Complete list of publications

To evaluate and compare the ability of CWDs to discriminate between sinus rhythm and AF.

In this selected population, the discrimination between sinus rhythm and AF using CWDs based on ECG or PPG was highly accurate, with no discernible variations across the examined devices.

Photoplethysmography- (PPG) based smartphone applications facilitate heart rate and rhythm monitoring in patients with paroxysmal and persistent atrial fibrillation (AF). Despite an endorsement from the European Heart Rhythm Association, validation studies in this setting are lacking. Therefore, we evaluated the accuracy of PPG-derived heart rate and rhythm classification in subjects with an established diagnosis of AF in unsupervised real-world conditions.

Smartphone applications using PPG can be used to monitor patients with AF in unsupervised real-world conditions. The accuracy of AF detection algorithms in this setting is excellent, but PPG-derived heart rate may tend to underestimate higher heart rates.

Although mobile health tools using photoplethysmography (PPG) technology have been validated for the detection of atrial fibrillation (AF), their utility for heart rate assessment during AF remains unclear. Therefore, we aimed to evaluate the accuracy of continuous PPG-based heart rate assessment during AF.

During persistent AF, continuous PPG-based heart rate assessment is feasible and shows high accuracy compared to Holter ECG. Motion and recording quality among other PPG-derived covariates did not introduce a systematic and correctable bias in the heart rate assessment.

Accuracy of a standalone Atrial Fibrillation detection algorithm added to a popular wristband and smartwatch: Prospective Diagnostic Accuracy Study

Continuous PPG-based 1 min mean heart rate assessment during AF seems feasible to guide a lenient rate control and shows good accuracy compared with Holter ECG as a reference

Future studies need to be performed to evaluate how to integrate PPG-derived heart rate information into clinical decision-making processes to guide rate control in patients with AF

Motion and recording quality among other PPG-derived covariates did not introduce a systematic and correctable bias in the 1 min mean heart rate assessment

Chronic heart failure was associated with lower accuracy of the PPG-based 1 min mean heart rate assessment

Preliminary results of the FLASH-AF: Validation of the device independent nature of a pulse deriving smartphone application for the detection of atrial fibrillation

The use of smartphone app to detect atrial fibrillation (AF) after cryptogenic stroke

MVP Risk score and new atrial fibrillation diagnosis: Prospective cohort PREFATE study

Protocol manuscript

To assess the association between ECG patterns according to the MVP ECG risk score (morphology-voltage-P-wave duration) and a diagnosis of AF.

The diagnosis of AF was confirmed in 14 cases (9.3%, 95% CI 5.6-15.1), 3 men and 11 women. In 3 cases, the arrhythmia was diagnosed on the baseline ECG, and in 11 cases by Holter after being reported as possible AF by the FibriCheck App. A higher prevalence of atypical advanced interatrial block (A-AIB) (p 0.007) was detected among participants with AF, as well as the prevalence of P-wave < 0.1 mV. (p = 0.006). All new diagnoses of AF were made at scores ≥ 4 in the MVP risk score. 

2022

To determine whether intermittent PPG-based smartphone rhythm monitoring, after being discharged home following cardiac surgery, impacts AF management.

In unselected patients discharged home following cardiac surgery, PPG-based smartphone monitoring revealed significantly more POAF which led to changes in AF management (OAC initiation, rhythm control therapy or CIED insertion). Longer follow-up is needed to determine whether these changes will lead to improved outcomes.

Data from this study strongly suggest that more intensive screening for AF is associated with a substantially higher diagnostic yield.
Participants adhering strictly to the recommended screening frequency of two heart rhythm assessments per day had almost a doubling of their chance to be detected with possible AF. A continuous increase in diagnostic yield is expected with longer screening periods, even beyond 7 days.
In the majority of cases where possible AF was detected, there were no specific symptoms and general well-being was similar compared to individuals with a normal regular heart rhythm. This indicates that the screening strategy as outlined in this manuscript is particularly interesting to potentially detect silent, subclinical AF, which is associated with more frequent complications.
This study provides convincing evidence that the built-in camera of a smartphone can be used to obtain reliable PPG signals in a broad population, also including elderly who might be less familiar with smartphone handling.

