Prolonged Smartphone-Based Photoplethysmography for Heart Rhythm Monitoring After Repeat Ablation of Atrial Fibrillation — A 6-Month Prospective Study on mHealth Compliance, Motivation and Arrhythmia Recurrence

BACKGROUND & AIM: Photoplethysmography (PPG) enables mobile health (mHealth) heart rhythm monitoring (HRM). We aimed to assess patient experience and detection rates of arrhythmia recurrence with a mHealth HRM after repeat ablation of atrial fibrillation (AF). METHODS: Patients undergoing repeat ablation of AF were instructed to perform three rhythm recordings daily using a PPG-based smartphone application over a follow-up (FU) period of 6 months. Compliance was assessed as the number of actual measurements per number of expected measurements. Motivation was calculated as the ratio of the total number of days where the expected measurements were performed to the total number of monitoring days. Arrhythmia recurrence was compared between mHealth and conventional HRM comprising of 12-lead- and Holter-ECGs at 3 and 6 months after ablation. RESULTS: A total of 58 patients (37.9% female; median age 66.0 years, interquartile range [IQR] 59.8-72.3) were enrolled and participated in FU. A total of 21,985 PPG recordings have been performed (27.7% symptomatic). The median compliance for performing three measurements per day was 73.8% (IQR 43.8-99.9) and the motivation rate was 33.6% (IQR 12.6-79.8). Freedom from AF/atrial flutter was observed in 58.6% of the patients in the mHealth HRM and 82.8% in the conventional HRM (HR 3.140; 95%CI 1.593-6.188; p=0.0012). Of the PPG measurements indicating AF or atrial flutter, symptoms were reported in only 43.0%. CONCLUSIONS: Patients undergoing repeat ablation of AF have high compliance for participating in a prolonged mHealth HRM over 6 months. The detection rate of atrial arrhythmia recurrences was higher in the mHealth compared to conventional FU.