Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta‐analysis

Abstract Background The prevalence of atrial fibrillation (AFib) continues to increase globally, posing a significant risk for serious cardiovascular complications, such as ischemic stroke and thromboembolism. Smartwatch single‐lead electrocardiogram (ECG) can be a practical and accurate early detec...

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Main Authors: Dr. Muhammad Iqhrammullah, Prof. Asnawi Abdullah, Dr. Hermansyah, Fahmi Ichwansyah, Prof. Dr. Ir. Hafnidar A. Rani, Meulu Alina, Artha M. T. Simanjuntak, Derren D. C. H. Rampengan, dr. Seba Talat Al‐Gunaid, dr. Naufal Gusti, dr. Arditya Damarkusuma, Edza Aria Wikurendra
Format: Article
Language:English
Published: Wiley 2025-06-01
Series:Journal of Arrhythmia
Subjects:
Online Access:https://doi.org/10.1002/joa3.70087
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author Dr. Muhammad Iqhrammullah
Prof. Asnawi Abdullah
Dr. Hermansyah
Fahmi Ichwansyah
Prof. Dr. Ir. Hafnidar A. Rani
Meulu Alina
Artha M. T. Simanjuntak
Derren D. C. H. Rampengan
dr. Seba Talat Al‐Gunaid
dr. Naufal Gusti
dr. Arditya Damarkusuma
Edza Aria Wikurendra
author_facet Dr. Muhammad Iqhrammullah
Prof. Asnawi Abdullah
Dr. Hermansyah
Fahmi Ichwansyah
Prof. Dr. Ir. Hafnidar A. Rani
Meulu Alina
Artha M. T. Simanjuntak
Derren D. C. H. Rampengan
dr. Seba Talat Al‐Gunaid
dr. Naufal Gusti
dr. Arditya Damarkusuma
Edza Aria Wikurendra
author_sort Dr. Muhammad Iqhrammullah
collection DOAJ
description Abstract Background The prevalence of atrial fibrillation (AFib) continues to increase globally, posing a significant risk for serious cardiovascular complications, such as ischemic stroke and thromboembolism. Smartwatch single‐lead electrocardiogram (ECG) can be a practical and accurate early detection tool for AFib. Objective The aim of this study was to fill the research gap in evaluating the accuracy and interpretability of smartwatch ECG for early AFib detection. Methods Data derived from indexed literature in the Scopus, Scilit, PubMed, Google Scholar, Web of Science, IEEE, and Cochrane Library databases (as of June 1, 2024) were systematically screened and extracted. The quantitative synthesis was performed using a two‐level mixed‐effects logistic regression model, as well as a proportional analysis with Freeman‐Tukey double transformation on a restricted maximum‐likelihood model. Results The sensitivity and specificity of smartwatch ECG in algorithmic readings were 86% and 94%, respectively. In manual readings, the sensitivity and specificity reached 96% and 95%, respectively. In a brand‐specific subgroup analysis, the algorithmic reading reached a summary area under the curve (sAUC) of 96%, while another brand achieved the highest sAUC of 98% in manual reading. The level of manual interpretability was relatively high with Cohen's Kappa of 0.83, but 3% of ECG results were difficult to read manually. Conclusion This study shows that smartwatch ECG is able to detect AFib with high accuracy, especially through manual reading by trained medical personnel. PROSPERO Registration CRD42024548537 (May 29, 2024).
