Digital devices for heart rhythm monitoring in atrial fibrillation patients scheduled for elective electrical cardioversion

Abstract

Introduction and objectives: Management in recent-onset atrial fibrillation (AF) is to achieve sinus rhythm (SR) by cardioversion (CV). However, frequently SR is spontaneously restored, making scheduled admission unnecessary and causing misutilization of healthcare resources. Emerging medical technology allows accurate heart rhythm monitoring. This study evaluated this technology in these patients, preventing unnecessary admission and providing an earlier management.

Methods: A multicenter study was designed including patients with AF scheduled for elective electrical CV. Patients submitted ECG recordings to a central CoreLab daily, twice a day and whenever they present symptoms, until CV (spontaneous or scheduled) and a week afterwards. Whenever a spontaneous conversion to SR was detected, investigators were contacted to confirm SR and abort admission. Patients' satisfaction was evaluated using a test for perceived utility, convenience, and accessibility.

Results: 74 patients were enrolled (age 62±10 years). Twenty-two patients (30%) showed spontaneous conversion to SR. A total of 22 admissions and 16 transesophageal echocardiograms were prevented. Among 52 patients admitted for CV, 45 (88%) were discharged in SR. During follow-up after conversion to SR (spontaneous or electrical), recurrences of AF occurred in 24 patients (34%). At the end of the follow-up 51 patients (69%) remained in SR. The CoreLab received 93% of the expected ECG transmissions. Patient's overall satisfaction score was 9.1 over 10.

Conclusion: Digital devices for heart rhythm monitoring can optimize the management of AF patients scheduled for elective CV, preventing unnecessary admissions and providing a more rational use of healthcare resources.

Keywords: Ambulatory electrocardiographic monitoring; Atrial fibrillation; Cardioversion; Cardioversión eléctrica; Digital health; Evaluación de las tecnologías de salud; Fibrilación auricular; Monitorización electrocardiográfica ambulatoria.