Heart, Lung and Circulation

The Role of Contemporary Wearable and Handheld Devices in the Diagnosis and Management of Cardiac Arrhythmias

Published:September 13, 2022DOI:
      Cardiac arrhythmias are associated with significant morbidity, mortality and economic burden on the health care system. Detection and surveillance of cardiac arrhythmias using medical grade non-invasive methods (electrocardiogram, Holter monitoring) is the accepted standard of care. Whilst their accuracy is excellent, significant limitations remain in terms of accessibility, ease of use, cost, and a suboptimal diagnostic yield (up to ∼50%) which is critically dependent on the duration of monitoring. Contemporary wearable and handheld devices that utilise photoplethysmography and the electrocardiogram present a novel opportunity for remote screening and diagnosis of arrhythmias. They have significant advantages in terms of accessibility and availability with the potential of enhancing the diagnostic yield of episodic arrhythmias. However, there is limited data on the accuracy and diagnostic utility of these devices and their role in therapeutic decision making in clinical practice remains unclear. Evidence is mounting that they may be useful in screening for atrial fibrillation, and anecdotally, for the diagnosis of other brady and tachyarrhythmias. Recently, there has been an explosion of patient uptake of such devices for self-monitoring of arrhythmias. Frequently, the clinician is presented such information for review and comment, which may influence clinical decisions about treatment. Further studies are needed before incorporation of such technologies in routine clinical practice, given the lack of systematic data on their accuracy and utility. Moreover, challenges with regulation of quality standards and privacy remain. This state-of-the-art review summarises the role of novel ambulatory, commercially available, heart rhythm monitors in the diagnosis and management of cardiac arrhythmias and their expanding role in the diagnostic and therapeutic paradigm in cardiology.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Murakoshi N.
        • Aonuma K.
        Epidemiology of arrhythmias and sudden cardiac death in Asia.
        Circ J. 2013; 77: 2419-2431
        • Ball J.
        • Thompson D.R.
        • Ski C.F.
        • Carrington M.J.
        • Gerber T.
        • Stewart S.
        Estimating the current and future prevalence of atrial fibrillation in the Australian adult population.
        Med J Aust. 2015; 202: 32-35
        • Velleca M.
        • Costa G.
        • Goldstein L.
        • Bishara M.
        • Boo L.M.
        A Review of the burden of atrial fibrillation: understanding the impact of the new millennium epidemic across Europe.
        EMJ Cardiol. 2019; 7: 110-118
        • Virani S.S.
        • Alonso A.
        • Aparicio H.J.
        • Benjamin E.J.
        • Bittencourt M.S.
        • Callaway C.W.
        • et al.
        Heart disease and stroke statistics-2021 update: a report from the American Heart Association.
        Circulation. 2021; 143: e254-e743
        • Healey J.S.
        • Connolly S.J.
        • Gold M.R.
        • Israel C.W.
        • Van Gelder I.C.
        • Capucci A.
        • et al.
        Subclinical atrial fibrillation and the risk of stroke.
        N Engl J Med. 2012; 366: 120-129
        • Srinivasan N.T.
        • Schilling R.J.
        Sudden cardiac death and arrhythmias.
        Arrhythm Electrophysiol Rev. 2018; 7: 111-117
        • Svennberg E.
        • Engdahl J.
        • Al-Khalili F.
        • Friberg L.
        • Frykman V.
        • Rosenqvist M.
        Mass Screening for untreated atrial fibrillation: the STROKESTOP study.
        Circulation. 2015; 131: 2176-2184
      1. Rawshani A. The ECG leads: electrodes, limb leads, chest (precordial) leads, 12-lead ECG (EKG). Clinical ECG Interpretation. [accessed 27.5.21].

        • Zimetbaum P.
        • Goldman A.
        Ambulatory arrhythmia monitoring: choosing the right device.
        Circulation. 2010; 122: 1629-1636
        • Mubarik A.
        • Iqbal A.
