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

Abstract

Introduction Direct current cardioversion (DCCV) is a commonly utilised rhythm control technique for atrial fibrillation (AF). Follow-up typically comprises a hospital visit for 12-lead ECG two weeks post-DCCV. We report the feasibility, costs and environmental benefit of remote photoplethysmography (PPG) monitoring as an alternative. Methods We retrospectively analysed DCCV cases at our centre from May 2020 to October 2022. Patients were stratified into those with remote PPG follow-up and those with traditional 12-lead ECG follow-up. Monitoring type was decided by the specialist nurse performing the DCCV at the time of the procedure after discussing with the patient and offering them both options if appropriate. Outcomes included the proportion of patients who underwent PPG monitoring, patient compliance and experience, and cost, travel and environmental impact. Results 416 patients underwent 461 acutely successful DCCV procedures. 246 underwent PPG follow-up whilst 214 underwent ECG follow-up. Patient compliance was high (PPG 89.4% vs ECG 89.8%; p > 0.999) and the majority of PPG users (90%) found the app easy to use. Sinus rhythm was maintained in 71.1% (PPG) and 64.7% (ECG) of patients (p = 0.161). 29 (11.8%) PPG patients subsequently required an ECG either due to non-compliance, technical failure or inconclusive PPG readings. Despite this, mean healthcare costs (£47.91 vs £135 per patient; p < 0.001) and median cost to the patient (£0 vs £5.97; p < 0.001) were lower with PPG. Median travel time per patient (0 vs 44min; p < 0.001) and CO2 emissions (0 vs 3.59kg; p < 0.001) were also lower with PPG. No safety issues were identified. Conclusion Remote PPG monitoring is a viable method of assessing for arrhythmia recurrence post-DCCV. This approach may save patients significant travel time, reduce environmental CO2 emission and be cost saving in a publicly-funded healthcare system.