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Observational Study
. 2021 Apr 15;9(4):e26519.
doi: 10.2196/26519.

Remote Heart Rhythm Monitoring by Photoplethysmography-Based Smartphone Technology After Cardiac Surgery: Prospective Observational Study

Marie Lamberigts  1 , Lucas Van Hoof  1 , Tine Proesmans  2 , Pieter Vandervoort  3 , Lars Grieten  2 , Peter Haemers  4 , Filip Rega  1
Affiliations
Observational Study

Remote Heart Rhythm Monitoring by Photoplethysmography-Based Smartphone Technology After Cardiac Surgery: Prospective Observational Study

Marie Lamberigts et al. JMIR Mhealth Uhealth. .

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery, yet the precise incidence and significance of arrhythmias after discharge home need to be better defined. Photoplethysmography (PPG)-based smartphone apps are promising tools to enable early detection and follow-up of arrhythmias.

Objective: By using a PPG-based smartphone app, we aimed to gain more insight into the prevalence of AF and other rhythm-related complications upon discharge home after cardiac surgery and evaluate the implementation of this app into routine clinical care.

Methods: In this prospective, single-center trial, patients recovering from cardiac surgery were asked to register their heart rhythm 3 times daily using a Food and Drug Administration-approved PPG-based app, for either 30 or 60 days after discharge home. Patients with permanent AF or a permanent pacemaker were excluded.

Results: We included 24 patients (mean age 60.2 years, SD 12 years; 15/23, 65% male) who underwent coronary artery bypass grafting and/or valve surgery. During hospitalization, 39% (9/23) experienced postoperative AF. After discharge, the PPG app reported AF or atrial flutter in 5 patients. While the app notified flutter in 1 patient, this was a false positive, as electrocardiogram revealed a 2nd-degree, 2:1 atrioventricular block necessitating a permanent pacemaker. AF was confirmed in 4 patients (4/23, 17%) and interestingly, was associated with an underlying postoperative complication in 2 participants (pneumonia n=1, pericardial tamponade n=1). A significant increase in the proportion of measurements indicating sinus rhythm was observed when comparing the first to the second month of follow-up (P<.001). In the second month of follow-up, compliance was significantly lower with 2.2 (SD 0.7) measurements per day versus 3.0 (SD 0.8) measurements per day in the first month (P=.002). The majority of participants (17/23, 74%), as well as the surveyed primary care physicians, experienced positive value by using the app as they felt more involved in the postoperative rehabilitation.

Conclusions: Implementation of smartphone-based PPG technology enables detection of AF and other rhythm-related complications after cardiac surgery. An association between AF detection and an underlying complication was found in 2 patients. Therefore, smartphone-based PPG technology may supplement rehabilitation after cardiac surgery by acting as a sentinel for underlying complications, rhythm-related or otherwise.

Keywords: atrial fibrillation; cardiac rehabilitation; cardiac surgery; home-monitoring; photoplethysmography; postoperative arrhythmias; postoperative follow-up.

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Conflict of interest statement

Conflicts of Interest: LG and TP are employees of Qompium NV, the developer of the specific photoplethysmography app “FibriCheck” used in this study. LG is CEO and shareholder of Qompium NV.

Figures

Figure 1
Figure 1
Schematic overview of the protocol for management of detected arrhythmias during the follow-up phase. AF: atrial fibrillation; PCP: primary care physician.
Figure 2
Figure 2
Overview of FibriCheck results comparing the proportion of each rhythm diagnosis between the first and second month of follow-up, with significance determined using 2-proportion z tests. AF: atrial fibrillation; PVC: premature ventricular contraction, SR: sinus rhythm.
See this image and copyright information in PMC

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