        Holter Monitor. StatPearls [Internet].
        StatPearls Publishing, Treasure Island (FL)2020
      2. American Heart Association. Holter Monitor.
        • Sana F.
        • Isselbacher E.M.
        • Singh J.P.
        • Heist E.K.
        • Pathik B.
        • Armoundas A.A.
        Wearable Devices for ambulatory cardiac monitoring: JACC state-of-the-art review.
        J Am Coll Cardiol. 2020; 75: 1582-1592
        • Steinberg J.S.
        • Varma N.
        • Cygankiewicz I.
        • Aziz P.
        • Balsam P.
        • Baranchuk A.
        • et al.
        2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry.
        Heart Rhythm. 2017; 14: e55-e96
        • Galli A.
        • Ambrosini F.
        • Lombardi F.
        Holter monitoring and loop recorders: from research to clinical practice.
        Arrhythm Electrophysiol Rev. 2016; 5: 136-143
        • Health Quality (Ontario)
        Long-term continuous ambulatory ECG monitors and external cardiac loop recorders for cardiac arrhythmia: a health technology assessment.
        Ont Health Technol Assess Ser. 2017; 17: 1-56
        • Srinivasulu A.
        • Sriraam N.
        An engineering perspective of external cardiac loop recorder: a systematic review.
        J Med Eng. 2016; 20166931347
        • Abi Khalil C.
        • Haddad F.
        • Al Suwaidi J.
        Investigating palpitations: the role of Holter monitoring and loop recorders.
        BMJ. 2017; 358: j3123
        • Francisco-Pascual J.
        • Santos-Ortega A.
        • Roca-Luque I.
        • Rivas-Gandara N.
        • Perez-Rodon J.
        • Mila-Pascual L.
        • et al.
        Diagnostic yield and economic assessment of a diagnostic protocol with systematic use of an external loop recorder for patients with palpitations.
        Rev Esp Cardiol (Engl Ed). 2019; 72: 473-478
        • Giada F.
        • Bertaglia E.
        • Reimers B.
        • Noventa D.
        • Raviele A.
        Current and emerging indications for implantable cardiac monitors.
        Pacing Clin Electrophysiol. 2012; 35: 1169-1178
        • Olgin J.E.
        Approach to the Patient with Suspected Arrhythmia.
        in: Goldman L. Schafer A.I. Goldman's Cecil Medicine (Twenty Fourth Edition). W.B. Saunders, Philadelphia2012: 337-344
        • Brignole M.
        • Vardas P.
        • Hoffman E.
        • Huikuri H.
        • Moya A.
        • Ricci R.
        • et al.
        Indications for the use of diagnostic implantable and external ECG loop recorders.
        Europace. 2009; 11: 671-687
        • Vilcant V.
        • Kousa O.
        • Hai O.
        Implantable Loop Recorder.
        StatPearls. Treasure Island (FL), 2022
        • Bisignani A.
        • De Bonis S.
        • Mancuso L.
        • Ceravolo G.
        • Bisignani G.
        Implantable loop recorder in clinical practice.
        J Arrhythm. 2019; 35: 25-32
        • Cheung C.C.
        • Krahn A.D.
        • Andrade J.G.
        The emerging role of wearable technologies in detection of arrhythmia.
        Can J Cardiol. 2018; 34: 1083-1087
        • Lee S.M.
        • Lee D.
        Healthcare wearable devices: an analysis of key factors for continuous use intention.
        Service Business. 2020; 14: 503-531
        • Patel S.
        • Park H.
        • Bonato P.
        • Chan L.
        • Rodgers M.
        A review of wearable sensors and systems with application in rehabilitation.
        J Neuroeng Rehabil. 2012; 9: 21
        • Kuehn B.M.
        Telemedicine helps cardiologists extend their reach.
        Circulation. 2016; 134: 1189-1191
        • Bayoumy K.
        • Gaber M.
        • Elshafeey A.
        • Mhaimeed O.
        • Dineen E.H.
        • Marvel F.A.
