The following are key points to remember from this state-of-the-art review about wearable devices for ambulatory cardiac monitoring:

1. Remote health care, virtual care, mobile health, and e-health refer to activities made possible due to ambulatory devices for continuous and remote monitoring. There are three essential components in such systems: 1) a wearable sensor, 2) a network and communication interface, and 3) remote cloud analytics managing large amounts of data.
2. Wearable ambulatory sensors often incorporate an accelerometer, which detects movements, and other modalities such as a ballistocardiogram, which allows for sensing the heart rate and blood ejection.
3. The Zio patch provides a single-lead electrocardiogram (ECG) and is used for continuous monitoring of cardiac rhythm. Due to the extended monitoring time of up to 14 days, the Zio device has a higher diagnostic yield than the Holter monitor. Like Holter, the data from Zio monitor are analyzed offline after the completion of monitoring. NUVANT Mobile Cardiac Telemetry (MCT) provides real-time wireless arrhythmia monitoring and analysis.
4. Scanadu is based on photoplethysmography, held between the fingers while directed at the head, and provides heart rate, blood pressure, temperature, respiratory rate, and oxygen saturation. Apple’s watch has sensitivity and specificity of 87% and 97% for the identification of silent atrial fibrillation. Another product, cvrPhone, is capable of identifying ischemic and apneic events using 12-lead ECG only.
5. A smartphone-based cuffless blood pressure monitoring device detects variable-amplitude of blood volume variations on the finger to produce a blood pressure measurement with a high precision. A number of devices provide estimates of cardiorespiratory fitness and even psychological stress.
6. Since 2016 there has already been widespread adoption of smartphone technology with nearly two-thirds of the US population owning a smartphone. According to surveys, Americans, especially the young, are open to health care options enabled through, and up to 78% of respondents appear willing to provide their health data from wearable devices to their physicians. The adoption of mobile health and telemonitoring is impeded by issues related to reimbursement and insurance policies. Some studies suggest health care savings secondary to the reduction in readmission rates.
7. A major vulnerability of the wearable devices is their susceptibility to motion artifacts, and changes in temperature, hair, skin color, and tattoos. Multimodal signals tend to reduce uncertainty.
8. Privacy, security, and data ownership are some issues that still need further consideration and scrutiny. General Data Protection Regulation, enacted by the European Union, aims to assure customer consent for the data collection, analysis, and utilization.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Stress

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Blood Pressure, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Blood Volume, Computer Security, Electrocardiography, Ambulatory, Mobile Applications, Monitoring, Ambulatory, Primary Prevention, Respiratory Rate, Stress, Psychological, Telemedicine, Telemetry

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