Smartwatch Performance for the Detection and Quantification of Atrial Fibrillation

Wasserlauf, Jeremiah; You, Cindy; Patel, Ruchi; Valys, Alexander; Albert, David; Passman, Rod

doi:10.1161/circep.118.006834

Cited by 245ECG Monitoring and AnalysisNon-Invasive Vital Sign MonitoringAtrial Fibrillation Management and Outcomes

Smartwatch Performance for the Detection and Quantification of Atrial Fibrillation

Wasserlauf, Jeremiah, You, Cindy, Patel, Ruchi, Valys, Alexander, Albert, David, Passman, Rod·2019·Circulation: Arrhythmia and Electrophysiology

DOI 10.1161/circep.118.006834

Open this paper in CoChat — free account

Abstract

Background: Atrial fibrillation (AF) burden and duration appear to be related to stroke risk. A wearable consumer electronic device could provide long-term assessment of these measures inexpensively and noninvasively. This study compares the accuracy of an AF-sensing watch (AFSW; Apple Watch with KardiaBand) with simultaneous recordings from an insertable cardiac monitor (ICM; Reveal LINQ). Methods: SmartRhythm 2.0, a convolutional neural network, was trained on anonymized data of heart rate, activity level, and ECGs from 7500 AliveCor users. The network was validated on data collected in 24 patients with ICMs and a history of paroxysmal AF who simultaneously wore the AFSW with SmartRhythm 0.1 software. The primary outcome was sensitivity of the AFSW for AF episodes ≥1 hour. Secondary end points included sensitivity of the AFSW for detection of AF by subject and sensitivity for total AF duration across all subjects. Subjects with >50% false-positive AF episodes on ICM were excluded. Results: We analyzed 31 348.9 hours (mean (SD), 11.3 (4.4) hours/day) of simultaneous AFSW and ICM recordings in 24 patients. The ICM detected 82 episodes of AF ≥1 hour while the AFSW was worn, with a total duration of 1127.1 hours. Of these, the SmartRhythm 2.0 neural network detected 80 episodes (episode sensitivity, 97.5%) with a total duration of 1101.1 hours (duration sensitivity, 97.7%). Three of the 18 subjects with AF ≥1 hour had AF only when the watch was not being worn (patient sensitivity, 83.3%; or 100% during time worn). Positive predictive value for AF episodes was 39.9%. Conclusions: An AFSW is highly sensitive for detection of AF and assessment of AF duration in an ambulatory population when compared with an ICM. Such devices may represent an inexpensive, noninvasive approach to long-term AF surveillance and management.

Integrity signals

Registry

Crossref · 10.1161/circep.118.006834

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Neural networks have been used to detect AF from PPG signals and PPG-derived HRs.
“neural networks have been used to detect AF from PPG signals and PPG-derived HRs”
From Wearable Photoplethysmography for Cardiovascular Monitoring (2022) · cites this paper as [192]

