Wearable Smartwatches for Atrial Fibrillation Detection and Burden Estimation After Ablation: Comparison With...

Area of Science:

• Cardiology
• Digital Health
• Medical Devices

Background:

• Wearable ECG smartwatches are validated for atrial fibrillation (AF) screening.
• Their accuracy for monitoring AF recurrence and AF burden post-catheter ablation remains uncertain.

Purpose of the Study:

• To evaluate the simulated performance of three commercial smartwatch algorithms.
• To compare smartwatch AF recurrence detection and AF burden estimation against implantable cardiac monitors (ICMs).

Main Methods:

• Utilized continuous ICM data from 346 patients (CIRCA-DOSE trial).
• Simulated three smartwatch algorithms assuming daytime wear (8 AM-10 PM) and intermittent rhythm monitoring.
• Analyzed sensitivity for arrhythmia recurrence and correlation with ICM-derived AF burden, stratified by wear time and activity.

Main Results:

• Simulated smartwatch sensitivities for AF recurrence detection: 82.2% (Apple Watch AF Burden), 70.6% (Apple Watch IRN), 64.4% (Fitbit IHRD).
• Wearables outperformed intermittent ECG monitors (15.8%-64.6%) and conventional strategies.
• All algorithms showed high correlation (r > 0.97) with ICM-derived AF burden; 24-hour wear improved sensitivity to >90%.

Conclusions:

• Smartwatch AF detection algorithms correlate strongly with AF burden and show good sensitivity for recurrence.
• These devices outperform conventional non-invasive monitoring strategies.
• Wearables offer a scalable alternative for post-ablation rhythm monitoring.