EP Edge Journal Watch Issue 3: Smartwatch AFib Detection: Accuracy, False Alerts, Apple Watch ECG, and What Clinicians Need to Know

Smartwatches are now among the most widely used heart-monitoring tools in the world — but how accurate are they really at detecting AFib? In this December 2025 Issue 3 of EP-Edge Journal Watch, Dr. Niraj Sharma, cardiologist and cardiac electrophysiologist, breaks down the strongest evidence to date on smartwatch AFib detection, Apple Watch ECG performance, false alerts, AF burden tracking, and post-ablation monitoring.With more than 450 million global smartwatch users and growing, both clinicians and patients rely on devices like the Apple Watch, Fitbit, Samsung Galaxy Watch, and Withings for early arrhythmia detection. This episode answers the questions everyone is asking:What You’ll Learn in This Episode• How accurate are smartwatches for detecting atrial fibrillation (AFib)?A breakdown of major meta-analyses across Apple Watch ECG, PPG sensors, and multi-device comparisons — including real numbers on sensitivity, specificity, and real-world diagnostic performance.• Why do so many smartwatch alerts end up being false positives?Dr. Sharma explains the positive predictive value problem in low-prevalence populations and why young, healthy users often receive incorrect AFib notifications.• Apple Watch ECG vs. Holter monitor vs. implantable monitorFind out when a smartwatch is good enough, when a clinical monitor is necessary, and when an implantable cardiac monitor (ICM) remains the gold standard.• Can smartwatches reliably detect AFib recurrence after ablation?Review of the CIRCADOSE data showing smartwatch AFib-burden algorithms compared with implantable monitors — and when they outperform intermittent Holters.• Why EP patients get so many inconclusive smartwatch readingsIncluding pacing, left bundle branch block, low-voltage signals, and ectopy — and when to move directly to patch or implantable monitoring.Clinical Framework & Real-World Decision PathwaysDr. Sharma provides practical, evidence-backed direction for:Confirming AFib from smartwatch ECG stripsManaging stroke risk using the CHADS-VASc (spoken as “Chads Two Vask”) scorePost-ablation AFib surveillanceChoosing between smartwatch monitoring, Holter monitoring, and ICMCounseling anxious, low-risk patients on false AFib alertsSupporting shared decision-making with objective dataWho This Episode Is ForCardiac electrophysiologistsCardiologistsInternal medicine & family medicine cliniciansAPPs (NPs, PAs)Medical traineesPatients living with AFibAnyone using a smartwatch for heart rhythm monitoringAbout EP-Edge Journal WatchEP-Edge Journal Watch delivers high-level electrophysiology insights, clinical trial reviews, and real-world practice frameworks — with every episode designed to help clinicians make smarter, faster, evidence-based decisions.Subscribe for in-depth analyses of landmark EP trials, AFib management strategies, ablation literature, device therapy updates, and translational insights shaping the future of arrhythmia care.

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