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955 · see citing works
Lifetime Risk for Development of Atrial Fibrillation: The Framingham Heart Study
Lloyd-Jones, D. M., Wang, T. J., Leip, E. P., Larson, M. G., Levy, D., Vasan, R. S., D’Agostino, R. B., Massaro, J. M., Beiser, A., Wolf, P. A., et al. (2004) · Circulation · doi:10.1161/01.cir.0000140263.20897.42 · Cited by 2,041 · see citing works
The Relationship Between Daily Atrial Tachyarrhythmia Burden From Implantable Device Diagnostics and Stroke Risk: The TRENDS Study
Glotzer, T. V., Daoud, E. G., Wyse, D. G., Singer, D. E., Ezekowitz, M. D., Hilker, C., Miller, C., Qi, D., & Ziegler, P. D. (2009) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.109.849638 · Cited by 879 · see citing works
Atrial High Rate Episodes Detected by Pacemaker Diagnostics Predict Death and Stroke: Report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST)
Glotzer, T. V., Hellkamp, A. S., Zimmerman, J., Sweeney, M. O., Yee, R., Marinchak, R., Cook, J., Paraschos, A., Love, J., Radoslovich, G., et al. (2003) · Circulation · doi:10.1161/01.cir.0000057981.70380.45 · Cited by 750 · see citing works
Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia
Page, R. L., Wilkinson, W. E., Clair, W. K., McCarthy, E. A., & Pritchett, E. L. (1994) · Circulation · doi:10.1161/01.cir.89.1.224 · Cited by 627 · see citing works
Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT
Gelder, I. C. V., Healey, J. S., Crijns, H. J. G. M., Wang, J., Hohnloser, S. H., Gold, M. R., Capucci, A., Lau, C., Morillo, C. A., Hobbelt, A. H., et al. (2017) · European Heart Journal · doi:10.1093/eurheartj/ehx042 · Cited by 604 · see citing works
Smartwatch Algorithm for Automated Detection of Atrial Fibrillation
Bumgarner, J. M., Lambert, C. T., Hussein, A. A., Cantillon, D. J., Baranowski, B., Wolski, K., Lindsay, B. D., Wazni, O. M., & Tarakji, K. G. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.03.003 · Cited by 446 · see citing works
Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association
Chen, L. Y., Chung, M. K., Allen, L. A., Ezekowitz, M. D., Furie, K. L., McCabe, P. J., Noseworthy, P. A., Perez, M. V., & Turakhia, M. P. (2018) · Circulation · doi:10.1161/cir.0000000000000568 · Cited by 443 · see citing works
Performance of a new leadless implantable cardiac monitor in detecting and quantifying atrial fibrillation - results of the XPECT trial
Hindricks, G., Pokushalov, E., Urban, L., Taborsky, M., Kuck, K.-H., Lebedev, D., Rieger, G., & Pürerfellner, H. (2010) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.877852 · Cited by 422 · see citing works
iPhone ECG application for community screening to detect silent atrial fibrillation: A novel technology to prevent stroke
Lau, J. K., Lowres, N., Neubeck, L., Brieger, D. B., Sy, R. W., Galloway, C. D., Albert, D. E., & Freedman, S. B. (2013) · International Journal of Cardiology · doi:10.1016/j.ijcard.2013.01.220 · Cited by 326 · see citing works
Self-citation
Discerning the Incidence of Symptomatic and Asymptomatic Episodes of Atrial Fibrillation Before and After Catheter Ablation (DISCERN AF): A Prospective, Multicenter Study
Verma, A., Champagne, J., Sapp, J., Essebag, V., Novak, P., Skanes, A., Morillo, C. A., Khaykin, Y., & Birnie, D. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.1561 · Cited by 315 · see citing works
Association of Burden of Atrial Fibrillation With Risk of Ischemic Stroke in Adults With Paroxysmal Atrial Fibrillation
Go, A. S., Reynolds, K., Yang, J., Gupta, N., Lenane, J. C., Sung, S. H., Harrison, T. N., Liu, T., & Solomon, M. D. (2018) · JAMA Cardiology · doi:10.1001/jamacardio.2018.1176 · Cited by 290 · see citing works
Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population
Reiffel, J. A., Verma, A., Kowey, P. R., Halperin, J. L., Gersh, B. J., Wachter, R., Pouliot, E., Ziegler, P., & for the REVEAL AF Investigators (2017) · JAMA Cardiology · doi:10.1001/jamacardio.2017.3180 · Cited by 267 · see citing works
A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation
McManus, D. D., Lee, J., Maitas, O., Esa, N., Pidikiti, R., Carlucci, A., Harrington, J., Mick, E., & Chon, K. H. (2013) · Heart Rhythm · doi:10.1016/j.hrthm.2012.12.001 · Cited by 253 · see citing works
Atrial Fibrillation Burden and Short-Term Risk of Stroke: Case-Crossover Analysis of Continuously Recorded Heart Rhythm From Cardiac Electronic Implanted Devices
