Management Strategies of Atrial Fibrillation Detected by Consumer Wearable Devices: A Systematic Review of Clinical Practice and Decision-Making

Consumer-grade wearable devices using photoplethysmography (PPG) and single-lead electrocardiography (ECG) are increasingly used to detect irregular rhythms suggestive of atrial fibrillation (AF) in ambulatory, asymptomatic populations. While these technologies have expanded opportunities for early AF detection, their rapid adoption has outpaced the development of standardized management pathways, and it remains unclear how a PPG-based notification, a patient triggered single-lead ECG tracing, and a continuously recorded ambulatory ECG patch should be evaluated in practice. A systematic search of MEDLINE, the Cochrane Library, and Google Scholar identified literature published from January 2015 through December 2025. Ten studies met eligibility criteria: one randomized clinical trial, five prospective or retrospective observational studies and single-arm studies, and four clinician surveys. Patient-level studies demonstrated high actionability of wearable alerts, with 57% to 83.5% of alert recipients seeking medical follow-up. Among patients whose alerts were subsequently confirmed as AF, direct oral anticoagulation initiation varied widely from 12% to 90%, reflecting differences in population risk, confirmation method, and reporting denominators rather than a single consistent practice. Survey data revealed a parallel lack of consensus: 99.5% of physicians required traditional diagnostic confirmation before treatment, yet thresholds for the AF duration warranting anticoagulation ranged from 5 to 6 minutes (15% of clinicians) to more than 24 hours (34%). Management also varied by specialty, with emergency medicine physicians more than twice as likely as primary care physicians to refer to a specialist. Building on these patterns, we propose a conceptual clinical pathway requiring prospective validation that integrates confirmatory diagnostic testing with risk-stratified management to help close this guideline-practice gap.