CHSU Discovery

Abstract
Background
Atrial fibrillation (AF) is the most common treated cardiac arrhythmia in the United States, contributing substantially 
to morbidity, mortality, and healthcare costs. AF is associated with significant complications, including ischemic 
stroke and heart failure, and often occurs in patients with underlying cardiovascular risk factors such as hypertension, 
diabetes, and structural heart disease. Given its variable presentation, from asymptomatic to life-threatening, early 
detection remains a critical component of effective management. The widespread adoption of wearable technologies 
has introduced new opportunities for scalable, noninvasive AF screening in the general population.
Objective
This review aims to evaluate the role of smartwatch-based electrocardiogram (ECG) technologies in the detection of 
atrial fibrillation, with a focus on device functionality, regulatory considerations, and current evidence regarding 
diagnostic performance.
Methods
A narrative review of the literature was conducted, synthesizing data from regulatory documents, clinical validation 
studies, and publicly available manufacturer specifications. Key areas of focus included smartwatch ECG technology, 
photoplethysmography (PPG)-based rhythm detection, US Food and Drug Administration (FDA) regulatory pathways, 
and reported sensitivity and specificity of commercially available devices.