Effectiveness of Smartwatches and Wearables for Cardiac Arrhythmia Detection and Monitoring: A Systematic Review

Abstract

Objective: To assess the effectiveness of photoplethysmography- and/or electrocardiography-based smartwatches and wearable devices for the detection and monitoring of cardiac arrhythmias in recent publications.

Materials and Methods: A systematic literature review with narrative synthesis was conducted following PRISMA 2020 recommendations. The main search was performed in PubMed and Scopus for the period 2021–2025, with a complementary search in Web of Science. Inclusion and exclusion criteria, duplicate removal, title/abstract screening, and full-text assessment were applied. The protocol was not registered in PROSPERO, which is acknowledged as a methodological limitation.

Results: A total of 753 records were identified. After screening and eligibility assessment, 18 original studies were included in the main synthesis. The evidence focused mainly on atrial fibrillation. Photoplethysmography-based devices showed usefulness as alert or screening tools, whereas single-lead electrocardiographic recordings provided greater value when integrated into clinical confirmation pathways. Diagnostic metrics varied according to device, algorithm, population, and reference standard.

Conclusions: Smartwatches and wearable devices are useful complementary tools for the detection and monitoring of atrial fibrillation and other paroxysmal arrhythmias. However, they do not replace the clinical standard. Their applicability improves when used in selected populations, with professional interpretation, electrocardiographic confirmation, and clear follow-up protocols.

Keywords: Wearable Electronic Devices; Photoplethysmography; Electrocardiography; Cardiac Arrhythmias; Atrial Fibrillation.