Recurrent atrial fibrillation/flutter detection after ablation or cardioversion using the AliveCor KardiaMobile device: iHEART results

Abstract

Objective: This study evaluated the impact of daily ECG self-recordings on time to documented recurrent atrial fibrillation (AF) or atrial flutter (AFL) and time to treatment of recurrent arrhythmia in patients undergoing catheter radiofrequency ablation (RFA) or direct current cardioversion (DCCV) for AF/AFL. Background: AF recurrence rates after RFA and DCCV are 20–45% and 60–80% respectively. Randomized trials comparing mobile ECG devices to standard of care have not been performed in an AF/AFL population after treatment. Methods: Of 262 patients consented, 238 were randomized to either standard of care (123) or to receive the iHEART intervention (115). Patients in the intervention group were provided with and trained to use an AliveCor® KardiaMobile ECG monitor, and were instructed to take and transmit daily ECG recordings. Data were collected from transmitted ECG recordings and patients’ electronic health records. Results: In a multivariate Cox model, the likelihood of recurrence detection was greater in the intervention group (hazard ratio = 1.56, 95% CI: 1.06–2.30, p = .024). Hazard ratios did not differ significantly for RFA and DCCV procedures. Recurrence during the first month after ablation strongly predicted later recurrence (hazard ratio = 4.53, 95% CI: 2.05–10.00, p = .0006). Time to from detection to treatment was shorter for the control group. (hazard ratio = 0.33, 95% CI: 0.57–2.92, p <.0001) Conclusions: The use of mobile ECG self-recording devices allows for earlier detection of AF/AFL recurrence and may empower patients to engage in shared health decision making.

Impact of Mobile Health Devices for the Detection of Atrial Fibrillation: Systematic Review

“…Kaura et al [ 34 ] reported a dropout of 22.4% and did not address this data in the report. This was also true for the RCT by Goldenthal et al [ 32 ], but the dropout in this trial was just 2.1%. As for allocation concealment in the trial carried out by Halcox et al [ 29 ], no clarity was provided in the method section of the paper.…”

Changes in the digital health landscape in cardiac electrophysiology: A pre-and peri-pandemic COVID-19 era survey

“…In the iHEART study, use of a mobile ECG device paired with a smartphone increased the detection of recurrent atrial arrhythmias after atrial fibrillation ablation, which strongly predicted later arrhythmia recurrence with a trend towards lower hospitalization and ER visits. 18 The randomized Heartline study (ClinicalTrials.gov Identifier: NCT04276441) is currently underway to determine if use of a 1-lead ECG capable smartwatch can not only increase the diagnosis of J o u r n a l P r e -p r o o f atrial fibrillation, but also improve major cardiovascular outcomes of stroke, myocardial infarction and all-cause mortality.…”

The portable device improves the detection of atrial fibrillation after ablation

“…There is emerging evidence that AF recurrence after ablation may be asymptomatic. Studies have shown that asymptomatic AF may be increasingly common after ablation and potentially pose a greater thromboembolic risk than symptomatic AF [17][18][19] . In the present study, we found that 785/3299 (23.8%) of AF detected after ablation were asymptomatic, that may explain the poor compliance with anticoagulation after catheter ablation even if patients receive recommendations of anticoagulation from doctors.…”