JACC Clin Electrophysiol. 2026 Jun 8:S2405-500X(26)00344-0. doi: 10.1016/j.jacep.2026.03.036. Online ahead of print.
ABSTRACT
BACKGROUND: Smartwatches integrated with photoplethysmography (PPG) can effectively identify the occurrence of atrial fibrillation (AF). However, the accuracy of their continuous monitoring of AF burden is still unclear.
OBJECTIVES: This study sought to verify the effectiveness of a smartwatch integrated with the PPG algorithm in continuously monitoring AF burden.
METHODS: This prospective study included patients diagnosed with AF at Beijing Anzhen Hospital between January and December 2024. Each participant continuously wore a smartwatch integrated with the PPG algorithm on the day prior to radiofrequency catheter ablation, together with patch-based electrocardiography (P-ECG) as the reference to validate algorithm performance for estimation of AF burden. The watch-based PPG data were segmented into 30-second intervals and verified with the data from P-ECG to analyze its accuracy, sensitivity, and specificity.
RESULTS: The study recruited 728 participants, with a mean age of 62.0 ± 10.5 years, of whom 412 (56.6%) had paroxysmal AF. The average monitoring time for each participant was 20.4 ± 4.5 hours. The overall validity rate for P-ECG was 96.2%, while the overall validity rate for watch-based PPG was 62.5%. After segmentation, a total of 1,440,826 PPG records were generated. At the interval level, sensitivity was 98.70% (95% CI: 98.66%-98.73%) and specificity was 99.56% (95% CI: 99.54%-99.57%). At the individual level, sensitivity was 91.73% (95% CI: 88.89%-94.15%) and specificity was 96.96% (95% CI: 95.09%-98.59%). The Bland-Altman analysis showed excellent agreement between the AF burden estimates from PPG and electrocardiography (ECG), with a mean difference of -1.34% and 95% limits of agreement ranging from -6.45% to 3.77%. A strong correlation (r = 0.999) was observed between PPG-based and ECG-measured AF burden (NCT05333380).
CONCLUSIONS: Smartwatches integrated with the PPG algorithm offer a practical and noninvasive approach for continuous AF burden monitoring. The results suggest that PPG can be an effective approach for long-term AF management, providing an accessible alternative to traditional ECG monitoring.
PMID:42283663 | DOI:10.1016/j.jacep.2026.03.036