Smartphone app-based symptom assessment in patients with atrial fibrillation on the waiting list for electrical cardioversion: a TeleConvert-atrial fibrillation sub analysis

Q: What are the key findings of this study?

Atrial fibrillation recurrence after electrical cardioversion was significantly associated with a reduced likelihood of symptom improvement (OR 0.167) compared to maintaining sinus rhythm.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=252). Intervention: Atrial fibrillation recurrence vs. Maintenance of sinus rhythm (no recurrence). Primary outcome: Improvement in symptom load (OR 0.167, 95% CI 0.092-0.205, p=<0.001).

Q: What does this research mean for the field?

Although electrical cardioversion reduces overall symptom load in patients with atrial fibrillation, symptom improvement is highly variable, with atrial fibrillation recurrence being the only independent determinant of failure to improve. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate peri-procedural changes in symptom burden using a smartphone photoplethysmography app in patients with atrial fibrillation scheduled for electrical cardioversion.

Maren Rippens; B J M Hermans; Emma Sandgren; JUSTIN G. L. M. LUERMANS; Sevasti‐Maria Chaldoupi; Jeroen Hendriks; Theo Lankveld; Mandy V M Kessels; Bianca J G H Vorstermans; Rypko J. Beukema; Kevin Vernooy; Wilfred F. Heesen; Astrid N L Hermans; Dominik Linz

doi:10.1093/europace/euag201

August 1, 2026EP EuropaceOpen Access

Smartphone app-based symptom assessment in patients with atrial fibrillation on the waiting list for electrical cardioversion: a TeleConvert-atrial fibrillation sub analysis

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Key result

AF recurrence after electrical cardioversion linked to ~83% lower odds of symptom improvement vs sinus rhythm.

OR 0.167
95% CI 0.092-0.205
P<0.001
n=252

Why the study?

Symptoms in patients with persistent atrial fibrillation scheduled for electrical cardioversion are traditionally assessed subjectively and retrospectively, lacking real-time evaluation for reliable AF patterns and symptoms.

Key Points

To evaluate peri-procedural changes in symptom burden using a smartphone photoplethysmography app in patients with atrial fibrillation scheduled for electrical cardioversion.
Sub-analysis of the prospective TeleConvert-AF study assessing N=252 patients (median age 68 years, 70.2% male) scheduled for electrical cardioversion.
Patients recorded smartphone photoplethysmography heart rhythm measurements (FibriCheck) three times daily for a median of 35 days pre-procedure and 28 days post-procedure.
Symptom load was defined as time spent in symptoms divided by total monitoring time, and atrial fibrillation load was monitored alongside rhythm status.
Overall median symptom load decreased from 20.7% [1.4–61.2] pre-procedure to 7.2% [0–37.6] post-procedure (P < 0.001), with 50.4% experiencing improvement, 18.3% remaining stable, and 30.2% worsening.
Symptom improvement occurred in 61/89 (68.5%) patients without arrhythmia recurrence versus 66/162 (40.7%) patients with recurrence.
Atrial fibrillation recurrence was the only independent determinant associated with reduced likelihood of symptom improvement (odds ratio 0.167, 95% CI 0.092–0.205; P < 0.001).

Study Design

Type

Cohort (n=252)

PICO

P

Population

252 stable patients with persistent atrial fibrillation scheduled for elective electrical cardioversion who underwent structured app-based rhythm and symptom monitoring for 2 weeks before and 4 weeks after the procedure.

E

Exposure / Comparator

Atrial fibrillation recurrence vs Maintenance of sinus rhythm (no recurrence)

O

Primary Outcome

Improvement in symptom load — OR 0.167 (0.092-0.205), p=<0.001

Main Result

Odds Ratio: 0.167 (95% CI 0.092–0.205)

Absolute Event Rate: 40.7% vs 68.5%

p-value: p=<0.001

Limitations

The cohort consisted of patients scheduled for elective ECV, which may represent a relatively stable population with an acceptable symptom burden, limiting generalizability.
Intermittent app-based monitoring may not capture all atrial fibrillation episodes or symptoms.

Implication

AF recurrence after cardioversion may limit symptom relief; hypothesis-generating for rhythm-control strategies in persistent AF.

Abstract

Contains fulltext : 334828.pdf (Publisher’s version ) (Open Access)

Discussion

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Cite This Study

Rippens et al. (2026) conducted a cohort in Atrial fibrillation (n=252). Atrial fibrillation recurrence vs. Maintenance of sinus rhythm (no recurrence) was evaluated on Improvement in symptom load (OR 0.167, 95% CI 0.092-0.205, p=<0.001). Atrial fibrillation recurrence after electrical cardioversion was significantly associated with a reduced likelihood of symptom improvement (OR 0.167) compared to maintaining sinus rhythm.

synapsesocial.com/papers/6ad0fc8615427f6a840401d2 https://doi.org/10.1093/europace/euag201

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Smartphone app-based symptom assessment in patients with atrial fibrillation on the waiting list for electrical cardioversion: a TeleConvert-atrial fibrillation sub analysis

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Smartphone app-based symptom assessment in patients with atrial fibrillation on the waiting list for electrical cardioversion: a TeleConvert-atrial fibrillation sub analysis

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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