What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation (n=12802). Intervention: ECG smart chest patches vs. PPG smartwatches. Primary outcome: Pooled sensitivity for atrial fibrillation detection.

February 25, 2025Open Access

Diagnostic accuracy of ECG smart chest patches versus PPG smartwatches for atrial fibrillation detection: a systematic review and meta-analysis

Key Result

ECG smart chest patches and PPG smartwatches both exhibited excellent performance in atrial fibrillation detection, with pooled sensitivities of 96.1% and 97.4%, respectively.

Study Design

Type

Meta-Analysis (n=12,802)

Multicenter

Yes

Structured PICO

Do ECG smart chest patches and PPG smartwatches improve atrial fibrillation detection in adults?

Population

12,802 participants across 15 studies evaluating the diagnostic accuracy of ECG smart chest patches versus PPG smartwatches for detecting atrial fibrillation.

Intervention

ECG smart chest patches and photoplethysmography (PPG)-based smartwatches

Comparator

Standard diagnostic methods (12-lead ECG, Holter ECG, and telemetry ECG)

Outcome

Diagnostic accuracy (sensitivity and specificity) for atrial fibrillation detection

Both ECG smart chest patches and PPG smartwatches exhibit excellent and comparable diagnostic accuracy for detecting atrial fibrillation, supporting their use in digital cardiac monitoring.

Main Result

Absolute Event Rate: 96.1% vs 97.4%

Limitations

Restricted scope of literature search excluding some databases
Variations in gold standards used for AF detection across studies (e.g., 12-lead ECG, Holter monitors, telemetry ECG)
Substantial heterogeneity among included studies due to different populations and clinical settings

Abstract

INTRODUCTION: Atrial fibrillation (AF), the most common form of cardiac arrhythmia, is associated with significant morbidity, mortality, and financial burden. Traditional diagnostic methods, such as 12-lead electrocardiograms (ECG), have limitations in detecting intermittent AF episodes. Consequently, smart wearables have been introduced to enhance continuous AF monitoring. This systematic review and meta-analysis aimed to evaluate and compare the diagnostic accuracy of ECG smart chest patches and photoplethysmography (PPG)- based smartwatches in AF detection. METHODS: From august 16-20, 2024, a comprehensive search was conducted across PubMed/MEDLINE, DOAJ, AJOL, and the Cochrane Library. Original studies assessing the performance of ECG smart chest patches and PPG smartwatches in detecting AF were included. Studies were screened based on predefined inclusion and exclusion criteria, and the most relevant were finally included. For ECG smart chest patches and PPG smartwatches groups, random-effects model was used to pool these performance metrics. Statistical analyses were performed using Jamovi 2.3.28, with a significance threshold of p < 0.05. RESULTS: A total of 15 studies were included in the current systematic review and meta-analysis. ECG smart chest patches demonstrated a pooled sensitivity of 96.1% (95% CI: 91.3-100.8), (I² = 94.59%), and a pooled specificity of 97.5% (95% CI: 94.7-100.2), (I² = 79.1%). PPG smartwatches showed a pooled sensitivity of 97.4% (95% CI: 96.5-98.3), (I² = 3.16%), and a pooled specificity of 96.6% (95% CI: 94.9-98.3), (I² = 75.94%). Comparatively, both ECG smart chest patches and PPG smartwatches exhibited excellent performance in atrial fibrillation detection, with PPG smartwatches showing slightly higher sensitivity and ECG chest patches exhibiting marginally greater specificity. CONCLUSION: Both ECG smart chest patches and PPG smartwatches are highly effective for detecting atrial fibrillation. However, further advancements are needed to match their accuracy with that of standard diagnostic methods and achieve comprehensive digital cardiac monitoring.

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