Effectiveness of photoplethysmography-based rhythm monitoring after atrial fibrillation ablation using a smartphone application: DIGITOTAL study

Abstract

Background: Recurrence after atrial fibrillation (AF) ablation is frequent. Monitoring with long-term electrocardiograms (ECGs) 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: We aimed to compare the effectiveness of digital follow-up using 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 by a 24-hour ECG at 3, 6, and 12 months on top of the ECGs conducted for clinical indications (conventional follow-up). In addition, patients were instructed to perform PPG measurements twice daily or whenever symptoms were perceived during the course of 1 year (digital follow-up).

Results: In total, 96 patients (69% male; mean age, 64 ± 9 years) performed 39,895 PPG measurements. The compliance rate (number performed/prescribed) was 92.6% for ECGs and 78.2% for PPG recordings. After 1 year of follow-up, atrial arrhythmia recurrence was detected in 17.7% of patients by conventional follow-up and in 38.5% of patients by digital follow-up (odds ratio, 3.4; 95% confidence interval [CI], 1.7-7.1). The CI lower limit exceeded the predefined noninferiority margin (P for noninferiority > .001). Hence, superiority was tested (P for superiority = .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%).

Conclusion: Digital rhythm follow-up using a smartphone application with PPG was noninferior 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.