Wearable Photoplethysmography for the Detection of Paroxysmal Atrial Fibrillation after Cryptogenic Stroke: A Review of Digital Rhythm Monitoring
DOI:
https://doi.org/10.5281/zenodo.22205991Keywords:
Photoplethysmography, Cryptogenic Stroke, Atrial Fibrillation, Wearable Devices, Rhythm MonitoringAbstract
One ischaemic stroke in four ends its work-up unexplained, and in many of those patients the answer is atrial fibrillation that was simply not present while anyone was recording. Wrist-worn photoplethysmography offers months of rhythm sampling at negligible marginal cost, but it samples a pulse rather than an electrogram.
Objectives:To review the evidence on the accuracy, yield and clinical utility of wearable photoplethysmography for identifying paroxysmal atrial l fibrillation after cryptogenic stroke, and to establish where it belongs alongside established prolonged monitoring.
Material and Methods:A narrative review. MEDLINE, Embase and the Cochrane Library were searched from January 2010 to May 2026 for r accuracy studies, randomised trials of prolonged monitoring, large-scale screening cohorts and society guidance. Values were extracted from the primary reports and tabulated without pooling. Results:Detection is governed chiefly by how long the rhythm is watched: 3.2% with a 24-hour Holter, 16.1% with a 30-day recorder, and 12.4% % at one year rising to 30.0% at three years with an insertable monitor. Photoplethysmographic algorithms achieve pooled sensitivity and specificity near 94% and 97%; the three consumer-scale studies alerted 0.23% to 1% of users with predictive values of 84% to 98.2%. In the only randomised
evaluation in stroke survivors, accuracy was 92.9% but the watch was worn on 21.2 of 30 days. Anticoagulation for device-detected atrial fibrillation cuts ischaemic stroke by about a third and raises major bleeding by three-fifths. Conclusion:Wearable photoplethysmography is an entry point to the pathway, not a diagnostic test. Its value lies in extending the observation
n window at a cost that permits extension, provided every positive signal is referred for electrocardiographic confirmation.
Abbreviations:AF – Atrial Fibrillation, ESUS – Embolic Stroke of Undetermined Source, ICM – Insertable Cardiac Monitor, PPG –
– Photoplethysmography, ECG – Electrocardiogram, PPV – Positive Predictive Value.
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