To compare the effectiveness of digital follow-up utilizing a PPG-based smartphone application with conventional ECG-based follow-up for the detection of atrial arrhythmia recurrence after ablation.

Among patients with AF ablation, digital PPG-based rhythm monitoring with a smartphone, was non-inferior in the detection of atrial arrhythmia recurrence after ablation. Moreover, the detection of atrial arrhythmia was significantly increased compared to conventional ECG-based monitoring.

Direct current cardioversion (DCCV) is a commonly utilised rhythm control technique for atrial fibrillation (AF). Follow-up typically comprises a hospital visit for 12-lead ECG two weeks post-DCCV. We report the feasibility, costs and environmental benefit of remote photoplethysmography (PPG) monitoring as an alternative.

Remote PPG monitoring is a viable method of assessing for arrhythmia recurrence post-DCCV. This approach may save patients significant travel time, reduce environmental CO2 emission and be cost saving in a publicly-funded healthcare system.

To provide insights into the promise of integrating digital health and remote monitoring into AF management via a virtual ward model.

This study indicates that the virtual ward model enabled patients to be effectively triaged remotely, allowed health deteriorations to be recognised early, ensuring patients received timely medical attention or emergency care, and reduced the likelihood of subsequent ED reattendances on discharge. It also demonstrates the potential cost effectiveness of the model through readmission avoidance and early supported discharge of stable hospitalised AF patients, who might otherwise have had a longer inpatient stay. This pilot study provides valuable insights into the promise of integrating digital health and remote monitoring into AF management via a virtual ward model.

To evaluate changes in healthcare utilisation and comprehensive packages of care activities and procedures (referred in the Netherlands to as ‘diagnose-behandelcombinatie (DBC) care products) during the implementation of the TeleCheck-AF approach (teleconsultation supported by app-based heart rate/rhythm monitoring) in a Dutch atrial fibrillation (AF) clinic.

The implementation of TeleCheck-AF was associated with a change in health care utilisation and a disproportional decrease in reimbursement by health insurers due to a change from medium-weight to light-weight DBC care products. Its implementation decreased the potential burden on patients caused by, for example, travel costs and time investment. These results were used as the basis for the development of a new optional reimbursement code for the TeleCheck-AF approach in the Netherlands. This example can serve as a roadmap for future development of digital AF care reimbursement models in the Netherlands and worldwide. 

Technical advances in photoplethysmography (PPG) utilizing smartphones have led to the capability of domestic heart rhythm monitoring (HRM). Longitudinal HRM after catheter ablation of atrial fibrillation (AF) may increase the detection rate of AF relapses and improve patient care. However, there is only limited evidence on patients’ motivation, compliance, and experience.

Our data show excellent compliance and good motivation as well as good experience with a prolonged smartphone-based HRM in the setting of re-ablation of AF showcasing patients willingness to actively take part in their own care process. This suggests that current standard of care after catheter ablation of AF should be complemented by more intensive HRM involving telemedical approaches.

To determine if the validated smartphone application
FibriCheck, which uses photoplethysmography to detect AF, can
remove the need for in-person monitors, thereby reducing costs.

Using FibriCheck, 12-lead ECGs and Holters were avoided, reducing the burden on primary care, and releasing Holter monitors to patients with higher acuity. This also equated to significant cost
and time savings, allowing for increased efficiency of the service, and making a positive impact on the carbon footprint. FibriCheck allowed safe at-home remote monitoring of symptoms with timely diagnosis, detection, and management of AF recurrence for patients in our post-AF ablation clinics. This is an easily replicated and cost-efficient
service. 

Developing & implementing a digital care pathway for patients with AF using remote monitoring.

