Improving atrial fibrillation or flutter detection and management by smartphone-based photoplethysmography rhythm monitoring following cardiac surgery: a pragmatic randomized trial.

• Tác giả: Nicolas De Melio, Lien Desteghe, Henri Gruwez, Peter Haemers, Hein Heidbuchel, Marie Lamberigts, Dieter Nuyens, Laurent Pison, Filip Rega, Inez Rodrigus, Hugo Van Herendael, Christiaan Van Kerrebroeck, Leen Van Langenhoven, Pieter Vandervoort, Paulien Vermunicht
• Ngôn ngữ: eng
• Ký hiệu phân loại: 636.0885 Animal husbandry
• Thông tin xuất bản: England : Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology , 2025
• Bộ sưu tập: NCBI
• ID: 60707

Tóm tắt

 AIMS: Atrial fibrillation (AF) and atrial flutter (AFL) after cardiac surgery are common and associated with adverse outcomes. The increased risk related to AF or AFL may extend beyond discharge. This study aims to determine whether photoplethysmography (PPG)-based smartphone monitoring to detect AF or AFL after hospital discharge following cardiac surgery improves AF management. METHODS AND RESULTS: The intervention group performed 1 min rhythm checks three times daily using a smartphone-based PPG application during 6 weeks after hospitalization for cardiac surgery. The primary outcome involved AF management interventions by independent physicians, including initiation of oral anticoagulation (OAC), direct cardioversion, and up-titration or initiation of antiarrhythmic drugs. The study included 450 patients [mean (SD) age, 64.1 (9.2) years
  96 women (21.3%)
  130 patients with AF history (28.9%)
  median (IQR) CHA2DS2-VASc score, 2 (1-3)], of whom 238 were randomized to PPG-based monitoring and 212 to usual care. AF/AFL was detected with PPG or electrocardiography in 44 patients (18.5%) in the monitoring group and 4 patients (1.9%) in the usual care group (OR 11.8
  95% CI, 4.2-33.3
  P <
  0.001)
  these were new detections in, respectively, 22 patients (9.2%) and 1 patient (0.5%) (OR 21.3
  95% CI, 2.9-166.7
  P = 0.003). AF management interventions occurred in 24 patients (10.1%) in the monitoring group compared to 5 patients (2.4%) in the usual care group [odds ratio (OR), 5.1
  95% CI, 1.8-14.4
  P = 0.002]. CONCLUSION: In unselected patients discharged home following cardiac surgery, PPG-based smartphone monitoring revealed significantly more AF/AFL which led to significantly more optimization of AF management.