Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation

ElsevierVolume 367, 15 November 2022, Pages 29-37International Journal of CardiologyHighlights•

In persistent atrial fibrillation patients, simultaneous mobile app-based symptom and rhythm monitoring revealed a relatively low overall symptom-rhythm correlation, which was mainly driven by a majority of atrial fibrillation recordings which were asymptomatic.

Patients with chronic heart failure and diabetes more often had a lower symptom-rhythm correlation.

Extrasystoles can explain a minority of symptomatic non-atrial fibrillation photoplethysmography recordings.

Pulse rate, but not pulse variability, is the main determinant of reported symptoms during atrial fibrillation and non-atrial fibrillation photoplethysmography recordings.

AbstractBackground

The assessment of symptom-rhythm correlation (SRC) in patients with persistent atrial fibrillation (AF) is challenging. Therefore, we performed a novel mobile app-based approach to assess SRC in persistent AF.

Methods

Consecutive persistent AF patients planned for electrical cardioversion (ECV) used a mobile app to record a 60-s photoplethysmogram (PPG) and report symptoms once daily and in case of symptoms for four weeks prior and three weeks after ECV. Within each patient, SRC was quantified by the SRC-index defined as the sum of symptomatic AF recordings and asymptomatic non-AF recordings divided by the sum of all recordings.

Results

Of 88 patients (33% women, age 68 ± 9 years) included, 78% reported any symptoms during recordings. The overall SRC-index was 0.61 (0.44–0.79). The study population was divided into SRC-index tertiles: low (<0.47), medium (0.47–0.73) and high (≥0.73). Patients within the low (vs high) SRC-index tertile had more often heart failure and diabetes mellitus (both 24.1% vs 6.9%). Extrasystoles occurred in 19% of all symptomatic non-AF PPG recordings. Within each patient, PPG recordings with the highest (vs lowest) tertile of pulse rates conferred an increased risk for symptomatic AF recordings (odds ratio [OR] 1.26, 95% coincidence interval [CI] 1.04–1.52) and symptomatic non-AF recordings (OR 2.93, 95% CI 2.16–3.97). Pulse variability was not associated with reported symptoms.

Conclusions

In patients with persistent AF, SRC is relatively low. Pulse rate is the main determinant of reported symptoms. Further studies are required to verify whether integrating mobile app-based SRC assessment in current workflows can improve AF management.

Keywords

Atrial fibrillation

Symptom-rhythm correlation

Mobile health

Telemonitoring

Electrical cardioversion

© 2022 The Author(s). Published by Elsevier B.V.

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