USE OF MODERN SMARTWATCHES IN EARLY DETECTION OF HEART RHYTHM DISTURBANCES AND PREVENTION OF CARDIOVASCULAR COMPLICATIONS: A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.4(52).2026.6452Keywords:
Atrial Fibrillation, Smartwatch, Photoplethysmography, Wearable Technology, Digital Health, Arrhythmia DetectionAbstract
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.
References
A'Court, C., Jenkins, W., Reidy, C., & Papoutsi, C. (2022). Patient-initiated cardiovascular monitoring with commercially available devices: How useful is it in a cardiology outpatient setting? Mixed methods, observational study. BMC Cardiovascular Disorders, 22(1), 428. https://doi.org/10.1186/s12872-022-02860-x
Abu-Alrub, S., Strik, M., Ramirez, F. D., Moussaoui, N., Racine, H. P., Marchand, H., Buliard, S., Haïssaguerre, M., Ploux, S., & Bordachar, P. (2022). Smartwatch electrocardiograms for automated and manual diagnosis of atrial fibrillation: A comparative analysis of three models. Frontiers in Cardiovascular Medicine, 9, 836375. https://doi.org/10.3389/fcvm.2022.836375
Campo, D., Elie, V., de Gallard, T., Bartet, P., Morichau-Beauchant, T., Genain, N., Fayol, A., Fouassier, D., Pasteur-Rousseau, A., Puymirat, E., & Nahum, J. (2022). Atrial fibrillation detection with an analog smartwatch: Prospective clinical study and algorithm validation. JMIR Formative Research, 6(11), e37280. https://doi.org/10.2196/37280
Chugh, S. S., Havmoeller, R., Narayanan, K., Singh, D., Rienstra, M., Benjamin, E. J., Gillum, R. F., Kim, Y. H., McAnulty, J. H., Jr., Zheng, Z. J., Forouzanfar, M. H., Naghavi, M., Mensah, G. A., Ezzati, M., & Murray, C. J. (2014). Worldwide epidemiology of atrial fibrillation: A Global Burden of Disease 2010 Study. Circulation, 129(8), 837–847. https://doi.org/10.1161/CIRCULATIONAHA.113.005119
Demkowicz, P. C., Dhruva, S. S., Spatz, E. S., Beatty, A. L., Ross, J. S., & Khera, R. (2023). Physician responses to Apple Watch-detected irregular rhythm alerts. American Heart Journal, 262, 29–37. https://doi.org/10.1016/j.ahj.2023.04.008
Ding, E. Y., Marcus, G. M., & McManus, D. D. (2020). Emerging technologies for identifying atrial fibrillation. Circulation Research, 127(1), 128–142. https://doi.org/10.1161/CIRCRESAHA.119.316342
Ding, E. Y., Svennberg, E., Wurster, C., Duncker, D., Manninger, M., Lubitz, S. A., Dickson, E., Fitzgibbons, T. P., Akoum, N., Al-Khatib, S. M., Attia, Z. I., Ghanbari, H., Marrouche, N. F., Mendenhall, G. S., Peters, N. S., Tarakji, K. G., Turakhia, M., Wan, E. Y., & McManus, D. D. (2020). Survey of current perspectives on consumer-available digital health devices for detecting atrial fibrillation. Cardiovascular Digital Health Journal, 1(1), 21–29. https://doi.org/10.1016/j.cvdhj.2020.06.002
Gill, S., Bunting, K. V., Sartini, C., Cardoso, V. R., Ghoreishi, N., Uh, H. W., Williams, J. A., Suzart-Woischnik, K., Banerjee, A., Asselbergs, F. W., Eijkemans, M., Gkoutos, G. V., & Kotecha, D. (2022). Smartphone detection of atrial fibrillation using photoplethysmography: A systematic review and meta-analysis. Heart (British Cardiac Society), 108(20), 1600–1607. https://doi.org/10.1136/heartjnl-2021-320417
Guo, Y., Zhang, H., Lip, G. Y. H., & mAF-App II Trial investigators (2022). Consumer-led screening for atrial fibrillation: A report from the mAFA-II Trial Long-Term Extension Cohort. JACC. Asia, 2(6), 737–746. https://doi.org/10.1016/j.jacasi.2022.07.006
Hermans, A. N. L., Gawalko, M., Dohmen, L., van der Velden, R. M. J., Betz, K., Duncker, D., Verhaert, D. V. M., Heidbuchel, H., Svennberg, E., Neubeck, L., Eckstein, J., Lane, D. A., Lip, G. Y. H., Crijns, H. J. G. M., Sanders, P., Hendriks, J. M., Pluymaekers, N. A. H. A., & Linz, D. (2022). Mobile health solutions for atrial fibrillation detection and management: A systematic review. Clinical Research in Cardiology: Official Journal of the German Cardiac Society, 111(5), 479–491. https://doi.org/10.1007/s00392-021-01941-9
Hughes, A., Shandhi, M. M. H., Master, H., Dunn, J., & Brittain, E. (2023). Wearable devices in cardiovascular medicine. Circulation Research, 132(5), 652–670. https://doi.org/10.1161/CIRCRESAHA.122.322389
Iqhrammullah, M., Abdullah, A., Hermansyah, Ichwansyah, F., Rani, H. A., Alina, M., Simanjuntak, A. M. T., Rampengan, D. D. C. H., Al-Gunaid, S. T., Gusti, N., Damarkusuma, A., & Wikurendra, E. A. (2025). Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta-analysis. Journal of Arrhythmia, 41(3), e70087. https://doi.org/10.1002/joa3.70087
