Cardiac Rhythm Monitoring Using Wearables for Clinical Guidance before and after Catheter Ablation

Henrike Aenne Katrin Hillmann, Samira Soltani, Johanna Mueller-Leisse, Stephan Hohmann, David Duncker, Henrike Aenne Katrin Hillmann, Samira Soltani, Johanna Mueller-Leisse, Stephan Hohmann, David Duncker

Abstract

Mobile health technologies are gaining importance in clinical decision-making. With the capability to monitor the patient's heart rhythm, they have the potential to reduce the time to confirm a diagnosis and therefore are useful in patients eligible for screening of atrial fibrillation as well as in patients with symptoms without documented symptom rhythm correlation. Such is crucial to enable an adequate arrhythmia management including the possibility of a catheter ablation. After ablation, wearables can help to search for recurrences, in symptomatic as well as in asymptomatic patients. Furthermore, those devices can be used to search for concomitant arrhythmias and have the potential to help improving the short- and long-term patient management. The type of wearable as well as the adequate technology has to be chosen carefully for every situation and every individual patient, keeping different aspects in mind. This review aims to describe and to elaborate a potential workflow for the role of wearables for cardiac rhythm monitoring regarding detection and management of arrhythmias before and after cardiac electrophysiological procedures.

Keywords: arrhythmia; atrial fibrillation; cardiac monitoring; catheter ablation; digital health; electrophysiological study; mHealth; remote monitoring; telemonitoring; wearable.

Conflict of interest statement

H.A.K.H. and S.S. do not report any conflicts of interest. J.M.-L. received a modest lecture honorary, travel grants and/or a fellowship grant from Medtronic and Boston Scientific. S.H. received an educational grant from Boston Scientific. D.D. received a modest lecture honorary, travel grants and/or a fellowship grant from Abbott, Astra Zeneca, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, CVRx, Medtronic, Microport, Pfizer, Zoll.

Figures

Figure 1
Figure 1
Characteristics of different mHealth devices and Holter monitoring. Colored fields signify that the wearable has the capability described. “Active” regards to the patients’ possibility of manually record an episode, whereas “passive” refers to monitoring via automatically recorded episodes using the individual device. A (semi-)continuous tracking describes the ability of the device to monitor patients’ heart rhythm via automatic pre-set intervals. PPG = photoplethysmography; ECG = electrocardiogram; * for a limited time.
Figure 2
Figure 2
Aspects to consider before choosing the type of wearable.
Figure 3
Figure 3
Implementation of wearables for cardiac rhythm monitoring before and after electrophysiological procedures. EPS = electrophysiological study.
Figure 4
Figure 4
Cardiac rhythm monitoring using wearables for clinical guidance before and after catheter ablation. EPS = electrophysiological study; AF = atrial fibrillation.

