What question did this study set out to answer?

This review evaluates the effectiveness of wearable ECG and PPG devices in detecting atrial fibrillation and their clinical implications.

June 24, 2026

Wearable devices for atrial fibrillation: diagnostic and screening roles of ECG and PPG—A systematic review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Atrial fibrillation. Intervention: Wearable electrocardiographic (ECG) and photoplethysmographic (PPG) devices vs. Short-duration Holter monitoring. Primary outcome: AF detection accuracy.

Key Result

Wearable ECG patches demonstrated high sensitivity (92-98%) and specificity (85-97%) for atrial fibrillation detection, identifying more episodes than short-duration Holter monitoring.

Key Points

This review evaluates the effectiveness of wearable ECG and PPG devices in detecting atrial fibrillation and their clinical implications.
Systematic review conducted following PRISMA guidelines, searching databases from 2010-2025.
Included studies had at least 30 participants and reported AF detection accuracy or outcomes.
PPG studies required ECG verification as the reference standard.
Wearable ECG patches had high sensitivity (92-98%) and specificity (85-97%), detecting more AF episodes than Holter monitors.
PPG smartwatches demonstrated moderate-to-high accuracy in irregular pulse detection, improved by AI.
Limitations included motion artifacts, false positives, adherence issues, and insufficient evidence for stroke prevention.

Study Design

Type

Systematic Review

Structured PICO

Do wearable ECG and PPG devices accurately detect atrial fibrillation compared to traditional monitoring methods?

Population

Participants in studies (n≥30) evaluating atrial fibrillation detection accuracy or clinical outcomes using wearable devices

Intervention

Wearable electrocardiographic (ECG) and photoplethysmographic (PPG) devices for continuous monitoring and large-scale AF screening

Comparator

Short-duration Holter monitoring (for ECG patches) and ECG verification (for PPG devices)

Outcome

Diagnostic performance (AF detection accuracy including sensitivity and specificity) and clinical outcomes

Wearable ECG devices provide reliable clinical atrial fibrillation detection, while PPG-based devices are effective for initial screening but require subsequent ECG confirmation.

Limitations

motion artifacts
false positives
adherence issues
clinician data burden
limited evidence for stroke prevention

Abstract

OBJECTIVE: Atrial fibrillation (AF) is a major predictor of heart failure, stroke, and mortality. Traditional Holter monitors and event recorders are limited by short recording times. Wearable electrocardiographic (ECG) and photoplethysmographic (PPG) devices enable continuous monitoring and large-scale AF screening. This review assesses their diagnostic performance, clinical usefulness, and implementation challenges. METHODS: Following PRISMA guidelines, PubMed, Embase, and Web of Science were searched for studies from 2010-2025. Included studies had ≥30 participants and reported AF detection accuracy or clinical outcomes. Studies evaluating PPG devices required ECG verification as the reference standard. RESULTS: Wearable ECG patches showed high sensitivity (92-98%) and specificity (85-97%) and detected more AF episodes than short-duration Holter monitoring. PPG-based smartwatches demonstrated moderate-to-high accuracy in irregular pulse detection, further improved by AI-assisted algorithms. Limitations included motion artifacts, false positives, adherence issues, clinician data burden, and limited evidence for stroke prevention. CONCLUSION: Wearable ECG devices are reliable for clinical AF detection. PPG-based devices are best used for screening, with subsequent ECG confirmation according to international AF management guidelines.

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