Progression in remote app-based monitoring of atrial fibrillation

Remote app-based monitoring of atrial fibrillation (AF) has been gaining ground in recent years. Photoplethysmography (PPG)-based devices have been providing data on regularity, frequency, and rate and can aid physicians to analyse symptom/rhythm correlation. App-based monitoring can be both useful for screening of older and younger patients. Finally, the Telecheck-AF study showed how collected app-based data could aid AF management.

The European Heart Rhythm Association (EHRA) has published a practical guide on ‘How to use digital devices to detect and manage arrhythmias’ during their annual meeting [1]. Prof. Dominik Linz (Maastricht University Medical Center, the Netherlands) reviewed the current state of the art regarding app-based monitoring of AF [2].

Many different wearable devices have been developed in recent years to monitor AF remotely: earlobe sensors, watches, chest belts, armbands, and finger bands. The devices can be divided into electrocardiogram (ECG)-based devices and PPG-based devices. Although PPG-based devices cannot be used to diagnose AF, since this requires ECG-based tools, PPG is a novel technique in cardiology that is highly useful in patients that have already been diagnosed with AF.

Advantages of PPG

Recently, a step-by-step approach to interpret PPG data was published [3]. Prof. Linz explained that PPG is very useful to assess the time spent in AF in patients who have already been diagnosed with AF. The output in waveform, tachogram, and Poincaré plot, which we know from implantable devices, provides data on regularity, frequency, and rate. For example, AF, atrial tachycardia, AV-nodal re-entrant tachycardia, and atrial flutter can be assessed through PPG-based monitoring. Furthermore, PPG recordings may aid physicians to analyse symptom/rhythm correlations. If electrical cardioversion is performed in a patient, PPG-based monitoring can be used to assess rhythm and symptoms before and after the procedure to objectively analyse rhythm/symptoms correlations.

Screening

App-based monitoring can also be useful for screening. Systematic screening through ECG-based devices is recommended in high-risk, older patients, in whom AF is more common. In younger patients without comorbidities, PPG-based devices can be used to exclude AF. Prof. Linz added that digital literacy should be taken into account when wearable devices are considered for AF screening.

Integration in practice

“Physicians need to integrate mobile health data in their clinical workflow,” stated Prof. Linz.

For this purpose, companies have been investing in the identification of meaningful, actionable data, which clinicians can use for their patient management. The Telecheck-AF study collected data on heart rhythm and heart rate on-demand for a pre-specified period before patients received a teleconsultation. This way, physicians could use the collected data directly in their approach for AF management. The study showed that fewer ECGs, Holters, and face-to-face consultations were needed, without increasing the number of emergency department visitations [4].

“App-based monitoring of AF has been evolving in recent years,” concluded Prof. Linz. “Importantly, patient education and engagement are key, since the patient must actively monitor its condition.”

1. Svennberg E, et al. EP Europace. 2022;euac038.


2. Linz D. Remote app-based monitoring of AF. Atrial fibrillation (AF) and heart failure (HF) in the digital era, EHRA 2022, 3–5 April, Copenhagen, Denmark.


3. Van der Velden RMJ, et al. EHJ Digital Health. 2021;2(3):363–373.


4. Gawalko M, et al. Europace. 2021;23(7):1003–1015.

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Posted on 1 June, 202213 June, 2022