Wearable Guardians: How Smartwatches and Smartphones are Transforming Atrial Fibrillation Screening

Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting millions globally and significantly increasing the risk of stroke, heart failure, and mortality. Traditional detection methods often fail to identify paroxysmal or asymptomatic atrial fibrillation, leaving many patients undiagnosed until serious complications arise. The proliferation of consumer-grade wearable technology, particularly smartwatches and smartphones with advanced sensing capabilities, has created unprecedented opportunities for large-scale, cost-effective atrial fibrillation screening. This review examines the current evidence regarding the accuracy, feasibility, and clinical impact of smartphone and smartwatch-based atrial fibrillation detection technologies. We analyze various technologies, including smartphone-based electrocardiogram attachments, photoplethysmography applications, and smartwatch algorithms, evaluating their diagnostic performance, implementation challenges, and potential for integration into clinical practice. The evidence suggests these technologies demonstrate promising diagnostic accuracy with sensitivity and specificity often exceeding 95% in controlled settings, though performance may vary in real-world conditions. Successful large-scale screening initiatives demonstrate the feasibility of technology-based approaches, while ongoing research continues to address limitations related to false positives, user adherence, and clinical workflow integration. As these technologies evolve, they stand to revolutionize atrial fibrillation screening paradigms, enabling earlier intervention and potentially reducing atrial fibrillation-related morbidity and mortality.