Remote Monitoring For Early Detection And Management Of Atrial Fibrillation
Özet
Atrial fibrillation (AF) is a global epidemic that significantly increases the risk of stroke, heart failure, and mortality. This chapter explores how remote monitoring Technologies including smartwatches, mobile ECG patches, and implantable devices are transforming AF care by enabling early detection and personalized management. It reviews major clinical trials demonstrating the effectiveness of wearable-based AF screening and discusses the diagnostic accuracy, clinical impact, and patient experience associated with these tools. The text also examines health system integration, international guideline differences (ESC, AHA, NICE, USPSTF), and ethical and practical challenges such as data overload, accessibility, and privacy. Looking ahead, the chapter highlights the role of artificial intelligence, predictive analytics, and digital health integration in advancing AF monitoring toward proactive and preventive cardiology. By bridging cardiology and digital innovation, remote monitoring offers a paradigm shift toward continuous, data-driven cardiovascular care that may reduce the global burden of AF-related stroke and heart failure.
Referanslar
Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014 Mar 15;383(9921):955-62. doi: 10.1016/S0140-6736(13)62343-0. Epub 2013 Dec 4. PMID: 24315724. Circ Res. 2020;127(1):4-20. doi:10.1161/CIRCRESAHA.120.316340
Go AS, Hylek EM, Phillips KA, et al. Prevalence of Diagnosed Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370. doi:10.1001/jama.285.18.2370
Krijthe BP, Kunst A, Benjamin EJ, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J. 2013;34(35):2746-2751. doi:10.1093/eurheartj/eht280
Di Carlo A, Bellino L, Consoli D, et al. Prevalence of atrial fibrillation in the Italian elderly population and projections from 2020 to 2060 for Italy and the European Union: the FAI Project. EP Eur. 2019;21(10):1468-1475. doi:10.1093/europace/euz141
Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular Trends in Incidence of Atrial Fibrillation in Olmsted County, Minnesota, 1980 to 2000, and Implications on the Projections for Future Prevalence. Circulation. 2006;114(2):119-125. doi:10.1161/CIRCULATIONAHA.105.595140
Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. The Lancet. 2014;383(9921):955-962. doi:10.1016/S0140-6736(13)62343-0
Mohamoud A, Jensen J, Buda KG. Consumer-grade wearable cardiac monitors: What they do well, and what needs work. Cleve Clin J Med. 2024;91(1):23-29. doi:10.3949/ccjm.91a.23030
Schnabel RB, Marinelli EA, Arbelo E, et al. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference. EP Eur. 2023;25(1):6-27. doi:10.1093/europace/euac062
Cardiology ES of. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;42(5):373-498.
Papalamprakopoulou Z, Stavropoulos D, Moustakidis S, Avgerinos D, Efremidis M, Kampaktsis PN. Artificial intelligence-enabled atrial fibrillation detection using smartwatches: current status and future perspectives. Front Cardiovasc Med. 2024;11:1432876. doi:10.3389/fcvm.2024.1432876
Screening for atrial fibrillation: a narrative review. Br J Cardiol. Published online 2025. doi:10.5837/bjc.2025.013
Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193
Prasitlumkum N, Cheungpasitporn W, Chokesuwattanaskul A, et al. Diagnostic accuracy of smart gadgets/wearable devices in detecting atrial fibrillation: A systematic review and meta-analysis. Arch Cardiovasc Dis. 2021;114(1):4-16. doi:10.1016/j.acvd.2020.05.015
Smartwatches and Atrial Fibrillation: What Works and What Needs Improvement? - American College of Cardiology.
Gawałko M, Duncker D, Manninger M, et al. The European TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: centre and patient experiences. EP Eur. 2021;23(7):1003-1015. doi:10.1093/europace/euab050
Hillmann HAK. Ultra-short-term heart rate variability using a photoplethysmography-based smartphone application: a TeleCheck-AF subanalysis.
