Introduction of smart devices/
new technologies for AF detection and
diagnosis, their roles, precautions

Individuals with AF have a 5-fold increased stroke risk compared with those without AF1; importantly, recent stroke registries showed that over 25% of individuals who experienced AF-related strokes did not know they had AF.2 The diagnosis of AF remains challenging as most individuals may not have symptoms, known as silent AF, or have paroxysmal AF (episodes of AF that terminates spontaneously or with intervention within 7 days of onset).1,3 As "AF begets AF," these individuals with long-term unrecognized and untreated silent AF are at greater risk of progression to persistent or permanent AF.3

Recent advances in technology have led to a rapid adaptation of the use of digital devices for heart rhythm monitoring in clinical practice, such as patches and various wearable or handheld devices.4 These devices allow either single time-point or continuous monitoring for AF detection1,5:


Digital devices for AF screening may also be classified based on the technology used to evaluate heart rhythm4,5:


Electrocardiogram (ECG)


The current gold standard for arrhythmia detection


Consumer-initiated single-lead ECG-based devices are used for single time-point assessments (eg, 30-second segments)



AliveCor® KardiaMobile device



Photoplethysmograpy (PPG)


Uses light sensors to measure changes in blood volume in peripheral circulation

Passive and near-continuous pulse signal processing using video cameras to calculate heart rate

Abnormal heart rhythm can be detected with embedded algorithms


Consumer-initiated PPG-based devices can be used for single time-point assessments and/or extended heart rhythm monitoring

May aid detection in patients with a very low probability of symptoms being caused by arrhythmias





*not all notifications will result in an AF diagnosis Bristol Myers Squibb and Pfizer do not recommend any specific screening device or methodology. There are important considerations and potential limitations associated with different methods of AF detection that must be independently evaluated by HCPs. AliveCor® and KardiaMobile® are registered trademarks of AliveCor, Inc. Apple Watch® is a registered trademark of Apple, Fitbit® Smartwatch is a registered trademark of Fitbit, Huawei® Band is a registered trademark of Huawei. The examples provided herein are for illustration purpose only. The information contained in this webpage have not been reviewed or endorsed by Apple, AliveCor, Fibit, Huawei or other companies.

The choice of digital heart rhythm device should be tailored to each person, based on their frequency of symptoms, expected duration of monitoring, local infrastructure, and personal preference.4


How to use digital devices to detect and manage arrhythmias: an EHRA practical guide4:

  • Systematic screening by intermittent ECG is beneficial to detect AF in those:
    • Aged ≥75 years
  • Systematic screening by intermittent ECG may be beneficial to detect AF in those:
    • Aged ≥65 years with comorbidities (CKD, COPD, diabetes, heart failure, hypertension, obesity, prior MI/CAD, sleep apnea)
  • Opportunistic screening for AF may be beneficial in those:
    • Aged ≥65 years without comorbidities (CKD, COPD, diabetes, heart failure, hypertension, obesity, prior MI/CAD, sleep apnea)
    • Aged <65 years with comorbidities (CKD, COPD, diabetes, heart failure, hypertension, obesity, prior MI/CAD, sleep apnea)
  • PPG-based or ECG-based devices are preferred for AF screening over pulse palpation
  • In systematic screening for AF, PPG-based or ECG-based devices can be used
  • If PPG screening is indicative of AF, an ECG-based method should be used
  • Any abnormal findings on digital devices should always be evaluated by a cardiac arrhythmia specialist or cardiologist

The information contained on this website is for informational purposes only. No material on this website is intended as a confirmation for AF diagnosis nor intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor, or other qualified healthcare professionals, if you have any concerns regarding your health or medical condition.

1. Hindricks G, et al. Eur Heart J 2021;42:373-498.

2. Freedman B, et al. Lancet 2016;388;806-17.

3. Dilaveris PE, Kennedy HL. Clin Cardial 2017;40:413-418.

4. Svennberg E, et al. Europace 2022;euac038.

5. Ding EY, et al. Circ Res 2020;127:128–42.

PP-ELI-HKG-1031 JUL 2022