Atrial fibrillation monitoring with wrist-worn photoplethysmography-based wearables: State-of-the-art review

Abstract

Early detection and diagnosis of atrial fibrillation (AF) is essential in order to prevent stroke and other severe health consequences. The challenges in diagnosing AF arise from its intermittent and asymptomatic nature. Wrist-worn devices that use monitoring based on photoplethysmography have been proposed recently as a possible solution because of their ability to monitor heart rate and rhythm for long periods of time at low cost. Long-term continuous monitoring with implantable devices has been shown to increase the percentage of detected AF episodes, but the additional value of wrist-worn devices has yet to be determined. In this review, we present the state of the art in AF detection with wrist-worn devices, discuss the potential of the technology and current knowledge gaps, and propose directions for future research. The state-ofthe-art methods show excellent accuracy for AF detection. However, most of the studies were conducted in hospital settings, and more studies showing the accuracy of the technology for ambulatory long-term monitoring are needed. Objective comparison of results and methodologies among different studies currently is difficult due to the lack of adequate public datasets.

Wearable Photoplethysmography for Cardiovascular Monitoring

“…3(b) . Several techniques have been proposed to assess the irregularity of IBIs and the shape of pulse waves in order to detect AF from the PPG [ 27 ], [ 28 ]. In addition, neural networks have been used to detect AF from PPG signals and PPG-derived HRs [ 192 ].…”

“…In addition, neural networks have been used to detect AF from PPG signals and PPG-derived HRs [ 192 ]. The performance of techniques for detecting AF from the PPG has been assessed in several studies [ 76 ], [ 193 ]–[ 196 ] although further work is required to determine which approach is most suitable for clinical use [ 28 ].…”

Paroxysmal Atrial Fibrillation in Horses: Pathophysiology, Diagnostics and Clinical Aspects

“…Newer wearables, such as smartwatches, can be used to self-monitor episodes of AF. Wrist-worn wearables use photoplethysmography, where a photosensor detects blood flow through arterioles using green LED light deflection [102]. By measuring HR, they can calculate HRV and thereby detect possible arrhythmias, which may be useful for AF detection and self-monitoring.…”

“…By measuring HR, they can calculate HRV and thereby detect possible arrhythmias, which may be useful for AF detection and self-monitoring. A review comparing a number of studies that tested devices with photoplethysmography highlighted that these were mainly carried out in ambulatory facilities, only measured at short time intervals, and did not account for motion artefacts [102]. However, self-monitoring AF can have negative consequences if it triggers health anxiety through a fear of stroke or worsening of the disease [103].…”

HRS White Paper on Clinical Utilization of Digital Health Technology

“…When compared with ILRs, sensitivity and specificity for AF detection from these wearables can exceed 95%. 56 A previous study performed simultaneous comparison between ILR and a PPG smartwatch with ECG confirmation and demonstrated a sensitivity of 97.5% for AF episodes >1 hour. 57 This suggests that wearables may be a viable alternative to ILRs or event monitors for screening of AF and may be utilized in monitoring for recurrence of AF after ablation.…”