To digitize and enhance pre-existing AF care pathways through implementation of an early supported discharge pathway, using an approach that leverages digital remote monitoring technologies. Two digital elements were integrated, being FibriCheck and a digital interface, integrated with the patient electronic health record. A remote monitoring hub, staffed by trained specialist nurses, managed the virtual AF ward environment and conducted telephone triage assessments, escalating to the cardiology team when needed.

Patients can be triaged safely and effectively in virtual AF wards. Out of the patients enrolled, there was 95% patient engagement with remote monitoring with positive patient feedback overall. This approach led to a 4-day shorter length of stay with reduction in rates of rehospitalization, which resulted in significant cost-savings of up to £990 per patient. The findings suggest that this model could be replicated across other NHS trusts, and could lead to improved care delivery, improved patient experience and shorter inpatient stay.

Comparison of pulsed-field ablation versus very high power short duration-ablation for pulmonary vein isolation

Pulsed-field ablation and VHPSD-PVI seem to be highly effective and safe to achieve PVI in the setting of PAF and persAF with comparable arrhythmia-free survival. However, procedure duration for PFA PVI is significantly shorter and therefore may be of potential benefit. Compared to PFA VHPSD-PVI might ensure information on left atrial substrate allowing to target concomitant secondary tachycardias.

Photoplethysmography-documented atrial fibrillation in the first week after catheter ablation is associated with lower success rates

PPG rhythm telemonitoring during the first week after AF ablation often triggered clinical interventions. Due to its high availability, PPG-based follow-up actively involving patients after AF ablation may close a diagnostic and prognostic gap in the blanking period and increase active patient-involvement.

The implementation of TeleCheck-AF was associated with a change in health care utilisation which resulted in a disproportional drop in reimbursement by health insurances due to a shift in declarable care products weights. Results of this analysis were basis to design a new reimbursement code for the TeleCheck-AF approach in the Netherlands.

The European TeleCheck-AF project on remote app-based management of atrial fibrillation: ablation outpatient clinic experience

The current sub-study of the TeleCheck-AF project aimed to provide the first real-world dataset on feasibility and patient experience of this standardized mobile health (mHealth) infrastructure in the clinical setting of follow-up after catheter ablation.

The TeleCheck-AF approach is feasible and associated with high adherence as well as motivation to use the app and with optimal patient experience. Whether this approach can replace conventional rhythm follow-up after catheter ablation required further study.

Despite different health care settings and mHealth experiences, the TeleCheck-AF approach could be set up within an extremely short time and easily used in different European centers during COVID-19.

To (1) analyze the SoMe Twitter network behind #TeleCheckAF, (2) describe the communities and behavioral groups within the network and (3) to determine the opinion leaders and influencers.

The SoMe network behind #TeleCheckAF showed a wide dissemination involving a broad spectrum of healthcare professionals and was accelerated by the official ESC Twitter handles. Social network analysis created a helpful insight into the mechanisms behind innovation dissemination within social media. Future research could further analyze the difssemination process using e.g. hazard modeling and investigate the evolution of the network and behaviors over time.

The aim of the document is to provide up-to-date practical guidance on the use of digital devices for arrhythmias, from early detection through management and implementation, using the categories of consensus.

Overall digital devices for heart rhythm monitoring are abundant, and with the rapid advancement of technologies likely to increase further.

In the future, a digital workflow will likely be implemented at most cardiology clinics, and the devices available will likely have additional monitoring capabilities and features.

Cardiac electrophysiologists were more likely to have recommended the use of a digital device compared to other HCPs, and those in private practice were more likely to do so than practitioners in university hospital settings.
Two in 5 HCPs reported that they would recommend anticoagulation for a patient at an elevated risk for stroke based on new AF detected from a 30-second ECG monitor without further confirmatory testing.
The majority also indicated they would re-evaluate their stroke prevention strategy in a patient with prior AF should an AF recurrence be detected using a digital device.