Clinical utility of rhythm control by electrical cardioversion to assess the association between self-reported symptoms and rhythm status in patients with persistent atrial fibrillation

Hermans, Astrid N L; Pluymaekers, Nikki A H A; Lankveld, Theo; Mourik, Manouk J.W. van; Zeemering, Stef; Dinh, Trang; Uijl, Dennis W. den; Luermans, Justin; Vernooy, Kevin; Crijns, Harry J.G.M.; Schotten, Ulrich; Linz, Dominik

doi:10.1016/j.ijcha.2021.100870

Cited by 11 publications

(15 citation statements)

References 26 publications

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“…Although most patients in our study reported symptoms during AF, a remarkable number of AF PPG recordings during the same persistent AF episode were not associated with self-reported symptoms assessed through active interrogation of patient-reported symptoms. Additionally, in line with previous observation, patients experienced a wide variety of symptoms during persistent AF episodes, including fatigue, chest pain, palpitations, light-headedness and shortness of breath [4,6], and there was high variability in patient-reported predominant symptoms before and after ECV [6]. Interestingly, fatigue was the most common reported symptom in patients with persistent AF, whereas individuals with paroxysmal AF are more likely to experience palpitations [14].…”

Section: Discussionsupporting

confidence: 84%

“…The central role of somatosensory and insula cortices in interoceptive attention endorses their proposed contribution to subjective emotional feeling states arising from representations of bodily responses [16]. Importantly, this variability in symptoms, overall symptom burden and SRC in patients with persistent AF cannot be adequately assessed by spot assessment in outpatient AF clinics [6], and therefore may require approaches of simultaneous rhythm monitoring and active interrogation of patient-reported symptoms as introduced in this study.…”

Section: Discussionmentioning

confidence: 81%

“…The assessment of SRC in AF patients has been addressed and discussed in previous analyses [6,12], and is frequently used in the clinic to guide AF management decision-making. To the best of our knowledge, the present study is the first to assess SRC in persistent AF patients using a mHealth approach of simultaneous PPG-based heart rhythm/rate monitoring and active interrogation of patient-reported symptoms, which provides a novel approach to systematically assess SRC in persistent AF.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with AF recurrence, median pulse rate per patient in AF prior and after ECV was 78 bpm (73-85) and 76 bpm (72-83), respectively, P = 0.008. There was no statistically significant difference between the low, moderate and high SRC-index group according to the time to AF recurrence (3 days [2][3][4][5]; n = 21 vs 4 days [3− 10]; n = 17 vs 1 day [1][2][3][4][5][6][7][8]; n = 9, P = 0.110). Patients in the high SRC-index tertile more often used dihydropyridine calcium channel blockers compared to those in the moderate and low SRC-index tertiles (35.5% vs 10.3% vs 10.7%, respectively, P = 0.018).…”

Section: Symptom-rhythm Correlationmentioning

confidence: 91%

“…Differentiating between symptoms caused by AF (specific AF symptoms) and those caused by other underlying cardiovascular or non-cardiovascular conditions or risk factors (non-specific symptoms in AF) is often challenging, and no standardized strategy to assess SRC in AF patients is available [5]. Previously, we showed that symptom assessment around electrical cardioversion (ECV), once before ECV and once within 1-month follow-up, rarely identifies an SRC in persistent AF patients and often suggests changes in symptom pattern irrespective of changes seen in heart rhythm [6]. Mobile app-based simultaneous symptom and rhythm monitoring may improve SRC assessment but has not been described nor investigated before.…”

Section: Introductionmentioning

confidence: 99%

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Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation

et al. 2022

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Funding Acknowledgements Type of funding sources: None. Background In patients with persistent atrial fibrillation (AF) it is difficult to determine the association between patient self-reported symptoms and the underlying heart rhythm (symptom-rhythm correlation [SRC]). No standardized strategy to assess SRC in AF patients is available. Purpose We assessed for the first time SRC in persistent AF patients using a mobile health approach of simultaneous photoplethysmography (PPG)-based rhythm monitoring and active interrogation of patient-reported symptoms, which provides a novel approach to systematically assess SRC in persistent AF. Methods Consecutive persistent AF patients planned for electrical cardioversion (ECV) used a mobile app to record a 60-second PPG and report symptoms once daily and in case of symptoms for four weeks prior and three weeks after ECV. Within each patient, SRC was quantified by the SRC-index defined as the sum of symptomatic AF recordings and asymptomatic non-AF recordings divided by the sum of all recordings. Results Of 88 patients (33% female, age 68±9 years) included, 78% reported any symptoms during recordings. The overall SRC-index was 0.61 (0.44-0.79). The study population was divided into SRC-index tertiles: low (<0.47), medium (0.47-0.73) and high (≥0.73). Patients within the low (vs high) SRC-index tertile had more often heart failure and diabetes mellitus (both 24.1% vs 6.9%). Extrasystoles occurred in 19% of all symptomatic non-AF PPG recordings. Within each patient, PPG recordings with the highest (vs lowest) tertile of pulse rates conferred an increased risk for symptomatic AF recordings (odds ratio [OR] 1.26, 95% coincidence interval [CI] 1.04-1.52) and symptomatic non-AF recordings (OR 2.93, 95% CI 2.16-3.97). Pulse variability was not associated with reported symptoms. Conclusion In persistent AF patients, simultaneous mobile app-based symptom and rhythm monitoring revealed a relatively low overall SRC, suggesting that the majority of patients experienced symptoms irrespective of AF. Extrasystoles can explain a minority of symptomatic non-AF PPG recordings. Pulse rate, but not pulse variability, is the main determinant of reported symptoms during AF and non-AF PPG recordings. Further studies are required to test whether mobile app-based SRC assessment can be implemented in current workflows and integrated into a personalized symptom and rhythm control AF management approach.

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