https://doi.org/10.1007/s00392-025-02737-x
1Universitätsklinikum OWL Klinik für Kardiologie und intern. Intensivmedizin Bielefeld, Deutschland; 2Philipps-Universität Marbug Marburg, Deutschland; 3Qompium NV Hasselt, Belgien
Background: Mobile health (mHealth) heart rhythm monitoring (HRM) is enabled by Photoplethysmography (PPG) facilitating smartphones.
Objective: To investigate patient compliance, motivation, and detection rates of atrial arrhythmia recurrence using a mHealth HRM after repeat ablation of atrial fibrillation (AF).
Methods: Patients instructed to perform 3 rhythm recordings daily using a PPG-based smartphone application over a follow-up (FU) period of 6 months after repeat ablation of AF. Compliance was assessed as the number of actual measurements per number of expected measurements. Motivation was calculated as the ratio of the total number of days where the expected measurements were performed to the total number of monitoring days. The detection rates of atrial arrhythmia recurrences were compared between mHealth and conventional HRM (comprising of 12-lead- and Holter-ECGs at 3 and 6 months after ablation).
Results: 58 patients (37.9 % female; median age 66.0 years [interquartile range = IQR 59.8-72.3]) participated in FU (for baseline characteristics see Table 1). Overall, 21,985 PPG recordings have been performed (27.7 % symptomatic). The median compliance for performing 3 measurements per day was 73.8 % (IQR 43.8-99.9) and the motivation rate was 33.6 % (IQR 12.6-79.8; Table 2). 58.6 % of the patients in the mHealth group and 82.8 % in the conventional HRM had freedom from AF/atrial flutter (HR 3.140; 95 % CI 1.593-6.188; p=0.0012; Figure 1). Symptoms were reported in only 43.0 % of the PPG measurements indicating AF or atrial flutter (Figure 2).
Conclusion: Patients undergoing repeat ablation of AF have high compliance for participating in a prolonged mHealth HRM over 6 months. The detection rate of atrial arrhythmia recurrences was higher in the mHealth compared to conventional FU.
Tables:
Table 1: Baseline characteristics.
|
Female, n (%) |
22 (37.9) |
|
Age in years, median (IQR) |
66.0 (59.8-72.3) |
|
At least 75 years or older, n (%) |
13 (22.4) |
|
Persistent atrial fibrillation, n (%) |
50 (86.0) |
|
Body-mass-index in kg/m2, median (IQR) |
27.4 (24.6-30.6) |
|
CHA2DS2-VASc-score, median (IQR) |
3 (1.0-3.3) |
Table 2: Compliance and motivation.
|
Expected number of days of mHealth HRM, n |
10,440 |
|
Total number of days with at least 1 PPG measurement, n (%) |
8,233 (78.9) |
|
Number of days with at least 1 PPG measurement per patient, median (IQR) |
165.0 (119.8-178.0) |
|
Compliance for 1 measurement/day per patient, % (median [IQR]) |
221.4 (131.3-299.7) |
|
Motivation for 1 measurement/day per patient, % (median [IQR]) |
93.4 (67.2-100.0) |
|
Compliance for 2 measurements/day per patient, % (median [IQR]) |
110.7 (65.6-149.9) |
|
Motivation for 2 measurements/day per patient, % (median [IQR]) |
69.6 (38.1-98.3) |
|
Compliance for 3 measurements/day per patient, % (median [IQR]) |
73.8 (43.8-99.9) |
|
Motivation for 3 measurements/day per patient, % (median [IQR]) |
33.6 (12.6-79.8) |
Figure 1: Freedom from AF/atrial flutter between conventional and mHealth HRM.
Figure 2: Proportion of recordings indicating ‘normal’, ‘warning’, ‘urgent’, or ‘insufficient quality’ according to symptoms.