Table 2.

Characteristics of Selected Wearable Devices for Continuous Monitoring to Detect AF

Device/Manufacturer	Underlying Technology	Performance to Detect AF or to Differentiate Between AF and SR	Comment
Adhesive devices with sensor
ZIO patch, iRhythm12,13	Single-lead ECG	Concordance of AF burden between Holter and patch, r=0.96 Concordance of AF burden between pacemaker and patch, r=0.99	Used in 15 trials for AF detection 14-d wear time Patient may shower
MCOT/ePatch, Biotel14,15	3-Lead ECG (MCOT)	MCOT: 100% sensitivity, 100% specificity for AF lasting >30 s	MCOT: 128% higher diagnostic yield compared with loop recorder Used in >30 trials to detect AF or to evaluate burden Up to 30 d of monitoring MCOT requires monitor to be within 30 ft of patient at all times; sensor transmits via Bluetooth ePatch is nontelemetry version with 14-d wear time Patient may shower
BodyGuardian Heart, BodyGuardian Mini, Preventice16,17	Single-lead ECG Deep learning BeatLogic platform	Body Guardian Heart: Episode detection for AF lasting >60 s: 99% sensitivity, 89% specificity	BodyGuardian Mini: Released 2018 16-d use Claimed as the smallest monitor Claimed to have superior P-wave visibility Patient may submerse in up to 3 ft of water
Carnation Ambulatory Monitor, Bardy Diagnostics12	Single-lead ECG	AF burden concordance with pacemaker electrograms=0.96 High precision for detecting AF >30 s: 0.99 (0.98–1.1)	7-d monitoring P-wave centric Claims superior P-wave visibility
Bands, wrist, or chest
Kardiaband by AliveCor with Apple Watch18	PPG to detect irregular rhythm Single-lead ECG	Differentiation between AF and SR: 93% sensitivity, 83% specificity	Requires paired iPhone Wearer may prompt recording of ECG, but ECG is not continuous Susceptible to error because of noise Use of this device may be limited because of availability of Apple Watch ECG Commercially available
Apple Watch ECG19	PPG to detect irregular rhythm using deep learning algorithm Single-lead ECG	C statistic=0.97 for differentiating AF from SR	Proof-of-concept study Follow-up study in progress Wearer may prompt recording of ECG, but recording is not continuous Susceptible to error because of noise Population who purchase device may not benefit the most because AF if present may not require treatment Commercially available
Simband, Samsung20	Multiwaveform PPG to detect irregular rhythm Single-channel ECG Accelerometer	Differentiation between AF and SR: 97% sensitivity, 94% specificity	Testing of an algorithm designed to reduce interference/noise Study participants were not engaged in usual activity Further study needed to evaluate device during daily activities Commercially available
Qardiocore chest band, Qardio21	3-Lead ECG transmits via Bluetooth real time to iPhone Qardio MD platform	Not reported in scientific literature	FDA approved 2017 Water resistant Measures HR variability, respiratory rate, activity tracking Commercially available

This list is not exhaustive, and inclusion in this table is not an endorsement of a given product. The list is a representative sample of the technologies currently in clinical and consumer use.

AF indicates atrial fibrillation; FDA, US Food and Drug Administration; HR, heart rate; MCOT, mobile cardiac outpatient telemetry; PPG, photoplethysmography; and SR, sinus rhythm.