Rosman L, Lampert R, Zhuo S, et al. Wearable Devices, Health Care Use, and Psychological Well‐Being in Patients With Atrial Fibrillation. J Am Heart Assoc. 2024;13(15):e033750. doi:10.1161/JAHA.123.033750
Williams K, Modi RN, Dymond A, et al. Cluster randomised controlled trial of screening for atrial fibrillation in people aged 70 years and over to reduce stroke: protocol for the pilot study for the SAFER trial. BMJ Open. 2022;12(9):e065066. doi:10.1136/bmjopen-2022-065066
Topol EJ SS. Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial. JAMA. 0;320(2):146-155.:146-155. doi:doi: 10.1001/jama.2018.8102.
Halcox JPJ, Wareham K, Cardew A, et al. Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study. Circulation. 2017;136(19):1784-1794. doi:10.1161/CIRCULATIONAHA.117.030583
Healey JS SJ. SCREEN-AF Investigators and Coordinators. Screening for Atrial Fibrillation in the Older Population: A Randomized Clinical Trial. AMA Cardiol 2021. 1;6(5):558-567. doi:doi: 10.1001/jamacardio.2021.0038.
Svennberg E, Friberg L, Frykman V, Al-Khalili F, Engdahl J, Rosenqvist M. Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial. The Lancet. 2021;398(10310):1498-1506. doi:10.1016/S0140-6736(21)01637-8
Wong JB DK. Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;Jan 25;327(4)(Jan 25;327(4)):360-367. doi:doi: 10.1001/jama.2021.23732.
Gibson CM, Steinhubl S, Lakkireddy D, et al. Does early detection of atrial fibrillation reduce the risk of thromboembolic events? Rationale and design of the Heartline study. Am Heart J. 2023;259:30-41. doi:10.1016/j.ahj.2023.01.004
Perez M, Mahaffey K, Hedlin H, et al. Large-scale assessment of a smartwatch to identify atrial fibrillation. N Engl J Med. 2019;381(20):1909-1917.
Lubitz SA, Faranesh AZ, Selvaggi C, et al. Detection of Atrial Fibrillation in a Large Population Using Wearable Devices: The Fitbit Heart Study. Circulation. 2022;146(19):1415-1424. doi:10.1161/CIRCULATIONAHA.122.060291
Shahid S, Iqbal M, Saeed H, et al. Diagnostic Accuracy of Apple Watch Electrocardiogram for Atrial Fibrillation. JACC Adv. 2025;4(2):101538. doi:10.1016/j.jacadv.2024.101538
Koh KT, Law WC, Zaw WM, et al. Smartphone electrocardiogram for detecting atrial fibrillation after a cerebral ischaemic event: a multicentre randomized controlled trial. EP Eur. 2021;23(7):1016-1023. doi:10.1093/europace/euab036
Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13(4):429-438. doi:10.1016/S1474-4422(13)70310-7
Gladstone DJ, Spring M, Dorian P, et al. Atrial Fibrillation in Patients with Cryptogenic Stroke. N Engl J Med. 2014;370(26):2467-2477. doi:10.1056/NEJMoa1311376
Sanna T, Diener HC, Passman RS, et al. Cryptogenic Stroke and Underlying Atrial Fibrillation. N Engl J Med. 2014;370(26):2478-2486. doi:10.1056/NEJMoa1313600
O’Sullivan JW, Grigg S, Crawford W, et al. Accuracy of Smartphone Camera Applications for Detecting Atrial Fibrillation: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(4):e202064. doi:10.1001/jamanetworkopen.2020.2064
Bumgarner JM, Lambert CT, Hussein AA, et al. Smartwatch Algorithm for Automated Detection of Atrial Fibrillation. J Am Coll Cardiol. 2018;71(21):2381-2388. doi:10.1016/j.jacc.2018.03.003
Dörr M, Nohturfft V, Brasier N, et al. The WATCH AF Trial: SmartWATCHes for Detection of Atrial Fibrillation. JACC Clin Electrophysiol. 2019;5(2):199-208. doi:10.1016/j.jacep.2018.10.006
National Health Service. NHS Long Term Plan – cardiovascular disease. London: NHS, 2019. Available from: https://www.longtermplan.nhs.uk/online-version/chapter-3-further-progress-on-care-quality-and-outcomes/better-care-for-major-health-conditions/cardiovascular-disease/
Briosa E Gala A, Pope MT, Leo M, Lobban T, Betts TR. NICE atrial fibrillation guideline snubs wearable technology: a missed opportunity? Clin Med. 2022;22(1):77-82. doi:10.7861/clinmed.2021-0436
John B. Wong, MD KW. Screening for Atrial Fibrillation US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(4):360-367.
