https://doi.org/10.1007/s00392-025-02625-4
1Heinrich-Heine-Universität Düsseldorf Düsseldorf, Deutschland; 2Evangelisches Krankenhaus Düsseldorf Klinik für Kardiologie Düsseldorf, Deutschland; 3Universitätsklinikum Essen Medizinische Psychologie und Verhaltensimmunbiologie Essen, Deutschland
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia impairing quality of life (QoL) in many patients. Pulmonary vein isolation (PVI) reduces AF burden and improves QoL, but AF episodes early after ablation can cause anxiety, even if not predictive for long-term success. Mobile electrocardiograms (ECGs) for self-monitoring of arrhythmia recurrences are increasingly used, but the impact of recurrent AF on patient adherence and QoL is unknown.
Aim: Therefore, we aimed to analyze the effects of AF recurrence determined by mobile ECG self-monitoring on patient adherence and QoL early after PVI.
Methods: The present study prospectively included 30 patients with paroxysmal AF undergoing PVI. Patients were instructed to record 30-second ECGs with a mobile 6-lead device (KardiaMobile 6L, AliveCor, USA) using a standardized protocol with measurements twice daily and during symptoms. QoL was assessed before and 90 days after PVI using the Short Form 36 Health Survey (SF-36) (max. 100 points) and the Cardiac Anxiety Questionnaire (HAF17) (max. 4 scale values).
Results: In our study population (62±9.5 years, 60% male), 4868 ECGs were recorded, with 2 (IQR 1–2) daily ECGs per patient. There were 448/4868 (9.2%) AF episodes in 16/30 patients (53.3%) (Fig. A). Patients with AF recurrence showed better adherence to the monitoring protocol, defined as <10% lost ECGs (75% vs. 28.6%, p=0.0261), than patients in constant sinus rhythm (SR) (Fig. B). Using the SF-36, at 90 days after PVI, patients in SR presented with improvements in QoL (45.8 (IQR 37.5–62.5) vs. 66.7 (IQR 56.3–71.9), p=0.0051), physical functioning (75 (IQR 35–90) vs. 87.5 (IQR 73.7–95), p=0.0059), physical role limitations (25 (IQR 0–75) vs. 87.5 (IQR 68.8–100), p=0.0078) and vitality (45 (IQR 35–70) vs. 57.5 (IQR 49.9–75), p=0.0081). In contrast, patients with AF recurrence improved only in physical functioning (68.3 (IQR 36.3–90) vs. 90 (IQR 55–95), p=0.0103) and physical role limitations (50 (IQR 0–100) vs. 100 (IQR 50–100), p=0.0156) (Fig. C). Both patient groups showed improvements across all domains of the HAF17 after PVI. Patients in SR exhibited reductions in the total score (1.7 (IQR 1.4–2.1) vs. 1.2 (IQR 0.9–1.5), p=0.0002), avoidance (1.8 (IQR 0.9–2.5) vs. 0.9 (IQR 0.3–1.6), p=0.0039), anxiety (1.8 (IQR 1.3–2.3) vs. 1.4 (IQR 0.6–1.7), p=0.0144), and self-awareness (1.6 (IQR 1.3–2.3) vs. 1.5 (IQR 1–2.2), p=0.0469). Similarly, patients with AF recurrence improved in the total score (1.7 (IQR 1.3–2.4) vs. 1.3 (IQR 0.8–1.8), p=0.0098), avoidance (2 (IQR 1.4–2.5) vs. 0.8 (IQR 0.3–1.8), p=0.0039), anxiety (1.8 (IQR 1.2–2.4) vs. 1.3 (IQR 0.6–1.8), p=0.0132), and self-awareness (1.7 (IQR 1.4–2.5) vs. 1.4 (IQR 0.8–2), p=0.0381) (Fig. D).
Conclusion: The usage of mobile ECGs for self-monitoring of arrhythmia recurrences early after PVI is well accepted, especially by patients with recurrent AF. While only patients in SR show improved QoL, both those in SR or with recurrent AF present with reduced anxiety suggesting a potential benefit of mobile ECG self-monitoring on the patients’ self-awareness, independent of AF recurrences.
Fig.: A, The majority of ECGs was recorded in SR. B, Patients with recurrent AF were more compliant to the monitoring protocol than patients in SR. C, Patients in SR showed improved QoL and vitality, those with AF recurrence did not. D, Both patients in SR (blue) and with AF recurrence (red) improved across all domains of the HAF17.