Effectiveness of Photoplethysmography-based Rhythm Monitoring after Atrial Fibrillation Ablation using a Smartphone Application: DIGITOTAL-Study.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2024-11-21 DOI:10.1016/j.hrthm.2024.11.026

Henri Gruwez, Hugo Van Herendael, Seppe Maris, Sebastiaan Dhont, Evelyne Meekers, Liesbeth Bruckers, Femke Wouters, Maximo Rivero-Ayerza, Dieter Nuyens, Pieter Vandervoort, Peter Haemers, Laurent Pison

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引用次数: 0

Abstract

Background: Recurrence after atrial fibrillation (AF) ablation is frequent. Monitoring with (long-term) electrocardiograms (ECG) is constrained by limited monitoring time, measurement dispersion, and cost. Selected photoplethysmography (PPG) smartphone applications have demonstrated excellent accuracy for AF detection and could mitigate these limitations.

Objective: To compare the effectiveness of digital follow-up utilizing a PPG-based smartphone application against conventional ECG-based follow-up for the detection of atrial arrhythmia recurrence after ablation.

Methods: Patients undergoing AF ablation were consecutively enrolled and monitored using a 24h-ECG at 3-6-12 months on top of the ECGs conducted for clinical indications (conventional follow-up). Additionally, patients were instructed to perform PPG measurements twice daily or whenever symptoms were perceived, over the course of one year (digital follow-up).

Results: In total, 96 patients (69% male, mean age 64±9 years) performed 39895 PPG measurements. The compliance rate (n performed/prescribed) was 92.6% for ECG and 78.2% for PPG recordings. After one year follow-up, atrial arrhythmia recurrence was detected by conventional follow-up in 17.7% and in 38.5% of patients by digital follow-up (OR 3.4; 95%CI: 1.7-7.1). The CI lower limit exceeded the predefined non-inferiority margin (p for non-inferiority >0.001). Hence, superiority was tested (p for superiority =0.001). The negative predictive value of digital follow-up for atrial arrhythmia detected with conventional follow-up was 98.3% (95%CI: 90.9-99.9%).

Conclusions: Digital rhythm follow-up using a smartphone application with PPG was non-inferior to conventional follow-up in detecting atrial arrhythmia recurrence between 3 and 12 months after ablation. Moreover, digital follow-up significantly increased the detection of atrial arrhythmia.

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心房颤动消融术后使用智能手机应用程序进行基于血压计的节律监测的有效性：DIGITOTAL-研究。

背景：心房颤动（房颤）消融术后经常复发。使用（长期）心电图（ECG）进行监测受到监测时间有限、测量分散和成本等因素的限制。部分光电血压计（PPG）智能手机应用已证明对房颤检测具有极高的准确性，可以缓解这些局限性：比较使用基于 PPG 的智能手机应用程序进行数字随访与基于传统心电图的随访在检测消融术后房性心律失常复发方面的有效性：方法：对接受房颤消融术的患者进行连续登记，并在3-6-12个月内使用24小时心电图对其进行监测，同时根据临床指征进行心电图检查（常规随访）。此外，还指导患者在一年内每天两次或在出现症状时进行 PPG 测量（数字随访）：共有 96 名患者（69% 为男性，平均年龄为 64±9 岁）进行了 39895 次 PPG 测量。心电图和 PPG 记录的符合率（执行/处方人数）分别为 92.6%和 78.2%。随访一年后，17.7% 的患者通过常规随访发现房性心律失常复发，38.5% 的患者通过数字随访发现房性心律失常复发（OR 3.4；95%CI：1.7-7.1）。CI下限超过了预先确定的非劣效性范围（非劣效性 p >0.001）。因此，进行了优越性测试（优越性 p =0.001）。数字随访对传统随访发现的房性心律失常的阴性预测值为 98.3%（95%CI：90.9-99.9%）：结论：在消融术后 3 至 12 个月期间，使用智能手机应用程序和 PPG 进行数字心律随访在检测房性心律失常复发方面并不优于传统随访。此外，数字化随访还能明显提高房性心律失常的检出率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.