Bergmann J, Chandaria V, McGregor A. Wearable and Implantable Sensors: The Patient’s Perspective. Sensors. 2012;12(12):16695-16709. doi:10.3390/s121216695
Mant J, Modi RN, Dymond A, et al. Randomised controlled trial of population screening for atrial fibrillation in people aged 70 years and over to reduce stroke: protocol for the SAFER trial. BMJ Open. 2024;14(4):e082047. doi:10.1136/bmjopen-2023-082047
Guo Y, Wang H, Zhang H, et al. Photoplethysmography-Based Machine Learning Approaches for Atrial Fibrillation Prediction. JACC Asia. 2021;1(3):399-408. doi:10.1016/j.jacasi.2021.09.004
Pereira T, Tran N, Gadhoumi K, et al. Photoplethysmography based atrial fibrillation detection: a review. Npj Digit Med. 2020;3(1):3. doi:10.1038/s41746-019-0207-9
Brandes A, Stavrakis S, Freedman B, et al. Consumer-Led Screening for Atrial Fibrillation: Frontier Review of the AF-SCREEN International Collaboration. Circulation. 2022;146(19):1461-1474. doi:10.1161/CIRCULATIONAHA.121.058911
Brik T, Harskamp RE, Himmelreich JCL. Screening and detection of atrial fibrillation in primary care: current practice and future perspectives. Eur Heart J Suppl. 2024;26(Supplement_4):iv12-iv18. doi:10.1093/eurheartjsupp/suae074
Bayoumy K, Gaber M, Elshafeey A, et al. Smart wearable devices in cardiovascular care: where we are and how to move forward. Nat Rev Cardiol. 2021;18(8):581-599. doi:10.1038/s41569-021-00522-7
Attia Z, Noseworthy P, Lopez-Jimenez F, et al. An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis. The Lancet. 2019;394(10201):861-867.
Aschbacher K, Yilmaz D, Kerem Y, et al. Atrial fibrillation detection from raw photoplethysmography waveforms: A deep learning application. Heart Rhythm O2. 2020;1(1):3-9. doi:10.1016/j.hroo.2020.02.002
Attia ZI, Noseworthy PA, Lopez-Jimenez F, et al. An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction. The Lancet. 2019;394(10201):861-867. doi:10.1016/S0140-6736(19)31721-0
Guo Z, Ding C, Do D, et al. Improving Atrial Fibrillation Detection Using a Shared Latent Space for ECG and PPG Signals. Harv Data Sci Rev. 2025;7(1). doi:10.1162/99608f92.9e63a630
Proesmans T, Mortelmans C, Van Haelst R, Verbrugge F, Vandervoort P, Vaes B. Mobile Phone–Based Use of the Photoplethysmography Technique to Detect Atrial Fibrillation in Primary Care: Diagnostic Accuracy Study of the FibriCheck App. JMIR MHealth UHealth. 2019;7(3):e12284. doi:10.2196/12284
Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of Current and Future Incidence and Prevalence of Atrial Fibrillation in the U.S. Adult Population. Am J Cardiol. 2013;112(8):1142-1147. doi:10.1016/j.amjcard.2013.05.063
Mahajan R, Perera T, Elliott AD, et al. Subclinical device-detected atrial fibrillation and stroke risk: a systematic review and meta-analysis. Eur Heart J. 2018;39(16):1407-1415. doi:10.1093/eurheartj/ehx731
Screening for atrial fibrillation: a narrative review. Br J Cardiol. Published online 2025. doi:10.5837/bjc.2025.013
