Smartphone application-based heart rhythm monitoring to cancel scheduled electrical cardioversion in patients with spontaneous conversion of presumed persistent atrial fibrillation: TeleConvert-AF

Aims Patients with presumed persistent atrial fibrillation (AF) scheduled for electrical cardioversion (ECV) might have self-terminating AF to sinus rhythm (SR) while awaiting ECV, leading to unnecessary visits and healthcare burden. The TeleConvert-AF study evaluated the effectiveness of a novel smartphone app-based and alert-supported heart rhythm monitoring approach to detect spontaneous conversion to SR or a paroxysmal AF to be able to cancel ECV appointments. Methods and results Patients with presumed persistent AF scheduled for ECV used a photoplethysmography (PPG) based smartphone app, supported by a red-amber-green alert system, to record their heart rhythm three times daily for at least two weeks prior to ECV and four weeks after ECV. ECV was cancelled if spontaneous conversion to SR or a paroxysmal AF pattern was confirmed by electrocardiogram. Among the 270 patients (median age 68years, 71% male), 37 (13.7%) had their ECV cancelled. Self-terminating AF was the leading cause of ECV cancellation (n = 22; 59%), and 41% being due to paroxysmal AF (n = 15). PPG had a 94% accuracy in detecting SR. No significant predictors for ECV cancellation were identified. AF recurrence occurred in 64% within four weeks. Previous ECVs and prior spontaneous AF conversions were independent predictors of AF recurrence following ECV. Overall, patient motivation, experiences, and adherence to the study protocol were favorable. Conclusion The TeleConvert-AF approach is feasible and effective in accurately identifying patients with spontaneous conversion to SR or paroxysmal AF while awaiting ECV. A significant number of unnecessary hospital admissions and cardioversions could be avoided.