        • et al.
        Smart wearable devices in cardiovascular care: where we are and how to move forward.
        Nat Rev Cardiol. 2021; 18: 581-599
        • Duncker D.
        • Ding W.Y.
        • Etheridge S.
        • Noseworthy P.A.
        • Veltmann C.
        • Yao X.
        • et al.
        Smart wearables for cardiac monitoring-real-world use beyond atrial fibrillation.
        Sensors (Basel). 2021; 21: 2539
        • Falter M.
        • Budts W.
        • Goetschalckx K.
        • Cornelissen V.
        • Buys R.
        Accuracy of Apple watch measurements for heart rate and energy expenditure in patients with cardiovascular disease: cross-sectional study.
        JMIR Mhealth Uhealth. 2019; 7e11889
      3. University of Deleware. How Garmin watch heart rate monitors work.
        • Nelson B.W.
        • Allen N.B.
        Accuracy of consumer wearable heart rate measurement during an ecologically valid 24-hour period: intraindividual validation study.
        JMIR Mhealth Uhealth. 2019; 7e10828
        • Apple Inc
        Using Apple Watch for Arrhythmia Detection.
        • Al-Kaisey A.M.
        • Koshy A.N.
        • Ha F.J.
        • Spencer R.
        • Toner L.
        • Sajeev J.K.
        • et al.
        Accuracy of wrist-worn heart rate monitors for rate control assessment in atrial fibrillation.
        Int J Cardiol. 2020; 300: 161-164
        • Lubitz S.A.
        • Faranesh A.Z.
        • Atlas S.J.
        • McManus D.D.
        • Singer D.E.
        • Pagoto S.
        • et al.
        Rationale and design of a large population study to validate software for the assessment of atrial fibrillation from data acquired by a consumer tracker or smartwatch: the Fitbit heart study.
        Am Heart J. 2021; 238: 16-26
        • Apple Inc. Apple Watch
        Helping your patients identify early warning signs.
        • Fitbit Inc
        Fitbit Charge 4.
        • Toshiyo Tamura Y.M.
        Masika Sekine and Masaki Yoshida. Wearable photoplethysmographic sensors—past and present.
        Electronics. 2014; 3: 282-302
        • Kamisalic A.
        • Fister Jr., I.
        • Turkanovic M.
        • Karakatic S.
        Sensors and functionalities of non-invasive wrist-wearable devices: a review.
        Sensors (Basel). 2018; 18: 1714
        • Zheng Y.L.
        • Ding X.R.
        • Poon C.C.
        • Lo B.P.
        • Zhang H.
        • Zhou X.L.
        • et al.
        Unobtrusive sensing and wearable devices for health informatics.
        IEEE Trans Biomed Eng. 2014; 61: 1538-1554
        • Vandenberk T.
        • Stans J.
        • Mortelmans C.
        • Van Haelst R.
        • Van Schelvergem G.
        • Pelckmans C.
        • et al.
        Clinical validation of heart rate apps: mixed-methods evaluation study.
        JMIR Mhealth Uhealth. 2017; 5: e129
        • Kroll R.R.
        • Boyd J.G.
        • Maslove D.M.
        Accuracy of a wrist-worn wearable device for monitoring heart rates in hospital inpatients: a prospective observational study.
        J Med Internet Res. 2016; 18: e253
        • Bolanos M.
        • Nazeran H.
        • Haltiwanger E.
        Comparison of heart rate variability signal features derived from electrocardiography and photoplethysmography in healthy individuals.
        Conf Proc IEEE Eng Med Biol Soc. 2006; 2006: 4289-4294
        • Selvaraj N.
        • Jaryal A.
        • Santhosh J.
        • Deepak K.K.
        • Anand S.
        Assessment of heart rate variability derived from finger-tip photoplethysmography as compared to electrocardiography.
        J Med Eng Technol. 2008; 32: 479-484
        • Castaneda D.
        • Esparza A.
        • Ghamari M.
