A virtual atrial fibrillation clinic after pulmonary vein isolation: lessons learned from 1000 patient-years

Abstract Background A virtual atrial fibrillation (AF) clinic was established to detect recurrent AF following pulmonary vein isolation (PVI). Previous research indicated that asymptomatic patients post-PVI conducted few or no measurements, affecting the quality of follow-up data. However, the optimal measurement frequency for effective follow-up remains unclear. Purpose To determine the optimal measurement instructions for photopletysmography (PPG)-assessed AF follow-up after PVI. Methods Patients were provided with a PPG application embedded in a Digital Health platform, monitored by trained eNurses. Three groups were studied; 1: group S: measurements taken when symptomatic or at will, 2: group SW: measurements taken when symptomatic, at will, plus weekly, and 3: group SWP: measurements taken when symptomatic, at will, plus weekly, with push notification reminders for weekly measurements. The relationship between AF recurrence and symptoms was analysed. Results This study included 1384 patients with a follow-up of one year, yielding 41068 measurements. The main monthly measurements per patient were 3.1 ± 4.4, 3.2 ± 1.8 and 5.1 ± 4.9 for groups S, SW, and SWP, respectively. The percentage of measurements detecting AF was 18% in group S, 14% in group SW, and 16% in group SWP. Notably, 33% of symptomatic measurements indicated AF, while 45% of AF-positive measurements were asymptomatic. Conclusions PPG monitoring post-PVI for one year revealed that push notifications for weekly measurements provided more comprehensive data on AF recurrence compared to control groups without such reminders. A weak correlation between AF recurrence and symptoms was observed.Number of measurement with and without s