Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany; 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Int J Cardiol. 2022 Nov 15;367:29-37. doi: 10.1016/j.ijcard.2022.08.021. Epub 2022 Aug 10.
The assessment of symptom-rhythm correlation (SRC) in patients with persistent atrial fibrillation (AF) is challenging. Therefore, we performed a novel mobile app-based approach to assess SRC in persistent AF.
Consecutive persistent AF patients planned for electrical cardioversion (ECV) used a mobile app to record a 60-s photoplethysmogram (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.
Of 88 patients (33% women, 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.
In patients with persistent AF, SRC is relatively low. Pulse rate is the main determinant of reported symptoms. Further studies are required to verify whether integrating mobile app-based SRC assessment in current workflows can improve AF management.
持续性心房颤动（AF）患者的症状-节律相关性（SRC）评估具有挑战性。因此，我们采用了一种新的基于移动应用程序的方法来评估持续性 AF 中的 SRC。
连续的持续性 AF 患者计划进行电复律（ECV），使用移动应用程序记录 60 秒光体积描记图（PPG），并在 ECV 前四周和后三周每天报告一次症状和出现症状时报告症状。在每个患者中，通过 SRC 指数来量化 SRC，SRC 指数定义为有症状的 AF 记录和无症状的非-AF 记录的总和除以所有记录的总和。
共纳入 88 例患者（33%为女性，年龄 68 ± 9 岁），78%的患者在记录期间报告有任何症状。总体 SRC 指数为 0.61（0.44-0.79）。研究人群被分为 SRC 指数三分位数：低（<0.47）、中（0.47-0.73）和高（≥0.73）。低 SRC 指数三分位数（vs 高 SRC 指数三分位数）的患者更常患有心力衰竭和糖尿病（均为 24.1% vs 6.9%）。所有无症状非-AF PPG 记录中有 19%出现期外收缩。在每个患者中，脉搏率最高（vs 最低）三分位数的 PPG 记录与有症状的 AF 记录（比值比[OR] 1.26，95%置信区间[CI] 1.04-1.52）和有症状的非-AF 记录（OR 2.93，95% CI 2.16-3.97）的风险增加相关。脉搏变异性与报告的症状无关。
在持续性 AF 患者中，SRC 相对较低。脉搏率是报告症状的主要决定因素。需要进一步研究以验证在当前工作流程中整合基于移动应用程序的 SRC 评估是否可以改善 AF 管理。
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