Remote Cardiac Rhythm Monitoring in the Era of Smart Wearables: Present Assets and Future Perspectives

Abstract

Remote monitoring and control of heart function are of primary importance for patient evaluation and management, especially in the modern era of precision medicine and personalized approach. Breaking technological developments have brought to the frontline a variety of smart wearable devices, such as smartwatches, chest patches/straps, or sensors integrated into clothing and footwear, which allow continuous and real-time recording of heart rate, facilitating the detection of cardiac arrhythmias. However, there is great diversity and significant differences in the type and quality of the information they provide, thus impairing their integration into daily clinical practice and the relevant familiarization of practicing physicians. This review will summarize the different types and dominant functions of cardiac smart wearables available in the market. Furthermore, we report the devices certified by official American and/or European authorities and the respective sources of evidence. Finally, we comment pertinent limitations and caveats as well as the potential answers that flow from the latest technological achievements and future perspectives.

An overview of the electrocardiographic monitoring devices in sports cardiology: Between present and future

“…Indeed, it is so widely used that approximately two-thirds of the European and North American populations own at least one of these appliances. 30 Administration certified or/and Conformité Européene-marked. 30 Currently, the user heart rate and the fitness status are the commonest used applications, albeit usually without healthcare supervision or sanitary approval.…”

“…30 Administration certified or/and Conformité Européene-marked. 30 Currently, the user heart rate and the fitness status are the commonest used applications, albeit usually without healthcare supervision or sanitary approval. The wearables most employed in medical settings operate through photoplethysmography (PPG) or single lead ECG tracings (iECG) and, in the minority of cases, mechanocardiography, which however is less used because unpractical, especially for athletes, and less affordable than other systems.…”

“…The wearables most employed in medical settings operate through photoplethysmography (PPG) or single lead ECG tracings (iECG) and, in the minority of cases, mechanocardiography, which however is less used because unpractical, especially for athletes, and less affordable than other systems. 30 The PPG is an optical technique that relies on a light specificity from 81.9% to 99.20%, 32 provided that physical activity negatively affects its reliability. More specifically, the PPG equipments are more susceptible to artifacts than wireless patches positioned on the chest.…”

“…Indeed, it is so widely used that approximately two‐thirds of the European and North American populations own at least one of these appliances 30 . Wearables are mainly represented by applications which run directly on mobile phones or on wrist‐worn devices, though sometimes may be integrated in different kinds of leadless accessories, including clothing, smart glasses, smart rings, chest belt, necklaces, headphones, most of them are Food and Drug Administration certified or/and Conformité Européene‐marked 30 . Currently, the user heart rate and the fitness status are the commonest used applications, albeit usually without healthcare supervision or sanitary approval.…”

“…Currently, the user heart rate and the fitness status are the commonest used applications, albeit usually without healthcare supervision or sanitary approval. The wearables most employed in medical settings operate through photoplethysmography (PPG) or single lead ECG tracings (iECG) and, in the minority of cases, mechanocardiography, which however is less used because unpractical, especially for athletes, and less affordable than other systems 30 . The PPG is an optical technique that relies on a light source and a photodetector to capture the percentage of nonabsorbed light, which is the expression of the beat‐to‐beat variations.…”