/author also notes the following:
A critical point for users to note is the potential system disruptions if the monitor remains connected to a Windows computer post-data transfer. The issues include malfunctioning program and web page menus, and occasional system freezes. I can’t explain why, but it’s a consistent and disruptive issue. Mitigation is simple– just disconnect the device from the USB clip.
N.B. George Hody, our Wellue revue author, lists relevant experience as
– Vice President of Thermonetics, a company which made sensors and instruments for heat flow measurements in biology and medicine. Our clients included the military, universities and the Sealab Project. I also directed the medical computer-assisted learning project (PLATO IV) at the University of Illinois School of Basic Medical Sciences (Urbana/Champaign) ages ago.
I took a two year Gerontology postdoc at the USC Ethel Percy Andrus Gerontology Center. I distinguished myself by working out a way to get ECG’s on aging mice! LOL
As one who has performed echocardiograms on mice at the Ohio State University, I have deep respect for this latter accomplishment!