Turakhia, M. P., Ziegler, P. D., Schmitt, S. K., Chang, Y., Fan, J., Than, C. T., Keung, E. K., & Singer, D. E. (2015) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.114.003057 · Cited by 197 · see citing works
A Comprehensive Evaluation of Rhythm Monitoring Strategies for the Detection of Atrial Fibrillation Recurrence: Insights From 647 Continuously Monitored Patients and Implications for Monitoring After Therapeutic Interventions
Charitos, E. I., Stierle, U., Ziegler, P. D., Baldewig, M., Robinson, D. R., Sievers, H.-H., & Hanke, T. (2012) · Circulation · doi:10.1161/circulationaha.112.098079 · Cited by 196 · see citing works
Clinical Implications of Brief Device-Detected Atrial Tachyarrhythmias in a Cardiac Rhythm Management Device Population
Swiryn, S., Orlov, M. V., Benditt, D. G., Dimarco, J., Lloyd‐Jones, D. M., Karst, E., Qu, F., Slawsky, M., Turkel, M., & Waldo, A. L. (2016) · Circulation · doi:10.1161/circulationaha.115.020252 · Cited by 154 · see citing works
Assessing the accuracy of an automated atrial fibrillation detection algorithm using smartphone technology: the iREAD study
William, A. D., Kanbour, M., Callahan, T., Bhargava, M., Varma, N., Rickard, J., Saliba, W., Wolski, K., Hussein, A., Lindsay, B. D., et al. (2018) · Heart Rhythm · doi:10.1016/j.hrthm.2018.06.037 · Cited by 154 · see citing works
Ambulatory External Electrocardiographic Monitoring
Mittal, S., Movsowitz, C., & Steinberg, J. S. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.07.026 · Cited by 136 · see citing works
Targeted Anticoagulation for Atrial Fibrillation Guided by Continuous Rhythm Assessment With an Insertable Cardiac Monitor: The Rhythm Evaluation for Anticoagulation With Continuous Monitoring (REACT.COM) Pilot Study
PASSMAN, R., LEONG‐SIT, P., ANDREI, A., HUSKIN, A., TOMSON, T. T., BERNSTEIN, R., ELLIS, E., WAKS, J. W., & ZIMETBAUM, P. (2016) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12864 · Cited by 115 · see citing works
Self-citation
Real-world performance of an enhanced atrial fibrillation detection algorithm in an insertable cardiac monitor
Mittal, S., Rogers, J., Sarkar, S., Koehler, J. L., Warman, E. N., Tomson, T. T., & PASSMAN, R. S. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.05.010 · Cited by 93 · see citing works
Self-citation
Diagnosis of Paroxysmal Atrial Fibrillation in Patients with Implanted Pacemakers: Relationship to Symptoms and Other Variables
Quirino, G., Giammaria, M., CORBUCCI, G., Pistelli, P., Turri, E., Mazza, A., Perucca, A., Checchinato, C., Dalmasso, M., & Barold, S. S. (2008) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2009.02181.x · Cited by 89 · see citing works
Performance of an Implantable Cardiac Monitor to Detect Atrial Fibrillation: Results of the DETECT AF Study
Nölker, G., Mayer, J., Boldt, L., Seidl, K., van Driel, V., Massa, T., Kollum, M., Brachmann, J., Deneke, T., Hindricks, G., et al. (2016) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13089 · Cited by 69 · see citing works
Intermittent anticoagulation guided by continuous atrial fibrillation burden monitoring using dual-chamber pacemakers and implantable cardioverter-defibrillators: Results from the Tailored Anticoagulation for Non-Continuous Atrial Fibrillation (TACTIC-AF) pilot study
Waks, J. W., PASSMAN, R. S., Matos, J. D., Reynolds, M. W., Thosani, A. J., Mela, T., Pederson, D. N., Glotzer, T. V., & ZIMETBAUM, P. J. (2018) · Heart Rhythm · doi:10.1016/j.hrthm.2018.06.027 · Cited by 58 · see citing works
Self-citation
Cryptogenic stroke and atrial fibrillation.
Malnick, S. D. H., Somin, M., & Goland, S. (2014) · PubMed · doi:10.1056/nejmc1409495 · Cited by 42 · see citing works
Current and Emerging Uses of Insertable Cardiac Monitors
Tomson, T. T., & PASSMAN, R. S. (2016) · Cardiology in Review · doi:10.1097/crd.0000000000000129 · Cited by 20 · see citing works
Self-citation
New implantable cardiac monitor with three-lead ECG and active noise detection
Lauschke, J., Busch, M., Haverkamp, W., et al. (2016) · Herz · doi:10.1007/s00059-016-4492-7 · Cited by 15 · see citing works
When is Device-Detected Atrial Fibrillation Actionable?
Wasserlauf, J., & PASSMAN, R. S. (2018) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2017.11.007 · Cited by 3 · see citing works
Self-citation

