Wearable devices in atrial fibrillation: screening, monitoring, and management

Atrial fibrillation (AF) remains the most prevalent cardiac arrhythmia worldwide, contributing substantially to the risk of ischemic stroke and heart failure. Brief monitoring windows inherently limit traditional episodic screening strategies and frequently fail to detect paroxysmal or asymptomatic occurrences. Wearable devices integrating multimodal sensors-such as photoplethysmography (PPG) and single-lead electrocardiography (ECG)-with artificial intelligence now enable continuous, real-world AF screening. However, the widespread consumer adoption of these technologies has precipitated a novel clinical dilemma. A marked increase in the detection of subclinical atrial fibrillation (SCAF) introduces considerable uncertainty regarding the appropriate threshold for initiating oral anticoagulation. In this review, we evaluate the underlying technical principles of wearable sensors and examine their integration into clinical practice across community screening, postoperative monitoring, and long-term patient management. We critically analyze emerging clinical challenges-focusing on the detection-vs.-intervention paradox emphasized by recent landmark outcome trials-and propose actionable strategies for future implementation. Successful clinical translation will require standardized computational algorithms, validated hardware accuracy, semantic electronic health record (EHR) interoperability, and the continuous quantification of AF burden to tailor personalized antithrombotic therapy.