Background: Technical advances in photoplethysmography (PPG) utilizing smartphones have led to the capability of domestic heart rhythm monitoring (HRM). Longitudinal HRM after catheter ablation of atrial fibrillation (AF) may increase the detection rate of AF relapses and improve patient care. However, there is only limited evidence on patients’ motivation, compliance, and experience.

Methods: Patients undergoing re-ablation of AF were prospectively enrolled and instructed to perform 3 measurements per day for 6 months with the CE-certified PPG-based smartphone-app FibriCheck©. Results including the experience of symptoms were telemedically transmitted to our institution. We evaluated motivation (ratio of the total number of days with the expected measurements to the total number of days throughout the entire period) and compliance (number of actual measurements per number of expected measurements throughout the study). The patients’ experience was assessed with a standardized questionnaire at follow-up visits after 6 months.

Results: 43 patients have been enrolled since May 2021 (33% female; median age 66 years [interquartile range 61-72]). 81% had persistent, 19% had paroxysmal AF. The median CHA₂DS₂-VASc-score was 3 (IQR 1-4), EHRA-Score was 3 (IQR 2-3). By June 2023, 7 patients were still in follow-up. It required 8 minutes (IQR 6-14) to train the patients on how to use the app at baseline and 4 minutes (IQR 3-8.75) to review the measurements at 6-months-visits. The total number of days of HRM was 7,005 (176.5 days [IQR 171.0-179.5] per patient). Overall, 16,548 measurements were recorded (423 [IQR 228-546] per patient). The compliance rate for performing the expected number of measurements was 81%. The motivation rate was 43%. 6% of all measurements indicated AF (Fig. 1). However, patients only reported symptoms in 47% of the AF measurements. Only 10% of the measurements under indication of symptoms were identified as AF. Patients reported an overall high benefit and a very positive user experience (Fig. 2). 

Conclusion: Our data show excellent compliance and good motivation as well as good experience with a prolonged smartphone-based HRM in the setting of re-ablation of AF showcasing patients willingness to actively take part in their own care process. This suggests that current standard of care after catheter ablation of AF should be complemented by more intensive HRM involving telemedical approaches.

Fig. 1: Results of the measurements related to reported symptoms. ‘normal’ = sinus rhythm, ‘warning’ = possibly indicating arrythmia (e.g. premature beats and atrial flutter), ‘urgent’ = suspicious for AF. 

Fig. 2: User experience about HRM assessed at 6 months.