        • Soltanpur C.
        • Nazeran H.
        A review on wearable photoplethysmography sensors and their potential future applications in health care.
        Int J Biosens Bioelectron. 2018; 4: 195-202
        • Zhang Y.
        • Liu B.
        • Zhang Z.
        Combining ensemble empirical mode decomposition with spectrum subtraction technique for heart rate monitoring using wrist-type photoplethysmography.
        Biomed Signal Process Control. 2015; 21: 119-125
        • Zhang Z.
        • Pi Z.
        • Liu B.
        TROIKA: a general framework for heart rate monitoring using wrist-type photoplethysmographic signals during intensive physical exercise.
        IEEE Trans Biomed Eng. 2015; 62: 522-531
        • Bent B.
        • Goldstein B.A.
        • Kibbe W.A.
        • Dunn J.P.
        Investigating sources of inaccuracy in wearable optical heart rate sensors.
        NPJ Digit Med. 2020; 3: 18
      4. Alive Technologies. KardiaMobile.
        • Hall A.
        • Mitchell A.R.J.
        • Wood L.
        • Holland C.
        Effectiveness of a single lead AliveCor electrocardiogram application for the screening of atrial fibrillation: a systematic review.
        Medicine (Baltimore). 2020; 99e21388
        • Albert D.
        A six-lead heart monitor on your smartphone: an interview with David Albert.
        Future Cardiol. 2020; 16: 9-11
        • Jin B.E.
        • Wulff H.
        • Widdicombe J.H.
        • Zheng J.
        • Bers D.M.
        • Puglisi J.L.
        A simple device to illustrate the Einthoven triangle.
        Adv Physiol Educ. 2012; 36: 319-324
        • Bumgarner J.M.
        • Lambert C.T.
        • Hussein A.A.
        • Cantillon D.J.
        • Baranowski B.
        • Wolski K.
        • et al.
        Smartwatch algorithm for automated detection of atrial fibrillation.
        J Am Coll Cardiol. 2018; 71: 2381-2388
        • Strik M.
        • Ploux S.
        • Ramirez F.D.
        • Abu-Alrub S.
        • Jais P.
        • Haissaguerre M.
        • et al.
        Smartwatch-based detection of cardiac arrhythmias: beyond the differentiation between sinus rhythm and atrial fibrillation.
        Heart Rhythm. 2021; 18: 1524-1532
        • Fung E.
        • Jarvelin M.R.
        • Doshi R.N.
        • Shinbane J.S.
        • Carlson S.K.
        • Grazette L.P.
        • et al.
        Electrocardiographic patch devices and contemporary wireless cardiac monitoring.
        Front Physiol. 2015; 6: 149
        • Lobodzinski S.S.
        • Laks M.M.
        New devices for very long-term ECG monitoring.
        Cardiol J. 2012; 19: 210-214
        • Barrett P.M.
        • Komatireddy R.
        • Haaser S.
        • Topol S.
        • Sheard J.
        • Encinas J.
        • et al.
        Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring.
        Am J Med. 2014; 127: 95 e11-7
        • Schreiber D.
        • Sattar A.
        • Drigalla D.
        • Higgins S.
        Ambulatory cardiac monitoring for discharged emergency department patients with possible cardiac arrhythmias.
        West J Emerg Med. 2014; 15: 194-198
        • Engel J.M.
        • Mehta V.
        • Fogoros R.
        • Chavan A.
        Study of arrhythmia prevalence in NUVANT Mobile Cardiac Telemetry system patients.
        Annu Int Conf IEEE Eng Med Biol Soc. 2012; 2012: 2440-2443
        • Walsh 3rd, J.A.
        • Topol E.J.
        • Steinhubl S.R.
        Novel wireless devices for cardiac monitoring.
        Circulation. 2014; 130: 573-581
        • Brieger D.
        • Amerena J.
        • Attia J.
        • Bajorek B.
        • Chan K.H.
        • et al.