Flagged first, then by citations

Sorted by citations

Wearable Photoplethysmography for Cardiovascular Monitoring
Charlton, P. H., Kyriacou, P. A., Mant, J., Marozas, V., Chowienczyk, P., & Alastruey, J. (2022) · Proceedings of the IEEE · doi:10.1109/jproc.2022.3149785 · Cited by 250 · see citing works
Clinical Validation of 5 Direct-to-Consumer Wearable Smart Devices to Detect Atrial Fibrillation
Mannhart, D., Lischer, M., Knecht, S., du Fay de Lavallaz, J., Strebel, I., Serban, T., Vögeli, D., Schaer, B., Osswald, S., Mueller, C., et al. (2023) · JACC: Clinical Electrophysiology · doi:10.1016/j.jacep.2022.09.011 · Cited by 175 · see citing works
2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play
Lampert, R., Chung, E. H., Ackerman, M. J., Arroyo, A. R., Darden, D., Deo, R., Dolan, J., Etheridge, S. P., Gray, B. R., Harmon, K. G., et al. (2024) · Heart Rhythm · doi:10.1016/j.hrthm.2024.05.018 · Cited by 167 · see citing works
Wearables in cardiology: Here to stay
Dagher, L., Shi, H., Zhao, Y., & Marrouche, N. F. (2020) · Heart Rhythm · doi:10.1016/j.hrthm.2020.02.023 · Cited by 107 · see citing works
Artificial intelligence for detection of cardiovascular-related diseases from wearable devices: A systematic review and meta-analysis
Lee, S., Chu, Y., Ryu, J., Park, Y. J., Yang, S., & Koh, S. B. (2022) · Yonsei Medical Journal · doi:10.3349/ymj.2022.63.s93 · Cited by 88 · see citing works
Role of wearable rhythm recordings in clinical decision making—The <scp>wEHRAbles</scp> project
Manninger, M., Kosiuk, J., Zweiker, D., Njeim, M., Antolic, B., Kircanski, B., Larsen, J. M., Svennberg, E., Vanduynhoven, P., & Duncker, D. (2020) · Clinical Cardiology · doi:10.1002/clc.23404 · Cited by 50 · see citing works
Atrial fibrillation monitoring with wrist-worn photoplethysmography-based wearables: State-of-the-art review
Eerikäinen, L. M., Bonomi, A. G., Dekker, L. R. C., Vullings, R., & Aarts, R. M. (2020) · Cardiovascular Digital Health Journal · doi:10.1016/j.cvdhj.2020.03.001 · Cited by 24 · see citing works

Authors: Wasserlauf, J., You, C., Patel, R., Valys, A., Albert, D., & Passman, R.
Affiliations: Northwestern University (US)
AliveCor, Mountain View, CA (A.V., D.A.).
ORCID: Wasserlauf, Jeremiah
You, Cindy
Patel, Ruchi
Valys, Alexander
Albert, David
Passman, Rod
Venue: Circulation: Arrhythmia and Electrophysiology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2019-06
Volume: 12
Issue: 6
Pages: e006834-e006834
ISSN: 1941-3084 (ISSN-L)
1941-3149
DOI: 10.1161/circep.118.006834
OpenAlex: W2946078250
Cited by: 245
References: 28
Citations by year: 2026: 10 · 2025: 29 · 2024: 30 · 2023: 40 · 2022: 32 · 2021: 59 · 2020: 35 · 2019: 9 · 2018: 1
FWCI: 24.38
Type: journal article
Language: en
Open access: closed
Locations: Circulation Arrhythmia and Electrophysiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Keywords: atrial fibrillation, smartwatches, wearable ECG, Apple Watch, implantable cardiac monitors, convolutional neural networks, atrial fibrillation detection, atrial fibrillation duration, paroxysmal atrial fibrillation, long-term cardiac monitoring, stroke risk
MeSH terms: Wearable Electronic Devices, Deep Learning, Action Potentials, Aged, Atrial Fibrillation, Female, Heart Atria, Heart Rate, Humans, Male, Predictive Value of Tests, Signal Processing, Computer-Assisted, Reproducibility of Results, Electrocardiography, Ambulatory, Remote Sensing Technology, Mobile Applications

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Smartwatch Performance for the Detection and Quantification of Atrial Fibrillation

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks