As of now, changing the region on watch and phone (not language) should allow ECG to work outside of the US.
According to 9to5mac,
https://9to5mac.com/2018/10/29/apple-watch-ecg-availability/
The side effect is that changing the region will affect date and time format among others.
According to 9to5mac,
"...if you buy an Apple Watch Series 4 in any country, it includes the new sensors. Looking at code within iOS related to the ECG feature, we’ve been able to confirm that its limitation to the US will be based on the software region of the user’s devices (iPhone and Apple Watch)."
https://9to5mac.com/2018/10/29/apple-watch-ecg-availability/
The side effect is that changing the region will affect date and time format among others.