Photoplethysmography recordings preceding onset atrial fibrillation show a higher heart rate variability - a TeleCheck-AF subanalysis

Abstract

Abstract Background An increased heart rate variability (HRV), mostly assessed by 12-lead electrocardiogram (ECG) or long-term Holter monitoring, can be associated with the onset of atrial fibrillation (AF). Data evaluating HRV measurements using digital devices, especially those using photoplethysmography (PPG), in patients at risk for AF are sparse. In this analysis, we aimed to assess if hand-held-based non-continuous PPG measurements can provide short-term HRV to predict AF. Methods Patients from the TeleCheck-AF project with at least one PPG measurement in AF and one measurement in sinus rhythm (SR) were analyzed. Briefly, patients were provided with a PPG-based heart rate/rhythm monitoring smartphone app. They were instructed to record a PPG measurements three times daily and in case of symptoms for seven consecutive days. Short-term HRV using root mean square of successive normal-to-normal interval differences (RMSSD) was calculated in recordings in SR and compared between those not preceding and preceding an episode of AF (figure 1). Results Overall, 136 patients [56.3% men, median age 66 (59; 72) years] were included in the analysis. Median total number of recordings per patient was 24 (19; 30) including 4 (2;7) AF episodes per 1 week recording period. RMSSD was significantly higher in PPG measurements preceding an AF episode than in PPG measurements not preceding an AF episode [42.5 (33.2;70.7)ms vs. 41.1 (32.4;54.7)ms; p<0.001]. Between-group comparison revealed no significant difference for gender, age, previous ablation or betablocker therapy (p=0.824; p=0.484; p=0.519 and p=0.624, respectively). Conclusion Short-term HRV based on RMSSD, assessed by digital hand-held devices is significantly higher in PPG recordings preceding an AF episode than in measurements not preceding a consecutive AF episode. Whether PPG-recording derived short-term HRV can help to predict onset-AF warrants further study in larger populations. Figure 1: Patient example and exemplary analysis scheme, depicting the total number of recordings (n=14). HRV of recordings in sinus rhythm (SR) not preceding an episode of atrial fibrillation (AF) (A; grey circles) were compared to recordings preceding a consecutive AF episode (B; blue circles).Figure 1