        • NHFA CSANZ Atrial Fibrillation Guideline Working Group
        National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018.
        Heart Lung Circ. 2018; 27: 1209-1266
        • Hindricks G.
        • Potpara T.
        • Dagres N.
        • Arbelo E.
        • Bax J.J.
        • Blomstrom-Lundqvist C.
        • et al.
        2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC.
        Eur Heart J. 2021; 42: 373-498
        • William A.D.
        • Kanbour M.
        • Callahan T.
        • Bhargava M.
        • Varma N.
        • Rickard J.
        • et al.
        Assessing the accuracy of an automated atrial fibrillation detection algorithm using smartphone technology: the iREAD study.
        Heart Rhythm. 2018; 15: 1561-1565
        • Halcox J.P.J.
        • Wareham K.
        • Cardew A.
        • Gilmore M.
        • Barry J.P.
        • Phillips C.
        • et al.
        Assessment of remote heart rhythm sampling using the AliveCor Heart Monitor to screen for atrial fibrillation: the REHEARSE-AF study.
        Circulation. 2017; 136: 1784-1794
        • Goldenthal I.L.
        • Sciacca R.R.
        • Riga T.
        • Bakken S.
        • Baumeister M.
        • Biviano A.B.
        • et al.
        Recurrent atrial fibrillation/flutter detection after ablation or cardioversion using the AliveCor KardiaMobile device: iHEART results.
        J Cardiovasc Electrophysiol. 2019; 30: 2220-2228
        • Perez M.V.
        • Mahaffey K.W.
        • Hedlin H.
        • Rumsfeld J.S.
        • Garcia A.
        • Ferris T.
        • et al.
        Large-scale assessment of a smartwatch to identify atrial fibrillation.
        N Engl J Med. 2019; 381: 1909-1917
        • Seshadri D.R.
        • Bittel B.
        • Browsky D.
        • Houghtaling P.
        • Drummond C.K.
        • Desai M.Y.
        • et al.
        Accuracy of Apple watch for detection of atrial fibrillation.
        Circulation. 2020; 141: 702-703
      5. Janssen Scientific Affairs LLC. A Study to Investigate if Early Atrial Fibrillation (AF) Diagnosis Reduces Risk of Events Like Stroke in the Real-World.
        • Guo Y.
        • Wang H.
        • Zhang H.
        • Liu T.
        • Liang Z.
        • Xia Y.
        • et al.
        Mobile photoplethysmographic technology to detect atrial fibrillation.
        J Am Coll Cardiol. 2019; 74: 2365-2375
        • Koshy A.N.
        • Sajeev J.K.
        • Nerlekar N.
        • Brown A.J.
        • Rajakariar K.
        • Zureik M.
        • et al.
        Smart watches for heart rate assessment in atrial arrhythmias.
        Int J Cardiol. 2018; 266: 124-127
        • Avram R.
        • Ramsis M.
        • Cristal A.D.
        • Nathan V.
        • Zhu L.
        • Kim J.
        • et al.
        Validation of an algorithm for continuous monitoring of atrial fibrillation using a consumer smartwatch.
        Heart Rhythm. 2021; 18: 1482-1490
        • Steinhubl S.R.
        • Waalen J.
        • Edwards A.M.
        • Ariniello L.M.
        • Mehta R.R.
        • Ebner G.S.
        • et al.
        Effect of a home-based wearable continuous ECG monitoring patch on detection of undiagnosed atrial fibrillation: the mSToPS randomized clinical trial.
        JAMA. 2018; 320: 146-155
        • Heo N.J.
        • Rhee S.Y.
        • Waalen J.
        • Steinhubl S.
        Chronic kidney disease and undiagnosed atrial fibrillation in individuals with diabetes.
        Cardiovasc Diabetol. 2020; 19: 157
        • Hwang J.
        • Kim J.
        • Choi K.J.
        • Cho M.S.
        • Nam G.B.
        • Kim Y.H.
        Assessing accuracy of wrist-worn wearable devices in measurement of paroxysmal supraventricular tachycardia heart rate.
