Digital devices for heart rhythm monitoring in atrial fibrillation patients scheduled for elective electrical cardioversion. Kardiover study

Abstract

Abstract Introduction the management of patients with recent-onset atrial fibrillation (AF) is to achieve sinus rhythm (SR) by electrical or pharmacological cardioversion (CV). However, frequently SR is spontaneously restored, making scheduled admission and/or transesophageal echocardiogram (TEE) unnecessary and therefore causing misutilization of healthcare resources. Emerging medical technology has allowed for accurate heart rhythm monitoring. Objective to evaluate the diagnostic ability of a smart device ECG monitor to detect spontaneous conversion to SR in AF patients, preventing unnecessary admission and providing an earlier management. Methods A prospective multicenter study (Kardiover study) was designed including patients with paroxysmal, persistent or first diagnosed AF scheduled for elective electrical CV in cardiology departments of 7 hospitals in Spain. Patients were asked to submit ECG recordings to a central Corelab daily, twice a day and whenever they present symptoms, until CV (spontaneous or scheduled) and a week afterwards. Whenever a spontaneous conversion to SR was detected, investigators were contacted to confirm SR and abort admission, likewise when AF recurrence after CV was detected. Patients’ satisfaction was evaluated using a test for perceived utility and value, convenience, and accessibility. Results A total of 74 patients were enrolled (age 62 ± 10 years). Twenty-two patients (30%) showed spontaneous conversion to SR correctly detected by the devices. 86% of the spontaneous CV occurred during the first week. Among 52 patients admitted for CV, 45 (88%) were discharged in SR. During follow up after conversion to SR (spontaneous or electrical), recurrences of AF occurred in 24 patients (34%). At the end of the follow-up 51 patients (69%) remained in SR. Due to the early detection of spontaneous conversion to SR, a total of 22 admissions and 16 TEE were prevented and these resources used for other patients. Patients’ adherence to the protocol in regard to ECG recording transmissions was high, the CoreLab received 93% of the expected transmissions. Patient’s overall satisfaction was also high with a punctuation of 9.1 over 10 in the feedback test. Conclusion Digital devices for heart rhythm monitoring can optimize the management of AF patients scheduled for CV, preventing unnecessary admissions and providing a more rational use of healthcare resources.Baseline characteristicsStudy design and results