Research Summary

Smartwatch-Based ECG Monitoring After AF Ablation Reduces Time to Recurrence Detection

Edited by:
Ashton L. Stahl

Key Highlights

  • Smartwatch-based ECG monitoring shortened the time to first atrial fibrillation (AF) recurrence detection after catheter ablation.
  • Overall AF recurrence detection at 12 months was higher in the smartwatch arm (52.9% vs 34.9%).
  • Unplanned hospitalizations were lower in patients using smartwatch monitoring.

Catheter ablation (CA) is an established rhythm control therapy for atrial fibrillation (AF), yet up to 50% of patients experience recurrent symptoms that may be difficult to characterize and can lead to anxiety and unplanned hospitalizations. In a randomized trial published in the Journal of the American College of Cardiology, investigators found that patient-led smartwatch electrocardiogram (ECG) monitoring after AF ablation reduced the time to arrhythmia recurrence detection and increased overall detection compared with standard care.

In this prospective study, adults with paroxysmal or persistent AF undergoing first-time CA were screened. Participants required access to an iPhone and were randomized 1:1, stratified by AF type, to either smartwatch-based monitoring or standard clinic-based follow-up. Patients in the active arm were loaned an Apple Watch (AW) Series 5 and prescribed a high-frequency monitoring protocol consisting of daily single-lead ECG recordings; additional recordings were triggered by symptoms or alerts. The control arm underwent routine follow-up at 3, 6, and 12 months, with ECG and symptom-guided Holter monitoring.

The primary endpoint was time to first ECG-recorded AF recurrence after a 90-day blanking period post-ablation, analyzed using a Cox proportional hazards model on an intention-to-treat basis. Secondary endpoints included freedom from AF at 12 months, unplanned hospitalization, and repeat CA referral.

Study Findings

Of the 449 assessed patients, 168 (37.4%) were enrolled. The mean age was 60.5 ± 9.9 years; 31.0% were female, and 50.0% had persistent AF. There were no significant baseline differences between groups. Participants in the smartwatch arm had a higher likelihood of AF recurrence detection after CA (hazard ratio [HR], 1.83; 95% CI, 1.15-2.93; P = .010). Median time to first recurrence detection was shorter in the active arm (116 days [IQR, 95-166] vs 132 days [IQR, 105-166]; P = .010).

Researchers identified AF recurrence in 52.9% of patients in the active arm compared with 34.9% in the control arm (P = .028), driven primarily by the detection of paroxysmal AF (32.9% vs 15.7%; P = .015). Including events during the blanking period, the likelihood of detection remained higher (HR, 2.10; 95% CI, 1.35-3.28; P = .001).

Unplanned hospitalizations were fewer in the smartwatch group (22 vs 47 events; P = .023), with a lower incidence rate ratio (0.46; 95% CI, 0.25-0.82; P = .009). Median hospital stay was 1 night in both groups. Repeat CA procedures within 12 months were similar between arms.

Clinical Implications

According to the study authors, the increased detection in the smartwatch arm likely reflects a surveillance effect related to higher-frequency monitoring rather than a biological increase in arrhythmia events. They also noted that real-time rhythm characterization via a patient-facing device may prevent unnecessary emergency presentations by differentiating AF from benign arrhythmias or unrelated symptoms. The findings may support the integration of patient-owned wearable devices into structured, post-ablation follow-up pathways.

Expert Commentary

“Patient-led AW-based monitoring after AF CA reduced the time to recurrent arrhythmia detection, increased the overall detection yield, and was associated with fewer unplanned hospitalizations compared with standard care. These findings may support the integration of patient-owned wearable devices into structured postablation follow-up pathways,” the researchers concluded.

Reference
Ahluwalia N, Abbass H, Hussain A, Saengkrajang G, Assadi R, Butcher C, Maclean E, Orini M, Finlay M, Honarbakhsh S, Hunter RJ, Schilling RJ. Patient-led smartwatch ECG monitoring after AF ablation: a randomized trial. J Am Coll Cardiol. 2026. doi:10.1016/j.jacc.2025.12.047