        Korean Circ J. 2019; 49: 437-445
        • Burke J.
        • Haigney M.C.P.
        • Borne R.
        • Krantz M.J.
        Smartwatch detection of ventricular tachycardia: case series.
        HeartRhythm Case Rep. 2020; 6: 800-804
        • Goel H.V.
        • Alpert J.S.
        • Shaheen M.H.
        • Jones T.A.
        • Skinner D.P.
        Comparing a mobile ECG device with holter monitoring for patients with palpitations in an urgent care setting: a preliminary study.
        Circulation. 2018; 138A10550
        • Reed M.J.
        • Grubb N.R.
        • Lang C.C.
        • O'Brien R.
        • Simpson K.
        • Padarenga M.
        • et al.
        Multi-centre randomised controlled trial of a smartphone-based event recorder alongside standard care versus standard care for patients presenting to the emergency department with palpitations and pre-syncope: the IPED (Investigation of Palpitations in the ED) study.
        EClinicalMedicine. 2019; 8: 37-46
        • Stavrakis S.
        • Garabelli P.J.
        • Smith L.
        • Albert D.
        • Po S.S.
        Clinical validation of a smartphone based, 6-lead ECG device.
        Circulation. 2017; 136A15576
        • Chua S.K.
        • Chen L.C.
        • Lien L.M.
        • Lo H.M.
        • Liao Z.Y.
        • Chao S.P.
        • et al.
        Comparison of arrhythmia detection by 24-hour Holter and 14-day continuous electrocardiography patch monitoring.
        Acta Cardiol Sin. 2020; 36: 251-259
        • Kirchhof P.
        • Benussi S.
        • Kotecha D.
        • Ahlsson A.
        • Atar D.
        • Casadei B.
        • et al.
        [2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS].
        Kardiol Pol. 2016; 74: 1359-1469
        • Meschia J.F.
        • Bushnell C.
        • Boden-Albala B.
        • Braun L.T.
        • Bravata D.M.
        • Chaturvedi S.
        • et al.
        Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2014; 45: 3754-3832
        • Wong K.C.
        • Klimis H.
        • Lowres N.
        • von Huben A.
        • Marschner S.
        • Chow C.K.
        Diagnostic accuracy of handheld electrocardiogram devices in detecting atrial fibrillation in adults in community versus hospital settings: a systematic review and meta-analysis.
        Heart. 2020; 106: 1211-1217
        • Chung E.H.
        • Guise K.D.
        QTC intervals can be assessed with the AliveCor heart monitor in patients on dofetilide for atrial fibrillation.
        J Electrocardiol. 2015; 48: 8-9
        • Koltowski L.
        • Balsam P.
        • Glowczynska R.
        • Rokicki J.K.
        • Peller M.
        • Maksym J.
        • et al.
        Kardia Mobile applicability in clinical practice: a comparison of Kardia Mobile and standard 12-lead electrocardiogram records in 100 consecutive patients of a tertiary cardiovascular care center.
        Cardiol J. 2021; 28: 543-548
        • Puranik S.
        • Harlow C.
        • Park M.
        • Martin L.
        • Coleman M.
        • Russell G.
        • et al.
        Monitoring prolongation of QT interval in patients with multidrug-resistant tuberculosis and non-tuberculous mycobacterium using mobile health device AliveCor.
        Thorax. 2020; 76
        • Spaccarotella C.A.M.
        • Migliarino S.
        • Mongiardo A.
        • Sabatino J.
        • Santarpia G.
        • De Rosa S.
        • et al.
        Measurement of the QT interval using the Apple Watch.
        Sci Rep. 2021; 1110817
        • Maille B.
        • Wilkin M.
        • Million M.
        • Resseguier N.
        • Franceschi F.
        • Koutbi-Franceschi L.
        • et al.
        Smartwatch electrocardiogram and artificial intelligence for assessing cardiac-rhythm safety of drug therapy in the COVID-19 pandemic. The QT-logs study.
