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Related Experiment Video

Updated: Jun 4, 2026

Patient Directed Recording of a Bipolar Three-Lead Electrocardiogram using a Smartwatch with ECG Function

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Published on: December 11, 2019

Precardioversion Heart Rhythm Monitoring Using Smartphone Photoplethysmography: The SMARTBEATS Randomized Clinical

Jonatan Fernstad^1,2, Emma Svennberg³, Peter Åberg¹

¹Karolinska Institutet, Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd University Hospital, Stockholm, Sweden.

JAMA Cardiology

|June 3, 2026

Summary

Precardioversion monitoring with smartphone photoplethysmography significantly reduced same-day cardioversion cancellations for atrial fibrillation. This digital intervention offers a scalable solution for managing these common procedure cancellations.

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Area of Science:

Cardiology
Digital Health
Medical Technology

Background:

Scheduled cardioversion is a common yet resource-intensive procedure for treating atrial fibrillation and atrial flutter.
Cancellations are frequent, often due to spontaneous conversion to sinus rhythm before the procedure.

Purpose of the Study:

To evaluate the efficacy and feasibility of using smartphone photoplethysmography for precardioversion rhythm monitoring.
To compare this digital approach against standard care in patients scheduled for cardioversion.

Main Methods:

A randomized, single-blinded study involving adult patients with persistent atrial fibrillation or flutter.
The intervention group used smartphone photoplethysmography for rhythm monitoring and received anticoagulation adherence reminders.
The control group received standard care without active precardioversion monitoring.

Main Results:

Smartphone monitoring led to a significant reduction in same-day cardioversion cancellations (4.8% vs. 23.2%, P < .001).
Cancellations due to spontaneous sinus rhythm conversion were markedly lower in the intervention group (1.0% vs. 18.2%, P < .001).
Over 5000 heart rhythm recordings were successfully made using the smartphone technology.

Conclusions:

Precardioversion monitoring with smartphone photoplethysmography is a highly scalable digital intervention.
This method significantly decreases same-day cardioversion cancellations, improving resource allocation and patient management.