Diagnostic performance of two commercially available, PPG-based smartphone applications to detect atrial fibrillation

Aims: Atrial fibrillation is the most common sustained cardiac arrhythmia, associated with considerable morbidity and mortality. Early detection is essential for optimal management. While wearable smart devices have shown promise, smartphone applications using photoplethysmography have also emerged as potential screening tools, but their diagnostic accuracy has not been adequately validated. This study aimed to compare the diagnostic performance of two commercially available photoplethysmography-based smartphone applications. Methods and results: In this prospective multicentre study, consecutive patients from three cardiology centres underwent simultaneous recordings with the FibriCheck® and Preventicus Heartbeats® applications and a 12-lead electrocardiogram during hospital admission or outpatient evaluation. Electrocardiograms were independently interpreted by blinded cardiologists. Diagnostic accuracy, rate of inconclusive recordings, technical performance, features, and pricing were compared between the two applications. A total of 206 patients (median age 69.5 years, 64.1% male) with 216 electrocardiograms were analysed; atrial fibrillation was present in 43.1%. Successful photoplethysmography recordings were obtained in 97.7% of FibriCheck (mean attempts 1.2 ± 0.7) and 87.5% of Preventicus Heartbeats (1.6 ± 1.3) measurements. Sensitivity and specificity were 89.0% and 100.0% for FibriCheck, and 86.4% and 99.0% for Preventicus Heartbeats. Inconclusive reading rates (where the algorithm indicated a suspicion of mild arrhythmia) were 8.5% and 11.1%, respectively. Conclusion: Both smartphone applications demonstrated high and comparable diagnostic accuracy for atrial fibrillation detection in a real-world population. These tools represent a viable, non-invasive option for early rhythm screening and follow-up, potentially improving patient outcomes, although further refinement is needed to reduce inconclusive recordings.