The Lead Episode 144: A Discussion of Enhanced Detection and Prompt Diagnosis of Atrial Fibrillation Using Apple Watch: A Randomized Controlled Trial

Join host Melissa Middeldorp and her guests Marco Perez and Kristie Coleman for this installment of The Lead! This multicenter randomized controlled trial evaluated whether smartwatch-based rhythm monitoring improves detection of previously undiagnosed atrial fibrillation (AF) in cardiology outpatients aged ≥65 years with elevated stroke risk. A total of 437 participants were randomized to either 6-month monitoring with an Apple Watch integrating photoplethysmography-based irregular rhythm detection and single-lead ECG confirmation, supported by a telemonitoring adjudication pathway, or to standard care. The primary endpoint of new AF occurred significantly more often in the intervention group than in controls (9.6% vs 2.3%; HR 4.40), with many cases asymptomatic and detected earlier through wearable monitoring. All diagnosed patients were initiated on anticoagulation, and major adverse cardiovascular events were similar between groups. Overall, the study demonstrates that prolonged smartwatch-based screening embedded within a clinical workflow substantially increases AF detection in a high-risk population, highlighting the feasibility of wearable-enabled case finding while underscoring ongoing questions regarding clinical outcomes and optimal implementation. Learning Objectives Describe the design and key findings of a randomized trial evaluating smartwatch-based screening for atrial fibrillation in older patients at elevated stroke risk. Discuss the clinical implications, limitations, and broader evidence context of wearable-enabled atrial fibrillation detection within contemporary screening strategies.   Article Authors Nicole J. van Steijn, Isabel S. Blommestijn, Sebastiaan Blok, Shari Pepplinkhuizen, Aernout Somsen, Reinoud E. Knops, Laura Breukel, Jan G.P. Tijssen, Igor I. Tulevski, Philip M. Croon, Michiel M. Winter Podcast Contributors Melissa E. Middeldorp, MPH, PhD Kristie Coleman, MPH, RN Marco Perez, MD Host and Contributor Disclosure(s): M. MiddeldorpNothing to disclose. K. Coleman •Honoraria/Speaking/Teaching/Consulting: Medtronic M. Perez •Honoraria/Teaching/Speaking/Consulting: Boston Scientific, Biontronik •Ownership/Partnership: QALY •Research: Apple, Inc.