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Canadian Journal of Cardiology

Atrial Fibrillation Detection by Smartwatch Devices in Patients With Underlying ECG Abnormalities: Still Not Smart Enough?

Published:October 11, 2022DOI:https://doi.org/10.1016/j.cjca.2022.09.007
      Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, and it is linked with increased morbidity and mortality.
      • Andrade J.G.
      • Aguilar M.
      • Atzema C.
      • et al.
      The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society comprehensive guidelines for the management of atrial fibrillation.
      The diagnosis of AF can be challenging owing to its paroxysmal behaviour and low burden of symptoms in some patients; however, early diagnosis is of paramount importance to reduce the risk of complications.
      • Andrade J.G.
      • Aguilar M.
      • Atzema C.
      • et al.
      The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society comprehensive guidelines for the management of atrial fibrillation.
      Different studies have shown that extended electrocardiographic monitoring in high-risk patients,
      • Godin R.
      • Yeung C.
      • Baranchuk A.
      • Guerra P.
      • Healey J.S.
      Screening for atrial fibrillation using a mobile, single-lead electrocardiogram in Canadian primary care clinics.
      after stroke,
      • Sanna T.
      • Diener H.C.
      • Passman R.S.
      • et al.
      Cryptogenic stroke and underlying atrial fibrillation.
      ,
      • Gladstone D.J.
      • Spring M.
      • Dorian P.
      • et al.
      Atrial fibrillation in patients with cryptogenic stroke.
      or in those with cardiac implantable electronic devices
      • Glotzer T.V.
      • Hellkamp A.S.
      • Zimmerman J.
      • et al.
      Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the Mode Selection Trial (MOST).
      can increase detection of AF up to 50% after 30 months of follow-up. Despite their good performance in AF detection, these diagnostic tools exhibit significant limitations, such as monitoring duration,
      • Steinberg J.S.
      • Varma N.
      • Cygankiewicz I.
      • et al.
      2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry.
      battery operation, that some of them are invasive, and they do not provide immediate feedback or advice to patients.
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      References

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      1. Apple. Using Apple Watch for arrhythmia detection. December 2020. Available at: https://www.apple.com/ca/healthcare/docs/site/Apple_Watch_Arrhythmia_Detection.pdf. Accessed September 16, 2022.

      Linked Article

      • Role of Coexisting ECG Anomalies in the Accuracy of Smartwatch ECG Detection of Atrial Fibrillation
        Canadian Journal of CardiologyVol. 38Issue 11
        • Preview
          Smartwatch electrocardiography (ECG) may be used to detect atrial fibrillation (AF), but its accuracy has been validated in only a limited number of patients with similar clinical profiles. We tested the accuracy of the Apple Watch ECG to detect AF in 734 patients (21% were in AF) with various ECG anomalies. The risk of having false positive automated AF detection was higher for patients with premature complexes, sinus node dysfunction, and atrioventricular (AV) block, and the risk of having false negative tracings was associated with broad QRS-complexes and pacing.
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