Plugging the Gaps: Bridging PPG, Wearables and CIEDs For a Holistic Approach to Stroke Prevention and AF Management Powered by IronRod-Plugging the Gaps: Bridging PPG, Wearables and CIEDs For a Holistic Approach to Stroke Prevention and AF Management Powered by IronRod

Plugging the Gaps: Bridging PPG, Wearables and CIEDs For a Holistic Approach to Stroke Prevention and AF Management Powered by IronRod

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Video Summary

This expert roundtable discussed integrating wearables and implantables for stroke prevention and atrial fibrillation (AF) management, focusing on optimizing monitoring strategies. They highlighted that detecting AF post-cryptogenic stroke is crucial since anticoagulation benefits depend on confirmed AF. AI applied to sinus rhythm ECGs shows promise in identifying patients with undetected AF, potentially guiding who needs intensive monitoring, though caution about false positives/negatives remains. The conversation emphasized the high cost and practicality of implantable loop recorders versus wearables like Apple Watches and patches, underscoring the need for tailored monitoring approaches based on patient risk and engagement.<br /><br />Several ongoing trials, including a large randomized Apple Watch study, are investigating intermittent anticoagulation triggered by wearable-detected AF episodes, aiming to personalize therapy and reduce bleeding risk. Panelists debated monitoring duration thresholds (e.g., 2 vs. 6 minutes of AF) and the challenges of interpreting brief episodes detected by wearables. They also addressed the overwhelming data from wearables, proposing AI-driven triage and integration into clinical workflows to manage alerts efficiently, reducing physician burden while ensuring safety.<br /><br />Use of wearables post-ablation to guide therapy and reduce unnecessary procedures was supported, with emphasis on patient education to mitigate anxiety from false alarms. Calls for standardization of photoplethysmography (PPG) data and combined PPG-ECG approaches were made to improve reliability and acceptance in clinical decision-making. Overall, the roundtable stressed the potential of AI and digital health to transform AF care but acknowledged the need for more outcome data, improved workflows, and patient-centered implementation.

Keywords

wearables

implantables

stroke prevention

atrial fibrillation

AI in ECG

implantable loop recorders

Apple Watch study

photoplethysmography