Gruwez Henri, De Melio Nicolas, Vermunicht Paulien, Van Langenhoven Leen, Desteghe Lien, Lamberigts Marie, Nuyens Dieter, Van Herendael Hugo, Rodrigus Inez, Van Kerrebroeck Christiaan, Vandervoort Pieter, Heidbuchel Hein, Pison Laurent, Rega Filip, Haemers Peter
Department of Cardiovascular Sciences, Herestraat 49, 3000 UZ Leuven, Leuven, Belgium.
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Europace. 2025 Feb 5;27(2). doi: 10.1093/europace/euaf015.
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.
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].
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.
心脏手术后房颤（AF）和房扑（AFL）很常见，且与不良预后相关。与AF或AFL相关的风险增加可能会持续到出院后。本研究旨在确定基于光电容积脉搏波描记法（PPG）的智能手机监测能否改善心脏手术后出院患者AF的管理，以检测AF或AFL。
干预组在心脏手术后住院6周期间，每天使用基于智能手机的PPG应用程序进行3次1分钟的心律检查。主要结局包括独立医生进行的AF管理干预措施，包括启动口服抗凝治疗（OAC）、直接心脏复律以及抗心律失常药物的滴定或启动。该研究纳入了450例患者[平均（标准差）年龄，64.1（9.2）岁；96名女性（21.3%）；130例有AF病史患者（28.9%）；中位数（四分位间距）CHA2DS2-VASc评分，2（1-3）]，其中238例被随机分配至基于PPG的监测组，212例接受常规护理。监测组44例患者（18.5%）通过PPG或心电图检测到AF/AFL，常规护理组4例患者（1.9%）检测到（比值比11.8；95%置信区间，4.2-33.3；P<0.001）；这些分别是22例患者（9.2%）和1例患者（0.5%）的新检测结果（比值比21.3；95%置信区间，2.9-166.7；P=0.003）。监测组24例患者（10.1%）进行了AF管理干预，而常规护理组为5例患者（2.4%）[优势比（OR），5.1；95%置信区间，1.8-14.4；P=0.002]。
在心脏手术后出院回家的未选择患者中，基于PPG的智能手机监测发现了显著更多的AF/AFL，这导致AF管理得到了显著更多的优化。
