Smartphone Mechanocardiography used for post-ablation home monitoring to detect atrial fibrillation recurrence: Usability, adherence and re-ablation

Aims Recurrence of atrial fibrillation (AF) following catheter ablation is common but may be underdetected using conventional intermittent monitoring. Smartphone-based Mechanocardiography (MCG) enables low-burden rhythm assessment; however, evidence regarding its real-world applicability in the post-ablation setting remains limited. We aimed to evaluate the feasibility, usability, and clinical relevance of MCG-based home monitoring after AF ablation, and to explore its association with re-ablation. Methods and results In this prospective single-center study, 640 consecutive patients with paroxysmal and persistent AF undergoing AF ablation were offered home monitoring using the CardioSignal® smartphone application. Among these, 521 (81%) were active users during the first month, and 354 (68%) remained active at 6 months. 8,240 recordings were performed in the first month, declining to 2,869 at 6 months. AF recurrence was detected in 40% of active users during the first 3 months and in 30% during months 4-6, with clear early clustering. Usability was high: 95% of survey respondents (n=338) reported the app was easy to use, and 91% perceived monitoring as valuable. In a predefined Danish subcohort (n=164), Kaplan-Meier survival analysis demonstrated early AF recurrence detected by MCG was strongly associated with re-ablation within 12 months (log-rank p< 0,0002), occurring in 27.6% of patients with early AF recurrence vs. 4.5% without. Conclusion Smartphone-based MCG is a feasible, well-accepted method for patient-initiated, low-burden event monitoring. Early AF recurrence detected by MCG is common and associated with re-ablation, supporting its role in early risk stratification and post-procedural management.