Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Dec 16, 2020
Date Accepted: Mar 24, 2021
Remote Heart Rhythm Monitoring by Photoplethysmography-based Smartphone Technology after Cardiac Surgery: Prospective Observational Study
ABSTRACT
Background:
Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery yet the precise incidence and significance of arrhythmias after discharge home needs to be better defined. Photoplethysmography (PPG) based smartphone applications are promising tools to enable early detection and follow-up of arrhythmias.
Objective:
By using a PPG based smartphone application, we aimed to gain more insight into the prevalence of AF and other rhythm-related complications upon discharge home after cardiac surgery and evaluate the implementation of this app into routine clinical care.
Methods:
In this prospective single center trial, patients recovering from cardiac surgery were asked to register their heart rhythm three times daily, using an FDA-approved PPG-based app, for either 30 or 60 days after discharge home. Patients with permanent AF or a permanent pacemaker were excluded.
Results:
24 patients (age 60.2 ± 12y, 65.2% male) who underwent CABG and/or valve surgery were included. During hospitalization, 39% experienced postoperative AF. After discharge, the PPG-app reported AF or atrial flutter in 5 patients. While the app notified flutter in 1 patient, this was a false positive as ECG revealed a 2nd degree 2:1 AV block necessitating a permanent pacemaker. AF was confirmed in 4 patients (4/24, 16.7%) and interestingly, was associated with an underlying postoperative complication in 2 participants (pneumonia n=1, pericardial tamponade n= 1). A significant increase in the proportion of measurements indicating sinus rhythm was observed when comparing the first to the second month of follow-up (p < 0.001). In the second month of follow-up, compliance was significantly lower with 2.2 ± 0.7 measurements per day versus 3.0 ± 0.8 in the first month (p=0.002). The majority of participants (73.9%), as well as the surveyed primary care physicians, experienced a positive value by using the app as they felt more involved in the postoperative rehabilitation.
Conclusions:
Implementation of smartphone-based PPG-technology enables detection of AF and other rhythm- related complications after cardiac surgery. Our observations indicate that smartphone-based PPG-technology supplements the rehabilitation after cardiac surgery by acting as a sentinel for underlying complications, rhythm-related or otherwise. Clinical Trial: “Ethics Committee Research of UZ/KU Leuven trial number S63159”
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