Smartphone app-based approximation of time spent with atrial fibrillation and symptoms in patients after catheter ablation: data from the TeleCheck-AF project

Abstract

Aims: Reduction of atrial fibrillation (AF) burden is the preferred outcome measure over categorical AF rhythm recurrence after AF ablation. In this sub-analysis of the TeleCheck-AF project, we tested the feasibility of smartphone app-based approximation of time spent with AF and/or symptoms.

Methods and results: Patients scheduled for at least one teleconsultation during the 12-month follow-up after AF ablation were instructed to use a smartphone photoplethysmography-based application for simultaneous symptom and rhythm monitoring three times daily for 1 week. Proxies of time spent with AF and/or symptoms (% recordings, load, and % days), temporal aggregation of AF and/or symptoms (density), and symptom-rhythm correlation (SRC) were assessed. In total, 484 patients (60% male, 62 ± 9.9 years) were included. Adherence, motivation, and patient satisfaction were high. %AF recordings, AF load, and %AF days (rs = 0.88-0.95) and %symptom recordings, symptom load, and %symptom days (rs = 0.95-0.98) showed positive correlations. The SRC correlated negatively with time spent with symptoms (rs = -0.65-0.90) and with time spent with AF (rs = -0.31-0.34). In patients with paroxysmal AF before ablation and AF during the monitoring period, 87% (n = 39/44) had a low-density score <50% ('paroxysmal AF pattern') while 5% (n = 2/44) had a high-density score >90% ('persistent AF pattern'). Corresponding numbers for patients with persistent AF before ablation were 48% (n = 11/23) and 43% (n = 10/23), respectively.

Conclusion: On-demand, app-based simultaneous rhythm and symptom assessment provides objective proxies of time spent with AF and/or symptoms and SRC, which may assist in assessing AF and symptom outcomes after AF ablation.

Keywords: AF burden; AF symptoms; Atrial fibrillation; Catheter ablation; Mobile health; Photoplethysmography.

Graphical Abstract

Figure 1

Smartphone app-based assessment of time spent with atrial fibrillation and/or symptoms.

Figure 2

Spearman’s correlation matrix for all patients (n = 484) including the following variables: %AF-rec., AF load, %AF days, AF density, %symptom-rec., symptom load, %symptom days, symptom density, and SRC. AF, atrial fibrillation; rec., recordings; SRC, symptom–rhythm correlation.

Figure 3

(A + B) Median and interquartile range for %AF-rec., AF load, %AF days, and AF density. (A) All patients with at least one episode of AF during the 7-day monitoring period (n = 79). (B) Patients with at least one episode of AF during the 7-day monitoring period are divided in patients with paroxysmal (n = 44) and persistent (n = 23) AF before the AF ablation. (C + D) Median and interquartile range for %symptom-rec., symptom load, %symptom days, and symptom density. (C) All patients with at least one symptomatic episode during the 7-day monitoring period (n = 281). (D) Patients with at least one symptomatic episode during the 7-day monitoring period are divided in patients with paroxysmal (n = 152) and persistent AF (n = 68) before the AF ablation. AF, atrial fibrillation; pAF, paroxysmal AF; psAF, persistent AF; rec., recordings.

Figure 4

(A) Individual variation in %AF-rec., AF load, %AF days, and AF density for each patient with at least one episode of AF during the 7-day monitoring period (n = 79). (B) Individual variation in %symptom-rec., symptom load, %symptom days, and symptom density for each patient with at least one symptomatic episode during the 7-day monitoring period (n = 281). AF, atrial fibrillation; rec., recordings.