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Review
. 2021 Apr 5;21(7):2539.
doi: 10.3390/s21072539.

Smart Wearables for Cardiac Monitoring-Real-World Use beyond Atrial Fibrillation

David Duncker  1 , Wern Yew Ding  2 , Susan Etheridge  3 , Peter A Noseworthy  4   5 , Christian Veltmann  1 , Xiaoxi Yao  4   5 , T Jared Bunch  6 , Dhiraj Gupta  2
Affiliations
Review

Smart Wearables for Cardiac Monitoring-Real-World Use beyond Atrial Fibrillation

David Duncker et al. Sensors (Basel). .

Abstract

The possibilities and implementation of wearable cardiac monitoring beyond atrial fibrillation are increasing continuously. This review focuses on the real-world use and evolution of these devices for other arrhythmias, cardiovascular diseases and some of their risk factors beyond atrial fibrillation. The management of nonatrial fibrillation arrhythmias represents a broad field of wearable technologies in cardiology using Holter, event recorder, electrocardiogram (ECG) patches, wristbands and textiles. Implementation in other patient cohorts, such as ST-elevation myocardial infarction (STEMI), heart failure or sleep apnea, is feasible and expanding. In addition to appropriate accuracy, clinical studies must address the validation of clinical pathways including the appropriate device and clinical decisions resulting from the surrogate assessed.

Keywords: arrhythmia; artificial intelligence; cardiac monitoring; digital health; heart failure; mobile health; remote monitoring; wearables.

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Conflict of interest statement

D.D. received speaker honoraria and/or travel grants from Abbott, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Medtronic, Pfizer and Zoll. C.V. received honoraria for lectures and/or consulting from Abbott, Astra Zeneca, Bayer, Biotronik, BMS, Boehringer Ingelheim, Boston Scientific, CVRx, Daichii Sankyo, Medtronic and Zoll. T.J.B. received research grants from Boston Scientific, Altathera and Boehringer Ingelheim. D.G. reports speaker honoraria from Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Medtronic, Biosense Webster and Boston Scientific; proctor honoraria for Abbott; and research grants from Medtronic, Biosense Webster and Boston Scientific. P.A.N. received research funding from the National Institutes of Health (NIH, including the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute on Aging [NIA]), Agency for Healthcare Research and Quality (AHRQ), Food and Drug Administration (FDA) and the American Heart Association (AHA). P.A.N. and Mayo Clinic are involved in a potential equity/royalty relationship with AliveCor. P.A.N. is a study investigator in an ablation trial sponsored by Medtronic. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Generic advantages and disadvantages of wearables for monitoring of cardiac arrhythmia.
Figure 2
Figure 2
Examples of photoplethysmography (PPG) recordings for ventricular bigeminy and atrial flutter. The top graph shows PPG signals of a 60-s recording. The bottom-left tachogram displays all consecutive pulse signal intervals. For ventricular bigeminy, it can be seen that there are heart beats with alternating intervals. For atrial flutter, the heart rate is rapid with an average of 146 bpm. The Lorenz plot provides a visual representation for clustering patterns.
Figure 3
Figure 3
The figure shows a standard ECG (A) and a compared “12-lead equivalent ECG” (B) from the same patient using 2 electrodes connected to a smartphone associated sensor as shown (C) that obtains multiple sequential single-lead ECG measurements that was used in the St. Leuis trial. A next-generation concept for improved detection from AliveCor (Mountainview, CA, USA) is shown in (D) for smart phone-based cordless detection of STEMI with direct lead equivalents annotated. (Figures (A–C) are courtesy of Dr. Brent Muhlestein and Viet Le. Figure (D) is courtesy of Dr. Dave Alpert).
Figure 4
Figure 4
Implementation of wearables may facilitate the transition from hospital-based to home care (created with BioRender.com, accessed on 2 April 2021).
See this image and copyright information in PMC

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