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publishDate 2025-06-01
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series Journal of Arrhythmia
spelling doaj-art-2d6719d6e54f4a1698de60af7885cf892025-08-20T03:29:52ZengWileyJournal of Arrhythmia1880-42761883-21482025-06-01413n/an/a10.1002/joa3.70087Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta‐analysisDr. Muhammad Iqhrammullah0Prof. Asnawi Abdullah1Dr. Hermansyah2Fahmi Ichwansyah3Prof. Dr. Ir. Hafnidar A. Rani4Meulu Alina5Artha M. T. Simanjuntak6Derren D. C. H. Rampengan7dr. Seba Talat Al‐Gunaid8dr. Naufal Gusti9dr. Arditya Damarkusuma10Edza Aria Wikurendra11Postgraduate Program of Public Health Universitas Muhammadiyah Aceh Banda Aceh IndonesiaPostgraduate Program of Public Health Universitas Muhammadiyah Aceh Banda Aceh IndonesiaPostgraduate Program of Public Health Universitas Muhammadiyah Aceh Banda Aceh IndonesiaPostgraduate Program of Public Health Universitas Muhammadiyah Aceh Banda Aceh IndonesiaDepartment of Civil Engineering Universitas Muhammadiyah Aceh Banda Aceh IndonesiaFaculty of Medicine Universitas Syiah Kuala Banda Aceh IndonesiaFaculty of Medicine Universitas Gadjah Mada Yogyakarta IndonesiaFaculty of Medicine Universitas Sam Ratulangi Manado IndonesiaFaculty of Medicine Universitas Syiah Kuala Banda Aceh IndonesiaPostgraduate Program of Public Health Universitas Muhammadiyah Aceh Banda Aceh IndonesiaDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada Yogyakarta IndonesiaDepartment of Public Health, Faculty of Health Universitas Nahdlatul Ulama Surabaya Surabaya IndonesiaAbstract Background The prevalence of atrial fibrillation (AFib) continues to increase globally, posing a significant risk for serious cardiovascular complications, such as ischemic stroke and thromboembolism. Smartwatch single‐lead electrocardiogram (ECG) can be a practical and accurate early detection tool for AFib. Objective The aim of this study was to fill the research gap in evaluating the accuracy and interpretability of smartwatch ECG for early AFib detection. Methods Data derived from indexed literature in the Scopus, Scilit, PubMed, Google Scholar, Web of Science, IEEE, and Cochrane Library databases (as of June 1, 2024) were systematically screened and extracted. The quantitative synthesis was performed using a two‐level mixed‐effects logistic regression model, as well as a proportional analysis with Freeman‐Tukey double transformation on a restricted maximum‐likelihood model. Results The sensitivity and specificity of smartwatch ECG in algorithmic readings were 86% and 94%, respectively. In manual readings, the sensitivity and specificity reached 96% and 95%, respectively. In a brand‐specific subgroup analysis, the algorithmic reading reached a summary area under the curve (sAUC) of 96%, while another brand achieved the highest sAUC of 98% in manual reading. The level of manual interpretability was relatively high with Cohen's Kappa of 0.83, but 3% of ECG results were difficult to read manually. Conclusion This study shows that smartwatch ECG is able to detect AFib with high accuracy, especially through manual reading by trained medical personnel. PROSPERO Registration CRD42024548537 (May 29, 2024).https://doi.org/10.1002/joa3.70087arrhythmiaatrial fibrillationECGelectrocardiogramsmartwatch
spellingShingle Dr. Muhammad Iqhrammullah
Prof. Asnawi Abdullah
Dr. Hermansyah
Fahmi Ichwansyah
Prof. Dr. Ir. Hafnidar A. Rani
Meulu Alina
Artha M. T. Simanjuntak
Derren D. C. H. Rampengan
dr. Seba Talat Al‐Gunaid
dr. Naufal Gusti
dr. Arditya Damarkusuma
Edza Aria Wikurendra
Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta‐analysis
Journal of Arrhythmia
arrhythmia
atrial fibrillation
ECG
electrocardiogram
smartwatch
title Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta‐analysis
title_full Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta‐analysis
title_fullStr Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta‐analysis
title_full_unstemmed Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta‐analysis
title_short Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta‐analysis
title_sort accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation a systematic review and meta analysis
topic arrhythmia
atrial fibrillation
ECG
electrocardiogram
smartwatch
url https://doi.org/10.1002/joa3.70087
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