From detection to action: PPG monitoring in the early post-ablation window

Background Early recurrence of atrial tachyarrhythmias (ERAT) is common after atrial fibrillation (AF) ablation and contributes to symptom burden. The clinical impact of early photoplethysmography (PPG) monitoring remains unclear. Purpose To evaluate the clinical interventions prompted by PPG-detected ERAT during the early post-ablation period. Methods We performed a retrospective single-center study where smartphone-based PPG monitoring is routinely offered after AF ablation. Patients who recorded at least one high-quality measurement within 8 weeks post-procedure were included. Clinical actions attributable to PPG-detected ERAT were identified through arrhythmia nurse documentation, emergency department reports and cardiology notes. Interventions judged unrelated to PPG findings were excluded. Standard care included twice-daily and symptom-triggered PPG measurements, reviewed daily by an arrhythmia nurse and a first follow-up consultation after 6 weeks. Results Among 789 ablated patients, 511 (64.8%) were offered smartphone-based PPG monitoring based on potential benefit and digital literacy, of whom 349 (68.3%) recorded at least one high-quality measurement. ERAT was detected in 110 patients (31.5%) within 8 weeks. Of these, 31 patients (28.2%) experienced at least one PPG-triggered clinical intervention (41 total). Interventions included adjustments or initiation of antiarrhythmic or rate control therapy (n=19), electrical cardioversion (n=11), emergency department visit (n=4), unscheduled outpatient visit (n=4) and extension of direct oral anticoagulation (DOAC) therapy (n=3). Conclusions In a real-world pathway for routine PPG-based post-ablation monitoring, PPG-detected ERAT prompted clinical interventions in nearly one-third of affected patients. These findings suggest that remote PPG monitoring could support timely clinical decision-making early after AF ablation, although prospective evaluation of clinical outcomes is warranted.