Patient Experiences With Smartwatch ECG Monitoring Compared to Traditional Holter Devices

Introduction

Wearable ECG technology is increasingly used to support ambulatory cardiac rhythm monitoring, but questions remain about how these tools fit into patients’ daily lives.

A recent qualitative study conducted in the Netherlands explored this issue by comparing patient experiences using a smartwatch with single-lead ECG (1L-ECG) capability and a traditional Holter monitor over the course of one week.

The findings offer useful insights into the practical benefits and limitations of smartwatch-based ECG monitoring and what matters most to patients when rhythm monitoring moves beyond the clinic.

Study Overview

The study included 18 adults referred for ambulatory rhythm monitoring at a diagnostic center in the Netherlands, specifically through referrals from primary care to the cardiology outpatient clinic of the Dijklander Hospital in Hoorn. Participants were aged 32–85, with a median age of 66.

Each participant wore both:

1. A smartwatch with 1L-ECG capability (Withings ScanWatch), and
2. A conventional chest-worn Holter monitor

for seven days. Afterward, researchers conducted semi-structured interviews to understand their experiences with usability, comfort, confidence, and perceived clinical value.

Rather than focusing on diagnostic accuracy, the study centred on how patients experienced the monitoring process itself, an increasingly important consideration as wearable technologies become more common in routine care.

What Patients Reported

Comfort and Ease of Use

Participants consistently described the smartwatch as easier to wear and less intrusive than the Holter monitor. Wearing the watch felt familiar and fit naturally into daily routines, including sleep and regular activities. In contrast, the Holter monitor’s electrodes and wiring were more noticeable and, for some, uncomfortable over time.

Several participants noted skin irritation or inconvenience associated with adhesive electrodes, whereas the smartwatch was generally described as something they could wear without significant disruption to daily life.

“It’s a bit heavier than my own smartwatch. That takes a minute to get used to, but after that you don’t even notice it anymore. It’s waterproof, so you barely notice you’re wearing it — not even at night, since I always sleep with a watch on. I don’t feel the difference anymore. Other than that, it does what it’s supposed to do: tell the time. Which is pretty handy, too.”P16, male patient, 48 years

Capturing Symptoms in Real Life

One of the key differences between the two approaches is how data are captured. The Holter monitor records continuously, while the smartwatch requires users to actively initiate an ECG recording.

Participants appreciated having control over recordings but also expressed uncertainty about when to trigger them, particularly when symptoms were brief, unexpected, or occurred during sleep or activities like driving. This highlights a trade-off between passive continuous monitoring and more user-driven approaches.

Automated ECG Results: Reassurance and Uncertainty

Some participants found algorithm-based ECG feedback reassuring, especially when results were reported as normal. Others described moments of uncertainty or anxiety when the smartwatch flagged potential abnormalities without immediate clinical context.

This finding underscores the importance of clear patient education and pathways for clinical follow-up when wearable ECG data are shared directly with users.

Integration With Clinical Care

Across interviews, participants emphasized that wearable ECG data felt most valuable when it could be reviewed by a healthcare professional. Many expressed a desire for smoother integration between smartwatch ECG recordings and clinical systems, as well as clearer guidance on how and when clinicians would review their data.

Patients generally viewed the smartwatch as a helpful complement to traditional monitoring, particularly when combined with clinician oversight, rather than a complete replacement.

Implications for Wearable ECG Monitoring

Overall, the study suggests that smartwatch-based 1L-ECG monitoring is acceptable to patients and may reduce some of the burden associated with traditional Holter monitoring, particularly in terms of comfort and day-to-day wearability.

At the same time, the findings point to areas where wearable ECG programs can improve:

1. Providing clearer guidance on when and how to record symptoms
2. Reducing uncertainty around automated ECG interpretations
3. Ensuring timely clinician review and communication

As devices like the Withings ScanWatch continue to be used in real-world clinical settings, patient experience will remain a critical factor alongside clinical validation.

Looking Forward

This study adds to a growing body of evidence showing that wearable ECG devices can support ambulatory rhythm monitoring in ways that align more closely with everyday life. Designing these tools and the care pathways around them with patient experience in mind will be key to realizing their full potential in clinical practice.

For more research-driven insights on connected health and remote monitoring, explore the latest updates on the Withings blog.

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