Why the study?
Because AF is frequently asymptomatic or paroxysmal, timely diagnosis remains a persistent clinical challenge. This review synthesizes current evidence on the diagnostic performance, clinical utility, and limitations of consumer smartwatches equipped with PPG and single-lead ECG for detecting heart rhythm disturbances.
Does consumer smartwatch-based photoplethysmography and single-lead ECG monitoring improve the early detection of atrial fibrillation and prevention of cardiovascular complications compared to conventional intermittent ECG monitoring?
Does consumer smartwatch-based photoplethysmography and single-lead ECG monitoring improve the early detection of atrial fibrillation and prevention of cardiovascular complications compared to conventional intermittent ECG monitoring?
Smartwatch-based PPG and single-lead ECG technologies provide high sensitivity and specificity as an adjunct for opportunistic atrial fibrillation screening, though structured clinical confirmatory pathways are necessary to manage false positives and guide therapy.
Atrial fibrillation (AF) and other cardiac rhythm disturbances represent a major and growing global health burden, contributing substantially to stroke, heart failure, and cardiovascular mortality worldwide. Because AF is frequently asymptomatic or paroxysmal, timely diagnosis remains a persistent clinical challenge. This narrative review aims to synthesize current evidence on the technological principles, diagnostic performance, clinical utility, and limitations of consumer smartwatches equipped with photoplethysmography (PPG) and single-lead electrocardiography (ECG) for the detection and prevention of heart rhythm disturbances. Large prospective cohorts, including the Apple Heart Study and the Fitbit Heart Study, together with multiple systematic reviews and meta-analyses, demonstrate that smartwatch-based PPG and ECG algorithms achieve high sensitivity and specificity for AF detection. This enables opportunistic screening and supports targeted secondary prevention of thromboembolic events, particularly ischemic stroke. However, real-world implementation raises concerns regarding false-positive alerts, overdiagnosis, patient anxiety, and the necessity of physician-confirmed diagnosis. Smartwatch-based rhythm monitoring constitutes a clinically meaningful, evidence-supported adjunct to conventional arrhythmia detection, but its integration into routine cardiological practice requires structured confirmatory pathways, clinician education, and further research addressing diverse populations and long-term outcomes.
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Balenkowski et al. (2026) studied this question.
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