Abstract
BACKGROUND: Electrocardiography (ECG) is the gold standard for the diagnosis of atrial fibrillation (AF). Recently, smartwatches like the Apple Watch have emerged as a promising, user-friendly device for rapid detection and diagnosis of AF, but the reliability and diagnostic accuracy still remain controversial. OBJECTIVES: The purpose of this study was to perform a systematic review and diagnostic test accuracy meta-analysis evaluating the diagnostic performance of the Apple Watch ECG in detecting AF. METHODS: The literature search was conducted on PubMed, Embase, and Cochrane Library through April 2024 for studies comparing the diagnostic accuracy of Apple Watch to standard 12-lead ECG. Statistical analysis was performed using R Software version 4.4.0 and OpenMeta[Analyst]. Pooled analyses of sensitivity, specificity, and area under the receiver operating characteristic curve were determined along with their 95% CIs. The quality of studies was analyzed using the QUADAS-2 tool. RESULTS: The meta-analysis included 11 studies comprising 4,241 participants. Their mean age was 62.56 ± 3.92 years, and 28% of the patients were females. The pooled sensitivity and specificity of the Apple Watch for detecting AF were 94.8% (95% CI: 91.7% to 96.8%; I(2) = 67%) and 95% (95% CI: 88.6% to 97.8%; I(2) = 88%), respectively. The area under the receiver operating characteristic curve was 0.96 (95% CI: 0.92-0.97). CONCLUSIONS: The Apple Watch ECG carries high accuracy in detecting atrial fibrillation, providing a convenient diagnostic option for patients.