Smart-watches: a potential challenger to the implantable loop recorder?

Abstract

The newest generation of smart-watches offer heart rate monitoring technology via photoplethysmography, a technology shown to demonstrate impressive ability in diagnosing arrhythmias including atrial fibrillation. Combining such technology with the portability, connectivity and other location and activity tracking features smart-watches could represent a powerful new tool in extended non-invasive arrhythmia detection. The technology itself, including potential uses and limitations, is discussed. There is a need for further software development but crucially, further work into clarifying the diagnostic accuracy of such technology.

Outcome of implantable loop recorder evaluation

“…The role of external loop recorders, which extend the conventional 24 h to 48 h capacity of Holter monitors, may be expanding as the syncopal population is a heterogeneous one; for example, external loop recorders may be appropriate first-line devices for patients experiencing palpitations or with suspected AF. Recent advances in software technology and photopletysmographic technology for monitoring AF may open the door to diagnostic tools such as smart-watches in disease management of certain patients [30].…”

Hidden Signals—The History and Methods of Heart Rate Variability

“…In the last years, heart rate has been increasingly measured by photoplethysmography (PPG), as implemented in newer smart watches {( 9 ) #2319}. For instance, the pulse watch Polar RS800cx, using an electrode belt and PPG measured with a finger cuff, compared with ECG showed moderate to excellent agreement levels.…”

“…In reality, the issue is more complicated {( 3 ) #2021} {( 4 ) #2317} {( 5 ) #2320}. Whether pulse watch-generated HRV calculations can be used is still a matter of debate {( 6 ) #2326} {( 7 , 8 ) #2022} {( 9 ) #2319}. Automated recognition of R-peaks is prone to errors {( 10 ) #2323} and manual editing is still the gold standard, which impairs clinical use.…”

Gyroscope vs. accelerometer measurements of motion from wrist PPG during physical exercise

“…Most smart watches, including the Apple Watch, Samsung Gear S2, and Fitbit Surge include a heart rate monitor which can be used for optimizing workouts [1] and potentially for automatically detecting serious events such as atrial fibrillation [2]. As such they are enabling the study of heart function in the general population in a way not possible with traditional Holter monitors and they are seen as an important part of future personalized and preventative healthcare.…”