Joshua A. Mikhail Daniel Tadros Rafael Shehata


Introduction: An ECG is the gold standard for detecting various cardiology pathologies including AF. Current ambulatory heart rhythm monitoring technology include Holter monitoring and various implantable event monitors, which provide continuous monitoring but are invasive, uncomfortable and may lack in detecting intermittent arrhythmias, due to their periodic exploratory monitoring strategy. 

Methods: A systematic search was conducted using the following databases: Cochrane Library, Embase, PubMed, and Google Scholar. The search was conducted using the keywords "atrial fibrillation," "smartwatch," "ECG," "stroke," and "PPG”. Relevant sources between 2018 and 2023 were chosen, and data was analysed to establish clinical utility in early diagnosis of AF.

Results: Two studies assessing the diagnostic efficacy of smartwatch technology, two studies investigating the usability of new technology and one study assessing cost-effectiveness were included in our review. The diagnostic efficacy of smartwatches ranges from 93.5-98.25% accurate, 92.45-97.3% sensitive and 88.6-100% specific, with PPV ranging from 91.6-100%, and NPV ranging from 93.85-96.83%. Targeted audiences of AF detection includes a larger proportion of older adults with possible declined technological and/or cognitive function, and may find difficulty using current smartwatch technology. With a simplified user interface, novel software like Pulsewatch promotes user accessibility in smartwatch technology, making AF detection simple to identify, particularly in elderly people. 90 patients used the Pulsewatch system, and more than half reported having a positive experience with the system; only 13% considered it excessively stressful.

Discussion: Due to the low 65+ age group representation (6.6%) in studies like Fitbit, Huawei, and Apple heart studies, they overlook potential bias in older adults' adherence to pAF monitoring. Pulsewatch addresses this issue. Smartwatches, being user-friendly and cost-effective, offer real-time, reasonably accurate prospective data for patients. However, further research is required to gauge their clinical utility in early AF detection, diagnostic effectiveness during daily activities, and the heterogeneity of smartwatch devices remains to be fully explored.

Conclusion: User-friendly PPG-based smartwatch technology is a medically accurate alternative to standard AF detection techniques that may speed up the diagnosis and treatment of AF, lowering stroke and cardiovascular disease-related morbidity and mortality as well as AF-related healthcare costs.

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