However according to a report from 9to5Mac’s Guilherme Rambo, it seems that you can “trick” the Apple Watch into enabling the ECG feature even if you’re not in the US, and it is as simple as changing your region to the United States. Given that the Apple Watch Series 4 comes with the ECG monitor built into the watch, it is not a hardware limitation which means that in theory changing your region could be all it takes to unlock the feature.
However as Rambo notes, changing your region could mean changing other settings too, like your date and time formats, units of measurements, and so on, so that’s something to consider. Note that the ECG tool has yet to be enabled and this report is based purely on looking at the code, which means that it is possible that maybe Apple could make changes at a later date that might make it harder to circumvent it since we’re sure that local governments might not be too pleased about Apple introducing a medical device without the proper clearance.
That being said, it was previously suggested that clearance by local regulators could take a while which means that if you don’t live in the US, maybe you might want to consider the Series 3 which is cheaper, unless there are other features of the Series 4 that you want besides the ECG monitor.