References

    1. Hermans A.N.L., Gawalko M., Dohmen L., van der Velden R.M.J., Betz K., Duncker D., Verhaert D.V.M., Heidbuchel H., Svennberg E., Neubeck L., et al. Mobile health solutions for atrial fibrillation detection and management: A systematic review. Clin. Res. Cardiol. 2021:1–13. doi: 10.1007/s00392-021-01941-9.
    1. Giebel G.D., Gissel C. Accuracy of mHealth Devices for Atrial Fibrillation Screening: Systematic Review. JMIR mHealth uHealth. 2019;7:e13641. doi: 10.2196/13641.
    1. Xintarakou A., Sousonis V., Asvestas D., Vardas P.E., Tzeis S. Remote Cardiac Rhythm Monitoring in the Era of Smart Wearables: Present Assets and Future Perspectives. Front. Cardiovasc. Med. 2022;9:853614. doi: 10.3389/fcvm.2022.853614.
    1. Bouzid Z., Al-Zaiti S.S., Bond R., Sejdić E. Remote and wearable ECG devices with diagnostic abilities in adults: A state-of-the-science scoping review. Heart Rhythm. 2022 doi: 10.1016/j.hrthm.2022.02.030.
    1. Duncker D., Ding W.Y., Etheridge S., Noseworthy P.A., Veltmann C., Yao X., Bunch T.J., Gupta D. Smart Wearables for Cardiac Monitoring—Real-World Use beyond Atrial Fibrillation. Sensors. 2021;21:2539. doi: 10.3390/s21072539.
    1. Ledwoch J., Duncker D. eHealth—Smart Devices revolutionieren die Kardiologie. Herzschrittmacherther. Elektrophysiol. 2020;31:368–374. doi: 10.1007/s00399-020-00700-z.
    1. Nagarajan V.D., Lee S.-L., Robertus J.-L., Nienaber C.A., Trayanova N.A., Ernst S. Artificial intelligence in the diagnosis and management of arrhythmias. Eur. Heart J. 2021;42:3904–3916. doi: 10.1093/eurheartj/ehab544.
    1. Manninger M., Kosiuk J., Zweiker D., Njeim M., Antolic B., Kircanski B., Larsen J.M., Svennberg E., Vanduynhoven P., Duncker D. Role of wearable rhythm recordings in clinical decision making—The wEHRAbles project. Clin. Cardiol. 2020;43:1032–1039. doi: 10.1002/clc.23404.
    1. Veltmann C., Ehrlich J.R., Gassner U.M., Meder B., Möckel M., Radke P., Scholz E., Schneider H., Stellbrink C., Duncker D. Wearable-basierte Detektion von Arrhythmien. Der Kardiol. 2021;15:341–353. doi: 10.1007/s12181-021-00488-3.
    1. Betz K., van der Velden R., Gawalko M., Hermans A., Pluymaekers N., Hillmann H.A.K., Hendriks J., Duncker D., Linz D. Interpretation of Photoplethysmography: A Step-by-Step Guide. Herzschrittmacherther. Elektrophysiol. 2021;32:406–411. doi: 10.1007/s00399-021-00795-y.
    1. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C., Boriani G., Castella M., Dan G.-A., Dilaveris P.E., et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) Eur. Heart J. 2020;42:ehaa612. doi: 10.1093/eurheartj/ehaa612.
    1. Kuck K.-H., Lebedev D.S., Mikhaylov E.N., Romanov A., Gellér L., Kalējs O., Neumann T., Davtyan K., On Y.K., Popov S., et al. Catheter ablation or medical therapy to delay progression of atrial fibrillation: The randomized controlled atrial fibrillation progression trial (ATTEST) Europace. 2020;23:362–369a. doi: 10.1093/europace/euaa298.
    1. Kirchhof P., Camm A.J., Goette A., Brandes A., Eckardt L., Elvan A., Fetsch T., Van Gelder I.C., Haase D., Haegeli L.M., et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N. Engl. J. Med. 2020;383:1305–1316. doi: 10.1056/NEJMoa2019422.
    1. Willems S., Borof K., Brandes A., Breithardt G., Camm A.J., Crijns H.J.G.M., Eckardt L., Gessler N., Goette A., Haegeli L.M., et al. Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: The EAST-AFNET 4 trial. Eur. Heart J. 2021:ehab593. doi: 10.1093/eurheartj/ehab593.
