Feasibility of repeated on-demand smartphone app-based approximation of time spent with atrial fibrillation and symptoms in patients after catheter ablation: Data from the ISOLATION study.

BACKGROUND

The preferred outcome after atrial fibrillation (AF) ablation is reducing AF burden, reflected by time spent with AF. Digital tools provide novel strategies to approximate time spent with AF.

OBJECTIVES

The purpose of this study was to assess the feasibility of repeated on-demand heart rhythm and symptom monitoring and analyze time spent with AF and symptoms over 12 months after AF ablation.

METHODS

Patients were instructed to monitor heart rhythm and symptoms using an on-demand photoplethysmography-supported smartphone application 3 times daily for 7 days at 3-, 6-, and 12-month follow-ups. Metrics assessed included AF load and density, symptom load and density, and symptom-rhythm correlation.

RESULTS

A total of 191 patients (median age 65 years [interquartile range 58-71 years]) 65% (n = 125/191) male) were included. Patient adherence (-7%; P=.04) declined slightly over 12 months. Forty-five patients (24%) had AF recurrence and 136 (71%) symptom recurrence. Among patients with high AF load and density at 3 months, 73% (n = 11/15) and 88% (n = 7/8) remained in the respective high class; among patients with low AF load and density, 0% (n = 0/1 respective n = 0/1) remained in the low class. Among patients with high symptom load and density, 84% (n = 36/43) and 75% (n = 15/20) remained in the respective high class; among patients with low symptom load and density, 0% (n = 0/12 respective n = 0/2) remained in the low class. Symptom-rhythm correlation was high (median 97% [interquartile range 77%-100%]).

CONCLUSION

Repeated on-demand smartphone-based monitoring is feasible after AF ablation. Patient adherence declined slightly over 12 months. At 3 months, high AF and symptom load reliably predicted the following year while low AF and symptom load necessitate repeated monitoring.