Wrist-worn wearables for atrial fibrillation detection: diagnostic performance of PPG versus single-lead ECG (review)

Short systematic-style review (PubMed, last 5 years, free full text): 13 of 44 records included. Controlled cohorts with good signal: PPG algorithms ~94–95%+ sensitivity and specificity. Real-world older post-stroke patients: irregular-rhythm notification sensitivity about one third, specificity 100%.

• Form factor: wrist

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and an important cause of stroke and reduced quality of life. Standard methods such as 12-lead electrocardiography and Holter monitoring cover only limited periods and are not ideal for repeated screening. Wrist-worn devices, including smartwatches and fitness bands, are now part of a healthy lifestyle and are widely used by athletes and physically active individuals. Many record photoplethysmography (PPG), single-lead electrocardiography (ECG), or both, but their diagnostic value in AF detection is still not fully established.  Aim: To compare the diagnostic performance of wrist-worn devices using PPG and single-lead ECG for AF detection in adults.  Material and methods: A systematic PubMed search was performed using smartwatch- and AF-related terms. The search was limited to the last five years, English language, human studies, and free full-text articles. Of 44 records, 13 original studies were included after screening. Results: In controlled cohorts with good signal quality, PPG-based algorithms usually showed sensitivity and specificity around 94–95% or higher. In real-world settings, especially in older post-stroke patients, sensitivity of irregular rhythm notifications was much lower, around one third, although specificity reached 100%. Single-lead ECG smartwatches and ambulatory ECG recorders usually achieved sensitivity and specificity above 90%. Physician interpretation of smartwatch ECG recordings improved diagnostic accuracy. Conclusions: Both PPG- and ECG-based wrist-worn devices can detect AF with high accuracy in selected settings. In routine practice, ECG-based devices seem more reliable, while PPG results are more dependent on signal quality and algorithm design. Positive findings should still be confirmed by standard ECG.

Verbatim from the publisher's DOI record (opens in a new tab) · Publisher licence: https://creativecommons.org/licenses/by-nc-sa/4.0

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