    1. Svennberg E., Tjong F., Goette A., Akoum N., Biaise L.D., Bordachar P., Boriani G., Burri H., Conte G., Deharo J.-C., et al. How to Use Digital Devices to Detect and Manage Arrhythmias: An EHRA Practical Guide. Europace. 2022 doi: 10.1093/europace/euac038.
    1. Gawałko M., Duncker D., Manninger M., van der Velden R.M., Hermans A.N.L., Verhaert D.V.M., Pison L., Pisters R., Hemels M., Sultan A., et al. The European TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: Centre and patient experiences. Europace. 2021;23:1003–1015. doi: 10.1093/europace/euab050.
    1. Chang P.-C., Wen M.-S., Chou C.-C., Wang C.-C., Hung K.-C. Atrial fibrillation detection using ambulatory smartwatch photoplethysmography and validation with simultaneous holter recording. Am. Heart J. 2022;247:55–62. doi: 10.1016/j.ahj.2022.02.002.
    1. Perino A.C., Gummidipundi S.E., Lee J., Hedlin H., Garcia A., Ferris T., Balasubramanian V., Gardner R.M., Cheung L., Hung G., et al. Arrhythmias Other Than Atrial Fibrillation in Those with an Irregular Pulse Detected with a Smartwatch: Findings from the Apple Heart Study. Circ. Arrhythm. Electrophysiol. 2021;14:e010063. doi: 10.1161/CIRCEP.121.010063.
    1. Behzadi A., Shamloo A.S., Mouratis K., Hindricks G., Arya A., Bollmann A. Feasibility and Reliability of SmartWatch to Obtain 3-Lead Electrocardiogram Recordings. Sensors. 2020;20:5074. doi: 10.3390/s20185074.
    1. Spaccarotella C.A.M., Polimeni A., Migliarino S., Principe E., Curcio A., Mongiardo A., Sorrentino S., De Rosa S., Indolfi C. Multichannel Electrocardiograms Obtained by a Smartwatch for the Diagnosis of ST-Segment Changes. JAMA Cardiol. 2020;5:1176–1180. doi: 10.1001/jamacardio.2020.3994.
    1. Wegner F.K., Kochhäuser S., Frommeyer G., Lange P.S., Ellermann C., Leitz P., Müller P., Köbe J., Eckardt L., Dechering D.G. Prospective blinded evaluation of smartphone-based ECG for differentiation of supraventricular tachycardia from inappropriate sinus tachycardia. Clin. Res. Cardiol. 2021;110:905–912. doi: 10.1007/s00392-021-01856-5.
    1. Samol A., Bischof K., Luani B., Pascut D., Wiemer M., Kaese S. Single-Lead ECG Recordings Including Einthoven and Wilson Leads by a Smartwatch: A New Era of Patient Directed Early ECG Differential Diagnosis of Cardiac Diseases? Sensors. 2019;19:4377. doi: 10.3390/s19204377.
    1. Kasai Y., Kasai J., Sekiguchi Y., Asano S., Fukunaga H., Nagase T., Nitta J. Apple Watch® facilitates single-session catheter ablation of coexisting atrioventricular nodal reentrant tachycardia and atrioventricular reentrant tachycardia. Clin. Case Rep. 2021;9:e04702. doi: 10.1002/ccr3.4702.
    1. Siddeek H., Fisher K., McMakin S., Bass J.L., Cortez D. AVNRT captured by Apple Watch Series 4: Can the Apple watch be used as an event monitor? Ann. Noninvasive Electrocardiol. 2020;25:e12742. doi: 10.1111/anec.12742.
    1. Wu S., Li C., Lin J., Weng C., Lin W., Hsieh Y. Detecting supraventricular tachycardia with smartwatches facilitates the decision for catheter ablation: A case series. Pacing Clin. Electrophysiol. 2021;45:157–159. doi: 10.1111/pace.14388.
    1. Aljuaid M., Marashly Q., AlDanaf J., Tawhari I., Barakat M., Barakat R., Zobell B., Cho W., Chelu M.G., Marrouche N.F. Smartphone ECG Monitoring System Helps Lower Emergency Room and Clinic Visits in Post-Atrial Fibrillation Ablation Patients. Clin. Med. Insights Cardiol. 2020;14:1179546820901508. doi: 10.1177/1179546820901508.
