# Periop Pacemaker vs ECGRef

The clearest difference is in-app purchases: ECGRef at none against Periop Pacemaker's 2. ECGRef also leads on update cadence (every 2 weeks vs every 2 months) and ratings volume (29 vs 8). Periop Pacemaker's advantage is iOS requirement (13.0 vs 26.0). On price, rating, review sentiment and ads there is nothing between them.

Both are free to download. Periop Pacemaker sells 2 in-app purchases, starting at $2.99 per year. ECGRef asks for nothing beyond the download.

On the App Store both sit at effectively the same score — 5.0 for Periop Pacemaker against 4.9 for ECGRef. Both are backed by a comparable volume of ratings — 8 and 29 respectively. Written reviews split almost evenly too, at 100% and 100% positive.

Periop Pacemaker ships an update every 2 months, ECGRef every 2 weeks. The most recent releases landed on September 27, 2026 and October 10, 2026 respectively.

## The numbers

| Metric | Periop Pacemaker | ECGRef |
| --- | --- | --- |
| Price | Free | Free |
| Rating | **[5.0 (8 ratings)](https://appshunter.io/ios/app/periop-pacemaker/id6615070538/reviews)** | [4.9 (29 ratings)](https://appshunter.io/ios/app/ecgref/id6757675855/reviews) |
| Number of ratings | 8 | **29** |
| Positive reviews | 100.0% of reviews | 100.0% of reviews |
| In-app purchases | Yes | **No** |
| Ads | No | No |
| Update frequency | Every 2 months | **Every 2 weeks** |
| Monetization | Free with in-app purchases | **Free** |
| Size | 43 MB | 12 MB |
| Requires iOS | **13.0** | 26.0 |
| Devices | iPhone, iPod | iPhone, iPad |
| Age rating | 17+ | 17+ |
| Developer | [Rhythm Management, LLC](https://appshunter.io/developer/1761518402) | [Rishi Kumar](https://appshunter.io/developer/1434016052) |

## What reviewers say

### Periop Pacemaker

[App page](https://appshunter.io/ios/app/periop-pacemaker/id6615070538)

This app provides medical professionals with a decision algorithm for managing surgical patients with implantable defibrillators or pacemakers. It is based on guidelines endorsed by the Heart Rhythm Society and updated annually by an expert committee.

**Highlights:** Decision algorithm for pacemaker/defibrillator management, Endorsed by Heart Rhythm Society, Based on ASA Perioperative Cardiac Implantable Electronic Device Management Aid, Annual expert committee updates, Designed for medical professionals

**Features:** macOS Compatibility, Vision Pro support

**In-app purchases (2)**

| Purchase | Price | Billing |
| --- | --- | --- |
| PERIOP PACEMAKER ANNUAL FEE | $2.99 | per year |
| Periop Pacemaker | $7.99 | one-time |


### ECGRef

[App page](https://appshunter.io/ios/app/ecgref/id6757675855)

An educational reference for interpreting electrocardiograms, this app covers electrophysiology, rhythm recognition, and common patterns. It aims to assist clinicians and students in accurate bedside ECG analysis.

**Highlights:** Electrophysiology concepts, Rhythm recognition, Clinically relevant patterns, Bedside ECG analysis support, Educational reference

**Features:** macOS Compatibility, Vision Pro support

**In-app purchases:** none


## Frequently asked questions

### Is Periop Pacemaker free?

Periop Pacemaker is free to download, with in-app purchases available.

### Is ECGRef free?

ECGRef is free to download, with no in-app purchases.

### Which has better reviews, Periop Pacemaker or ECGRef?

Periop Pacemaker is rated higher. Periop Pacemaker averages 5.0 out of 5 from 8 ratings, while ECGRef averages 4.9 from 29 ratings.

### Do Periop Pacemaker or ECGRef have ads?

Neither Periop Pacemaker nor ECGRef shows ads.

### Which is updated more often, Periop Pacemaker or ECGRef?

Periop Pacemaker ships an update every 2 months, and ECGRef every 2 weeks. Most recently, Periop Pacemaker was updated on September 27, 2026 and ECGRef on October 10, 2026.

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*Compared by [AppsHunter](https://appshunter.io/) from daily US App Store data. Review summaries are generated from verbatim App Store reviews.*