Kornej, J., Börschel, C. S., Benjamin, E. J., & Schnabel, R. B. (2020). Epidemiology of atrial fibrillation in the 21st century: Novel methods and new insights. Circulation Research, 127(1), 4–20. https://doi.org/10.1161/CIRCRESAHA.120.316340
Lubitz, S. A., Faranesh, A. Z., Selvaggi, C., Atlas, S. J., McManus, D. D., Singer, D. E., Pagoto, S., McConnell, M. V., Pantelopoulos, A., & Foulkes, A. S. (2022). Detection of atrial fibrillation in a large population using wearable devices: The Fitbit Heart Study. Circulation, 146(19), 1415–1424. https://doi.org/10.1161/CIRCULATIONAHA.122.060291
Pereira, T., Tran, N., Gadhoumi, K., Pelter, M. M., Do, D. H., Lee, R. J., Colorado, R., Meisel, K., & Hu, X. (2020). Photoplethysmography based atrial fibrillation detection: A review. NPJ Digital Medicine, 3, 3. https://doi.org/10.1038/s41746-019-0207-9
Perez, M. V., Mahaffey, K. W., Hedlin, H., Rumsfeld, J. S., Garcia, A., Ferris, T., Balasubramanian, V., Russo, A. M., Rajmane, A., Cheung, L., Hung, G., Lee, J., Kowey, P., Talati, N., Nag, D., Gummidipundi, S. E., Beatty, A., Hills, M. T., Desai, S., … Apple Heart Study Investigators (2019). Large-scale assessment of a smartwatch to identify atrial fibrillation. The New England Journal of Medicine, 381(20), 1909–1917. https://doi.org/10.1056/NEJMoa1901183
Predel, C., & Steger, F. (2021). Ethical challenges with smartwatch-based screening for atrial fibrillation: Putting users at risk for marketing purposes? Frontiers in Cardiovascular Medicine, 7, 615927. https://doi.org/10.3389/fcvm.2020.615927
Ramkumar, S., Nerlekar, N., D'Souza, D., Pol, D. J., Kalman, J. M., & Marwick, T. H. (2018). Atrial fibrillation detection using single lead portable electrocardiographic monitoring: A systematic review and meta-analysis. BMJ Open, 8(9), e024178. https://doi.org/10.1136/bmjopen-2018-024178
Rosman, L., Gehi, A., & Lampert, R. (2020). When smartwatches contribute to health anxiety in patients with atrial fibrillation. Cardiovascular Digital Health Journal, 1(1), 9–10. https://doi.org/10.1016/j.cvdhj.2020.06.004
Tan, S. C. W., Tang, M. L., Chu, H., Zhao, Y. T., & Weng, C. (2024). Trends in global burden and socioeconomic profiles of atrial fibrillation and atrial flutter: Insights from the Global Burden of Disease Study 2021. CJC Open, 7(3), 247–258. https://doi.org/10.1016/j.cjco.2024.11.017
Tison, G. H., Sanchez, J. M., Ballinger, B., Singh, A., Olgin, J. E., Pletcher, M. J., Vittinghoff, E., Lee, E. S., Fan, S. M., Gladstone, R. A., Mikell, C., Sohoni, N., Hsieh, J., & Marcus, G. M. (2018). Passive detection of atrial fibrillation using a commercially available smartwatch. JAMA Cardiology, 3(5), 409–416. https://doi.org/10.1001/jamacardio.2018.0136
Tran, K. V., Filippaios, A., Noorishirazi, K., Ding, E., Han, D., Mohagheghian, F., Dai, Q., Mehawej, J., Wang, Z., Lessard, D., Otabil, E. M., Hamel, A., Paul, T., Gottbrecht, M. F., Fitzgibbons, T. P., Saczynski, J., Chon, K. H., & McManus, D. D. (2023). False atrial fibrillation alerts from smartwatches are associated with decreased perceived physical well-being and confidence in chronic symptoms management. Cardiology and Cardiovascular Medicine, 7(2), 97–107. https://doi.org/10.26502/fccm.92920314
Treewaree, S., & Lip, G. Y. H. (2024). An updated global perspective of atrial fibrillation: Trends, risk factors, and socioeconomic disparities. CJC Open, 7(3), 259–261. https://doi.org/10.1016/j.cjco.2024.12.003
Turakhia, M. P., Desai, M., Hedlin, H., Rajmane, A., Talati, N., Ferris, T., Desai, S., Nag, D., Patel, M., Kowey, P., Rumsfeld, J. S., Russo, A. M., Hills, M. T., Granger, C. B., Mahaffey, K. W., & Perez, M. V. (2019). Rationale and design of a large-scale, app-based study to identify cardiac arrhythmias using a smartwatch: The Apple Heart Study. American Heart Journal, 207, 66–75. https://doi.org/10.1016/j.ahj.2018.09.002
Wyatt, K. D., Poole, L. R., Mullan, A. F., Kopecky, S. L., & Heaton, H. A. (2020). Clinical evaluation and diagnostic yield following evaluation of abnormal pulse detected using Apple Watch. Journal of the American Medical Informatics Association: JAMIA, 27(9), 1359–1363. https://doi.org/10.1093/jamia/ocaa137
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Copyright (c) 2026 Michał Bałenkowski, Mateusz Antonow, Agnieszka Górska, Anna Kozieł, Amelia Sztangierska, Konrad Kowalski, Michał Kardela, Katarzyna Gołąbek, Mariusz Siemiński

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