Reviews
Vol. 4 No. 3 (2026)
Diagnostic accuracy of wearable technologies for atrial fibrillation detection: a systematic review and meta-analysis
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 19 October 2026
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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of ischemic stroke. Because AF is frequently paroxysmal and asymptomatic, conventional short-term monitoring often fails to detect it. Wearable technologies have emerged as promising tools for AF screening, but their diagnostic performance requires comprehensive evaluation. We conducted a systematic review and diagnostic test accuracy meta-analysis following PRISMA-DTA guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to 25 February 2026 for prospective and retrospective studies using electrocardiographic reference standards. Bivariate random-effects and Bayesian hierarchical models were used to pool diagnostic accuracy estimates. Fifty-one studies involving 33,374 participants from 15 countries were included. PPG-based smartwatches demonstrated the highest sensitivity (96.3%) with specificity of 93.6%. ECG-based smartwatches achieved sensitivity of 89.0% and specificity of 92.8% (DOR 103.9). Smartphone-based ECG devices showed the strongest overall diagnostic performance, with sensitivity of 94.5%, specificity of 95.8%, DOR of 396.4, LR+ of 22.6, and LR− of 0.057. Smartphone-based PPG applications achieved sensitivity of 92.0% and specificity of 91.9%. Apple Watch demonstrated sensitivity of 94.1% and specificity of 94.6%. Meta-regression revealed no statistically significant differences in diagnostic accuracy between device categories despite slightly higher point estimates for PPG-based smartwatches. No significant publication bias was detected (Deeks' test, p=0.18). Wearable devices demonstrate excellent diagnostic accuracy for AF detection, particularly smartphone-based ECG applications. These technologies support scalable AF screening and monitoring, although heterogeneity in study populations and diagnostic thresholds should be considered when applying these findings to routine clinical practice.
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How to Cite
1.
Abbas A, Hamid G, Kumar B, Hussain Qamari SM, Riaz H. Diagnostic accuracy of wearable technologies for atrial fibrillation detection: a systematic review and meta-analysis. Global Cardiol [Internet]. 2026 Oct. 19 [cited 2026 Oct. 22];4(3). Available from: https://www.globalcardiology.info/site/article/view/120
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