Non-Watch Wearables in Cardiovascular Care: Interview With Marco Perez, MD

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EP LAB DIGEST. 2025;25(9):Online Only.

In this interview, EP Lab Digest speaks with Dr Perez to discuss his moderated session entitled “Non-Watch Wearables in Cardiovascular Care” at HRX 2025, exploring his insights on clinical integration, challenges, and future applications in clinical practice. Dr Perez is the Director of the Cardiac Electrocardiography Laboratory and Director of the Inherited Cardiac Arrhythmia Clinic at Stanford Medicine. 

From smart rings and adhesive patches to implantable devices and smart clothing, the landscape is rapidly expanding. Could you give us an overview of the key themes or breakthroughs that this session will highlight? 

The landscape is changing very rapidly. We have had wearable devices now for many years in the clinic, with electrocardiogram patch monitors being the prime example. It was just a few years ago that the use of smartwatches came into play, and we have seen pretty explosive growth in the consumer space, with about 30% of US consumers having a smartwatch that can monitor for health purposes. But what we are seeing now, and this is something that you are going to hear about at HRX and beyond, is the growing use of these consumer devices that go beyond the wrist, such as earpieces, clothing, and rings. As with many things like this, the science always takes a little longer to catch up to the technology. However, I think we are going to start seeing a series of studies using these smart technologies, allowing us a better understanding of the accuracy of these new devices.

You will be moderating a panel that brings together diverse expertise. Who will be represented on the stage, and how do their perspectives—whether clinical, technological, or patient-focused—help paint a full picture of where non-watch wearables are headed?

It is an exciting panel—we have a broad representation in the sense that we have some academics on the panel, representatives from established industries, and representatives from up-and-coming, exciting new technologies. So, we will be hearing from experts in the field who have been working on some of these devices now for many years. Some of these devices are well established and available to consumers, and other devices are on the horizon and quite exciting in some of their potential capabilities. So, I think attendees will get a sense of the landscape of this non-watch wearable field in the session.

This session promises to explore not only the opportunities in arrhythmia detection, heart failure monitoring, and vital sign assessment, but also the challenges around data validation, workflow integration, and reimbursement. From your vantage point, which of these barriers do you think the panel will wrestle with most, and how close are we to seeing scalable solutions in practice?

I think that one of the issues that a lot of us struggle with and that reflects the struggle that a lot of clinicians are having is that there are a growing number of devices and algorithms on each of these devices that are coming into the consumer space. It can be challenging for a clinician, and much more so for a consumer, to keep up with the science regarding the validation and accuracy of some of these algorithms. I think that you will probably hear a struggle with this question of how best to validate these technologies, what the best mechanism is for validation, what authorities we should rely on for this type of validation, and to what extent these technologies can and should be used in the clinic. These are the types of questions I think clinicians all over the US and beyond are struggling with, so we will aim to address the challenges that we are all seeing in this area. 

One of the most promising applications of non-watch wearables is in the early detection and ongoing monitoring of atrial fibrillation (AF). How are these technologies changing the way clinicians can identify and intervene in AF, and what do you see as the next leap forward in this area?

AF is a prime example because it is just so common in our population and the potential impact that we would have on patients with early detection is so great. When smartwatches became available and we had the ability to start detecting AF, it opened up the possibility of early intervention and diagnosis in a large number of patients. It is important to remember, though, that not every consumer out there can or wants to wear a smartwatch all the time, and this is where some of these newer technologies can also play a role, such as smart rings, earpieces, and wearable clothing. There are plenty of examples of companies developing products to detect AF, with some of the smart ring companies now able to be able to detect AF, with FDA clearance. The smartwatch consumer space is now a lot more prevalent than the non-smartwatch wearable space. But I think that in the near future, as these devices come to market and with the FDA clearance, we are going to start seeing these in our clinics. We do not yet have a large volume of patients coming in with their smart rings detecting AF, but that is just a matter of time. These are relatively newly released algorithms that I believe we are going to inevitably start seeing in our clinics.

The transcripts were edited for clarity and length.