    1. Kaitani K., Inoue K., Kobori A., Nakazawa Y., Ozawa T., Kurotobi T., Morishima I., Miura F., Watanabe T., Masuda M., et al. Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) trial. Eur. Heart J. 2016;37:610–618. doi: 10.1093/eurheartj/ehv501.
    1. Willems S., Khairy P., Andrade J.G., Hoffmann B.A., Levesque S., Verma A., Weerasooriya R., Novak P., Arentz T., Deisenhofer I., et al. Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial. Circ. Arrhythm. Electrophysiol. 2016;9:e003909. doi: 10.1161/CIRCEP.115.003909.
    1. Gaztañaga L., Frankel D.S., Kohari M., Kondapalli L., Zado E.S., Marchlinski F.E. Time to recurrence of atrial fibrillation influences outcome following catheter ablation. Heart Rhythm. 2013;10:2–9. doi: 10.1016/j.hrthm.2012.09.005.
    1. Linz D., Pluymaekers N.A.H.A., Hendriks J.M. TeleCheck-AF for COVID-19. Eur. Heart J. 2020;41:1954–1955. doi: 10.1093/eurheartj/ehaa404.
    1. Pluymaekers N.A.H.A., Hermans A.N.L., van der Velden R.M.J., Gawałko M., Den Uijl D.W., Buskes S., Vernooy K., Crijns H.J.G.M., Hendriks J.M., Linz D. Implementation of an on-demand app-based heart rate and rhythm monitoring infrastructure for the management of atrial fibrillation through teleconsultation: TeleCheck-AF. Europace. 2020;23:345–352. doi: 10.1093/europace/euaa201.
    1. Hermans A.N.L., Van Der Velden R.M.J., Gawalko M., Verhaert D.V.M., Desteghe L., Duncker D., Manninger M., Heidbuchel H., Pisters R., Hemels M., et al. On-demand mobile health infrastructures to allow comprehensive remote atrial fibrillation and risk factor management through teleconsultation. Clin. Cardiol. 2020;43:1232–1239. doi: 10.1002/clc.23469.
    1. Hermans A.N.L., Gawałko M., Hillmann H.A.K., Sohaib A., van der Velden R.M.J., Betz K., Verhaert D., Scherr D., Meier J., Sultan A., et al. Self-Reported Mobile Health-Based Risk Factor and CHA2DS2-VASc-Score Assessment in Patients with Atrial Fibrillation: TeleCheck-AF Results. Front. Cardiovasc. Med. 2022;8:757587. doi: 10.3389/fcvm.2021.757587.
    1. Brugada J., Katritsis D.G., Arbelo E., Arribas F., Bax J.J., Blomström-Lundqvist C., Calkins H., Corrado D., Deftereos S.G., Diller G.-P., et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. Eur. Heart J. 2019;41:655–720. doi: 10.1093/eurheartj/ehz467.
    1. Manninger M., Zweiker D., Svennberg E., Chatzikyriakou S., Pavlovic N., Zaman J.A.B., Kircanski B., Lenarczyk R., Vanduynhoven P., Kosiuk J., et al. Current perspectives on wearable rhythm recordings for clinical decision-making: The wEHRAbles 2 survey. Europace. 2021;23:1106–1113. doi: 10.1093/europace/euab064.
    1. Gruwez H., Evens S., Proesmans T., Duncker D., Linz D., Heidbuchel H., Manninger M., Vandervoort P., Haemers P., Pison L. Accuracy of Physicians Interpreting Photoplethysmography and Electrocardiography Tracings to Detect Atrial Fibrillation: INTERPRET-AF. Front. Cardiovasc. Med. 2021;8:734737. doi: 10.3389/fcvm.2021.734737.
    1. van der Velden R.M.J., Verhaert D.V.M., Hermans A.N.L., Duncker D., Manninger M., Betz K., Gawalko M., Desteghe L., Pisters R., Hemels M., et al. The photoplethysmography dictionary: Practical guidance on signal interpretation and clinical scenarios from TeleCheck-AF. Eur. Heart J.-Digit. Health. 2021;2:363–373. doi: 10.1093/ehjdh/ztab050.

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