In the UK, World Heart Rhythm week (3–8 June) aims to raise awareness of cardiac arrhythmias – specifically their early detection and treatment – and educate the public and healthcare professionals. The most commonly presenting arrhythmias are atrial fibrillation (AF), supraventricular tachycardia (SVT), atrial flutter, tachybrady syndrome (sick sinus syndrome) and heart blocks. However, the majority are cases of AF, with an estimated 1.5 million diagnoses in the UK, and significantly rising – likely owing to an ageing population, increasing comorbidity, improved awareness and detection. About 30% of AF cases are undiagnosed, many of which are asymptomatic, often referred to as ‘silent ‘AF (Slater, 2023). Symptoms include palpitations, dizziness, dyspnoea, chest discomfort and lethargy; and although not limited to AF, persistent symptoms with associated chest pain.
We have come a long way from the first association between an irregular pulse and heart conditions, noted initially in animals by William Harvey in 1628. The first electrocardiography (ECG) recording of AF was by William Einthoven in 1906. Today, we know that AF risk factors can be mitigated through lifestyle changes, such as weight loss, reducing alcohol and tobacco consumption, and managing any associated hypertension, furthering lowering AF risk. Initial diagnosis is undertaken partly through 24-hour ECG monitoring, while treatments aimed at normalising the heart rhythm include medications, to slow and convert heart rhythm to normal sinus rhythm. Surgical interventions include cardioversion, ablation and occasionally implantable cardioverter-defibrillators (ICDs).
A key treatment for AF includes direct oral anticoagulants (DOACs), including apixaban, dabigatran, edoxaban or rivaroxaban. DOACs aim to prevent the biggest risk factors for acute ischaemic stroke (AIS) and myocardial infarction (MI). Sadly, many patients are only diagnosed retrospectively with AF on presentation of AIS or MI. DOACs have mainly replaced traditional Warfarin anticoagulation, as they have a more predictable anticoagulant effect with reduced need for frequent blood monitoring (although Warfarin is still prescribed to some patients).
As AF management approaches are aimed at educating and supporting patients through their AF diagnosis, awareness of risk factors, prevention of further embolic events, monitoring and detection, have become increasingly important.
An interesting aspect of detection is the technological advancement of personal devices, such as smartwatches. The Apple Heart Watch study was based on the premise of smartwatches/fitness bands passively measuring pulse rate from the wrist using photoplethysmography (PPG). Turakhia and Desai (2019) concluded that the devices had the potential for the detection of ‘undiagnosed AF at scale’, supported by Shahid and Iqbal (2025), who noted their high degree of accuracy for detecting AF.
The Apple Watch has American FDA approval as a portable ECG device for detecting heart rhythms (with its sensitivity to automatically detect AF rated at 99.54% (Alnasser and Alkalthem, 2023). There is no national guidance for paramedics regarding its use but paramedics are encouraged to use their own approved ECG monitoring device to detect and assess for AF. Clearly a space to watch!