Wearable devices for atrial fibrillation: diagnostic and screening roles of ECG and PPG-A systematic review.

OBJECTIVE: Atrial fibrillation (AF) is a major predictor of heart failure, stroke, and mortality. Traditional Holter monitors and event recorders are limited by short recording times. Wearable electrocardiographic (ECG) and photoplethysmographic (PPG) devices enable continuous monitoring and large-scale AF screening. This review assesses their diagnostic performance, clinical usefulness, and implementation challenges. METHODS: Following PRISMA guidelines, PubMed, Embase, and Web of Science were searched for studies from 2010-2025. Included studies had ≥30 participants and reported AF detection accuracy or clinical outcomes. Studies evaluating PPG devices required ECG verification as the reference standard. RESULTS: Wearable ECG patches showed high sensitivity (92-98%) and specificity (85-97%) and detected more AF episodes than short-duration Holter monitoring. PPG-based smartwatches demonstrated moderate-to-high accuracy in irregular pulse detection, further improved by AI-assisted algorithms. Limitations included motion artifacts, false positives, adherence issues, clinician data burden, and limited evidence for stroke prevention. CONCLUSION: Wearable ECG devices are reliable for clinical AF detection. PPG-based devices are best used for screening, with subsequent ECG confirmation according to international AF management guidelines.