        Int J Cardiol. 2021; 331: 333-339
        • Liao Y.
        • Thompson C.
        • Peterson S.
        • Mandrola J.
        • Beg M.S.
        The future of wearable technologies and remote monitoring in health care.
        Am Soc Clin Oncol Educ Book. 2019; 39: 115-121
        • Kumar S.
        • Haqqani H.
        • Wynn G.
        • Pathak R.K.
        • Lipton J.
        • Mahajan R.
        • et al.
        Position statement on the management of cardiac electrophysiology and cardiac implantable electronic devices in Australia During the COVID-19 pandemic: a living document.
        Heart Lung Circ. 2020; 29: e57-e68
        • Lakkireddy D.R.
        • Chung M.K.
        • Gopinathannair R.
        • Patton K.K.
        • Gluckman T.J.
        • Turagam M.
        • et al.
        Guidance for cardiac electrophysiology during the COVID-19 pandemic from the Heart Rhythm Society COVID-19 task force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Heart Association.
        Circulation. 2020; 141: e823-e831
        • Lowres N.
        • Neubeck L.
        • Salkeld G.
        • Krass I.
        • McLachlan A.J.
        • Redfern J.
        • et al.
        Feasibility and cost-effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study.
        Thromb Haemost. 2014; 111: 1167-1176
        • Wyatt K.D.
        • Poole L.R.
        • Mullan A.F.
        • Kopecky S.L.
        • Heaton H.A.
        Clinical evaluation and diagnostic yield following evaluation of abnormal pulse detected using Apple Watch.
        J Am Med Inform Assoc. 2020; 27: 1359-1363
        • Ajami S.
        • Teimouri F.
        Features and application of wearable biosensors in medical care.
        J Res Med Sci. 2015; 20: 1208-1215
        • Johnson D.M.
        • Junarta J.
        • Gerace C.
        • Frisch D.R.
        Usefulness of mobile electrocardiographic devices to reduce urgent healthcare visits.
        Am J Cardiol. 2021; 153: 125-128
        • Mandrola J.
        • Foy A.
        • Naccarelli G.
        Screening for atrial fibrillation comes with many snags.
        JAMA Intern Med. 2018; 178: 1296-1298
        • Farivar S.
        • Abouzahra M.
        • Ghasemaghaei M.
        Wearable device adoption among older adults: a mixed-methods study.
        Int J Inf Manage. 2020; 55102209
        • Carpenter A.
        • Frontera A.
        Smart-watches: a potential challenger to the implantable loop recorder?.
        Europace. 2016; 18: 791-793
        • Kiranyaz S.
        • Ince T.
        • Gabbouj M.
        Personalized monitoring and advance warning system for cardiac arrhythmias.
        Sci Rep. 2017; 7: 9270
        • Wicks P.
        • Stamford J.
        • Grootenhuis M.A.
        • Haverman L.
        • Ahmed S.
        Innovations in e-health.
        Qual Life Res. 2014; 23: 195-203
        • Kim N.H.
        • Ko J.S.
        Introduction of wearable device in cardiovascular field for monitoring arrhythmia.
        Chonnam Med J. 2021; 57: 1-6
        • Alive Technologies
        Alive Technologies.
        Date accessed: May 27, 2021
        • Tieleman R.G.
        • Plantinga Y.
        • Rinkes D.
        • Bartels G.L.
        • Posma J.L.
        • Cator R.
        • et al.
        Validation and clinical use of a novel diagnostic device for screening of atrial fibrillation.
        Europace. 2014; 16: 1291-1295
        • Bansal A.
        • Joshi R.
        Portable out-of-hospital electrocardiography: a review of current technologies.
        J Arrhythm. 2018; 34: 129-138
        • Brito R.
        • Mondouagne L.P.
        • Stettler C.
        • Combescure C.
        • Burri H.
        Automatic atrial fibrillation and flutter detection by a handheld ECG recorder, and utility of sequential finger and precordial recordings.
