Objectives: Despite improvements of outcome of ablation for AF, early arrhythmia recurrence is not uncommon up to 3 months post-ablation. Although these arrhythmias are transient and do not represent treatment failure, it is widely recognized as a risk factor for long-term recurrence. To date, a better understanding in the correlation between early and long-term recurrence is hindered by an inability to continuously monitor these patients. We hypothesize that the implementation of a pulse-deriving smartphone application in this population offers the potential to detect early as well as late recurrence in order to initiate proper treatment in a timely manner.
Methods: Four clinical centres included a total of 80 participants who underwent successful AF treatment using ablation therapy. All participants were instructed to measure twice daily with a pulse-deriving smartphone application and additionally when experiencing symptoms, for a monitoring period of 4 months post-ablation. The planned usual-care pathway was registered at study inclusion. All measurements were revised algorithmically and confirmed by the treating physicians and healthcare professionals from a monitoring centre. At time of inclusion and study end a 12-lead ECG was performed.
Results: The mean age of the study population was 66 (±13) years from which 25% was male. Using the CHA2DS2-VASc score, 61% of the participants had an increased stroke risk (i.e. a score of 2 or more). Overall compliance to conduct measurements was recorded at 91% with 2 measurements per day. The smartphone app was able to identify 29 AF-cases (36%) of which 27 paroxysmal and 2 persistent. Only 37% of the AF cases were symptomatic. In the usual care path only 3/29 (10%) cases were identified with 12-lead ECG at the next scheduled consult and 9 (31%) patients identified with AF would been monitored by Holter.
Conclusion: Pulse-deriving smartphone applications implemented in combination with a structured care path proved to be a promising methodology for short- and long-term outcome monitoring of post-ablation patients and are capable in the detection of silent intermittent atrial fibrillation episodes.