Patient experiences with a smartwatch 1L-ECG versus traditional Holter monitoring for ambulatory cardiac rhythm monitoring: a qualitative study

OBJECTIVE: To explore patients' experiences and perspectives on using a direct-to-consumer smartwatch with single-lead electrocardiography (1L-ECG) for ambulatory rhythm diagnostics in primary care. DESIGN: Qualitative study using semi-structured interviews and thematic analysis. SETTING: Primary care patients referred for ambulatory rhythm monitoring in a diagnostic centre. PARTICIPANT: Eighteen adults with paroxysmal palpitations, of whom nine were female patients (50%), aged 32-85 (median 66) years. INTERVENTION: Participants simultaneously wore a smartwatch with 1L-ECG capability (Withings ScanWatch) and a conventional Holter monitor for 7 days. OUTCOME MEASURES: Patient experiences and perceived barriers and facilitators to smartwatch use for rhythm monitoring, reported after the monitoring period. RESULTS: Patients found the smartwatch more user-friendly and feasible than the Holter monitor. Difficulties included uncertainty about when to initiate recordings, challenges capturing brief episodes and anxiety triggered by automated algorithm outputs. Participants emphasised the importance of accessible healthcare support for interpretation and reassurance. CONCLUSIONS: This study shows that smartwatch-based 1L-ECG monitoring is feasible and acceptable for ambulatory rhythm diagnostics in primary care. Prior to routine implementation, it is crucial to address the identified challenges: particularly anxiety related to algorithm results, uncertainty about when to record and accessible clinician support.