        J Electrocardiol. 2018; 51: 1135-1140
      6. Cardiac Designs Inc. ECG Check.
        Date accessed: July 11, 2021
        • Garmin Ltd
        VivoSmart 4 Owners Manual.
      7. Huawei Device Co. Ltd. HUAWEI WATCH GT.
      8. Samsung Electronics Co. Ltd. Galaxy Watch Active2.
      9. Withings. Move ECG | ECG Monitor & Activity watch.
        Date accessed: May 27, 2021
        • Fitbit Inc
        Heart Rhythm Assessment with Fitbit ECG app.
      10. Apple Inc. Why Apple Watch.
        • Haverkamp H.T.
        • Fosse S.O.
        • Schuster P.
        Accuracy and usability of single-lead ECG from smartphones - a clinical study.
        Indian Pacing Electrophysiol J. 2019; 19: 145-149
        • University Hospital (Basel Switzerland)
        Accuracy of Cardiac Wearables Devices to Detect Atrial Fibrillation.
        • Kansas City Heart Rhythm Research Foundation
        Accuracy of Rhythm Detection by a Wearable Smart Watch for Cardiac Arrhythmias (The WATCH-RHYTHM Study).
        • Seoul National University Bundang Hospital
        Diagnostic Validation of Wearable ECG Monitoring Patch, ATP-C120.
        • University of Cambridge
        A Study of the Acceptability and Performance of Wearables for Atrial Fibrillation Screening in Older Adults.
        • University Hospital (Basel Switzerland)
        Determine AF Burden With PPG Trial - Detection and Quantification of Episodes of Atrial Fibrillation.
        • University of Kansas Medical Center
        Atrial Fibrillation Detection Using Garmin Wearable Technology (GARMIN AF).
        • Yale University
        Effect of Wearable Devices on Patient-Reported Outcomes and Clinical Utilization.
        • Unity Health Toronto
        Detection of Atrial Fibrillation After Cardiac Surgery (SEARCH-AF).
        • Verily Life Sciences LLC
        Study Watch AF Detection At Home.
        • Fundación EPIC
        Evaluation of Ambulatory Monitoring of Patients After High-risk Acute Coronary Syndrome Using Two Different Systems: Biomonitor-2 and Kardia Mobile (Monitor- ACS).
        • Victoria Cardiac Arrhythmia Trials
        Early Diagnosis of Atrial Fibrillation in the Wait-Time Prior to Seeing a Cardiologist (CATCH-AF).
        • Waks J.W.
        • Fein A.S.
        • Das S.
        Wide complex tachycardia recorded with a smartphone cardiac rhythm monitor.
        JAMA Intern Med. 2015; 175: 437-439
        • Richley D.
        • Graham A.
        Diagnosing symptomatic arrhythmia via mobile phone.
        Br J Card Nurs. 2015; 10
        • Tabing A.
        • Harrell T.
        • Romero S.
        • Francisco G.
        Supraventricular tachycardia diagnosed by smartphone ECG.
        BMJ Case Reports. 2017; 2017
        • Goldstein L.N.
        • Wells M.
        Smart watch-detected tachycardia: a case of atrial flutter.
        Oxf Med Case Reports. 2019; 2019: 495-497
        • Siddeek H.
        • Fisher K.
        • McMakin S.
        • Bass J.L.
        • Cortez D.
        AVNRT captured by Apple Watch Series 4: Can the Apple watch be used as an event monitor?.
        Ann Noninvasive Electrocardiol. 2020; 25e12742
        • Ringwald M.
        • Crich A.
        • Beysard N.
        Smart watch recording of ventricular tachycardia: Case study.
        Am J Emerg Med. 2020; 38: 849 e3-849 e5
        • Phillips D.
        • O'Callaghan P.
        • Zaidi A.
        Arrhythmia in an athlete diagnosed by smartphone electrocardiogram: a case report.
        Eur Heart J Case Rep. 2021; 5: ytab186