Accuracy of Detecting Atrial Fibrillation: A Systematic Review and Meta-Analysis of Wrist-Worn Wearable Technology

Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia, and ECG remains the gold standard for diagnosing AF. Wrist-worn technologies are appealing for their ability to passively process near-continuous pulse signals. The clinical application of wearable devices is controversial. Our systematic review and meta-analysis qualitatively and quantitatively analyze available literature on wrist-worn wearable devices (Apple Watch, Samsung, and KardiaBand) and their sensitivity and specificity in detecting AF compared to conventional methods. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, yielding nine studies (n = 1,581). Observational studies assessing the sensitivity and specificity of wrist-worn wearables in detecting AF in patients with and without a history of AF were included and analyzed using a fixed-effect model with an inverse-variance method. In patients with a history of AF, the overall sensitivity between device groups did not significantly differ (96.83%; P = 0.207). Specificity significantly differed between Apple, Samsung, and KardiaBand (99.61%, 81.13%, and 97.98%, respectively; P<0.001). The effect size for this analysis was highest in the Samsung device group. Two studies (n = 796) differentiated cohorts to assess device sensitivity in patients with known AF and device specificity in patients with normal sinus rhythm (NSR) (sensitivity: 96.02%; confidence intervals (CI) 93.85%-97.59% and specificity: 98.82%; CI:97.46%-99.57%). Wrist-worn wearable devices demonstrate promising results in detecting AF in patients with paroxysmal AF. However, more rigorous prospective data is needed to understand the limitations of these devices in regard to varying specificities which may lead to unintended downstream medical testing and costs.