Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation. (15th November 2022)

• Record Type: Journal Article
• Authors: Hermans, Astrid N.L.; Gawalko, Monika; Slegers, Daniek P.J.; Andelfinger, Nora; Pluymaekers, Nikki A.H.A.; Verhaert, Dominique V.M.; van der Velden, Rachel M.J.; Betz, Konstanze; Evens, Stijn; Luermans, Justin G.L.M.; den Uijl, Dennis W.; Baumert, Mathias; Nguyen, Hien L.; Isaksen, Jonas L.; Kanters, Jørgen K.; Rienstra, Michiel; Vernooy, Kevin; Van Gelder, Isabelle C.; Hendriks, Jeroen M.; Linz, Dominik
• Is Part Of: International journal of cardiology. Volume 367(2022)
• Page Start: 29
• Page End: 37
• Publication Date: 2022-11-15
• Subjects: Atrial fibrillation -- Symptom-rhythm correlation -- Mobile health -- Telemonitoring -- Electrical cardioversion; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.08.021
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: 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. Highlights: 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.