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

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.