Photoplethysmography-documented atrial fibrillation in the first week after catheter ablation is associated with lower success rates

Abstract

AimsTo test the feasibility of postprocedural photoplethysmography (PPG) rhythm telemonitoring during the first week after atrial fibrillation (AF) ablation and its predictive value for later AF recurrence.MethodsPPG rhythm telemonitoring during the first week after the ablation procedure was offered to a total of 382 consecutive patients undergoing AF ablation. Patients were instructed to perform 1 min PPG recordings by a mobile health application 3 times per day and in case of symptoms. Clinicians assessed the PPG tracings via a secured cloud and the information was remotely integrated into the therapeutic pathway via teleconsultation (TeleCheck-AF approach).Results119 patients (31%) agreed to perform PPG rhythm telemonitoring after ablation. Patients included in the TeleCheck-AF approach were younger compared to those who declined participation (58 ± 10 vs. 62 ± 10 years, p < 0.001). Median follow up duration was 544 (53–883) days. 27% of patients had PPG tracings suggestive of AF in the week following the ablation. In 24% of patients, the integration of PPG rhythm telemonitoring resulted in a remote clinical intervention during teleconsultation. During follow-up of one year, 33% of patients had ECG-documented AF recurrences. PPG recordings suggestive of AF in the week after ablation were predictive of late recurrences (p < 0.001).ConclusionPPG rhythm telemonitoring during the first week after AF ablation often triggered clinical interventions. Due to its high availability, PPG-based follow-up actively involving patients after AF ablation may close a diagnostic and prognostic gap in the blanking period and increase active patient-involvement.

Real-world validation of smartphone-based photoplethysmography for rate and rhythm monitoring in atrial fibrillation

“… 23 This was first demonstrated by the TeleCheck-AF project during the COVID-19 pandemic, when patients were unable to visit a physician. 24 After the COVID-19 pandemic, PPG remained an attractive solution to monitor AF recurrence after ablation; 25 , 26 and to monitor AF burden with intermittent or continuous PPG. 27 …”

Remote rhythm monitoring using a photoplethysmography smartphone application after cardioversion for atrial fibrillation

“…This could also be expanded to other settings, such as post-catheter ablation, where early recurrence may portend a greater risk of long-term recurrence. 14 …”

Atrial fibrillation: epidemiology, screening and digital health

“… 47 In a pilot study from a single-center patients using digital devices 3 months after AF ablation had similar AF detection rates and a reduced need for additional ECG-monitoring compared to standard-of-care. 48 A caveat here is that validation of most devices has not been performed in the post-ablation population, which might be more prone to atrial tachycardias other than AF, which is notably more difficult to diagnose with digital devices using single-lead ECG or PPG. Prior studies have shown that 2 weeks of long-term intermittent monitoring by digital devices more effectively detected AF recurrences and had a higher patients’ usability than short continuous Holter monitoring.…”