Monitoring Atrial Fibrillation Using Wearable Digital Technologies: The Emerging Role of Smartwatches

Sep 30, 2026

Atrial fibrillation (AF) is the most common sustained arrhythmia and a major global health burden, while conventional monitoring methods often miss recurrence. This narrative review synthesizes current evidence on smartwatch-based AF monitoring, covering core technologies such as photoplethysmography, single-lead electrocardiography, and AI fusion algorithms, along with validation studies after ablation. Compared with traditional modalities, smartwatch monitoring can improve AF recurrence detection, characterize AF burden, align symptoms with rhythm, and increase patient engagement, while also presenting limitations including motion artifacts, false positives, short recordings, adherence dependence, digital access gaps, and unresolved regulatory, interoperability, and privacy issues.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Abstract

1. Introduction

Atrial fibrillation burden and consequences

Limitations of traditional AF monitoring

Review Monitoring Atrial Fibrillation Using Wearable Digital Technologies: The Emerging Role of Smartwatches Panagiotis Stachteas 1, *, Marios G. Bantidos 1, Nikolaos Papoutsidakis 1, Athina Nasoufidou 1, Paschalis Karakasis 1, Georgios Sidiropoulos 1, Christos Kofos 1, Dimitrios Patoulias 2, Vasileios Ediaroglou 3, George Stavropoulos 1, Efstratios Karagiannidis 3, Barbara Fyntanidou 3, Dimitrios Tsalikakis 4, Emmanouil Smyrnakis 5, George Kassimis 1, Christodoulos E. Papadopoulos 6 and Nikolaos Fragakis 1 Academic Editor: Boyoung Joung Received: 25 November 2025 Revised: 14 December 2025 Accepted: 17 December 2025 Published: 19 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Second Department of Cardiology, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; [mbadidos@gmail.com](mbadidos@gmail.com) (M.G.B.); [nipapou4@gmail.com](nipapou4@gmail.com) (N.P.); [athinanassi@gmail.com](athinanassi@gmail.com) (A.N.); [pakar15@hotmail.com](pakar15@hotmail.com) (P.K.); [sidiropoulos.georges@gmail.com](sidiropoulos.georges@gmail.com) (G.S.); [chriskofos21@gmail.com](chriskofos21@gmail.com) (C.K.); [stavropoulosgeo@gmail.com](stavropoulosgeo@gmail.com) (G.S.); [gksup@yahoo.gr](gksup@yahoo.gr) (G.K.); [nfrag@auth.gr](nfrag@auth.gr) (N.F.) 2 Second Propedeutic Department of Internal Medicine, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; [dipatoulias@gmail.com](dipatoulias@gmail.com) 3 Department of Emergency Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; [billedi03@gmail.com](billedi03@gmail.com) (V.E.); [stratoskarag@gmail.com](stratoskarag@gmail.com) (E.K.); [bfyntan@yahoo.com](bfyntan@yahoo.com) (B.F.) 4 Department of Electrical and Computer Engineering, University of Western Macedonia, 50100 Kozani, Greece; [tsalikakis@gmail.com](tsalikakis@gmail.com) 5 Laboratory of Primary Health Care, General Practice and Health Services Research-Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; [smyrnak@auth.gr](smyrnak@auth.gr) 6 Third Cardiology Department, Medical School, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; [chrpapado@gmail.com](chrpapado@gmail.com) * Correspondence: [staxteasp@gmail.com](staxteasp@gmail.com) Abstract Atrial fibrillation (AF) is the most common sustained arrhythmia and a growing global health burden, yet conventional monitoring with Holter devices, event recorders and implantable loop recorders often fails to adequately capture recurrence. Rapid advancesin digital health, wearable biosensors and artificial intelligence (AI) have transformed consumer smartwatches and wearables into potential clinical tools capable of continuous, real-world rhythm surveillance. This narrative review synthesizes contemporary evidence on smartwatch-based AF monitoring, spanning core technologies—photoplethysmography, single-lead electrocardiography and AI fusion algorithms—and validation studies across post-ablation follow-up. Compared with traditional modalities, smartwatch-based AF monitoring demonstrates improved detection of AF recurrence, enhanced characterization of AF burden, symptom–rhythm correlation, and greater patient engagement. At the sametime, key limitations are critically examined, including motion artifacts, false-positive alerts, short recording windows, adherence dependence, digital literacy and access gaps, as well as unresolved issues around regulation, interoperability and data privacy. By integrating engineering advances with guideline-directed care pathways, smartwatchbased AF monitoring holds promise to complement, rather than im

FAQs

Why do conventional AF monitoring methods often fail to capture recurrence?

Conventional tools such as Holter devices, event recorders, and implantable loop recorders can be limited by monitoring duration, reduced patient adherence, and insufficient sensitivity for unpredictable paroxysmal or asymptomatic episodes between clinical visits.

Which technologies are used for smartwatch-based AF monitoring in the review?

The review covers photoplethysmography, single-lead electrocardiography, and AI fusion algorithms that combine signals to support rhythm surveillance.

What benefits does smartwatch-based AF monitoring offer compared with traditional modalities?

It can improve detection of AF recurrence, enhance characterization of AF burden, support symptom–rhythm correlation, and increase patient engagement.

Sep 30, 2026

Uploaded by Well Done