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| Title | Year | Objective | Key Message(s) |
|---|---|---|---|
| Symptom severity assessment in patients with atrial fibrillation after catheter ablation using a smartphone application | 2026 | Symptom severity in atrial fibrillation (AF) influences healthcare use, but conventional assessments lack temporal precision. We evaluated the feasibility of smartphone-based symptom severity assessment after AF catheter ablation and explored predictors and variability of symptom severity. | Smartphone-based symptom severity assessment after AF ablation is feasible and reveals substantial individual variability beyond rhythm status alone. |
| Pre-procedural time spent in atrial fibrillation using intermittent ECG monitoring is associated with arrhythmia recurrence after ablation: the ISOLATION cohort study | 2026 |
Atrial fibrillation (AF) is conventionally classified as paroxysmal or persistent. AF burden might better reflect response to rhythm-control interventions. This study evaluated the association between estimated pre-procedural time spent in AF and recurrences after AF ablation, compared with conventional AF classification. | A higher pre-procedural percentage of time spent in AF derived from 60-second single-lead ECGs is independently associated with atrial arrhythmia recurrence after ablation. Assessing the percentage of pre-procedural time spent in AF might help identify paroxysmal AF patients with a high AF recurrence risk in future studies. |
| Smartphone Application–Derived Clusters of Persistent Symptoms in Patients After Atrial Fibrillation Ablation: Data From the ISOLATION Study | 2026 |
This study sought to perform a cluster analysis to identify clinically relevant AF subphenotypes based on persistent symptoms following AF ablation and evaluate their associations with clinical characteristics and AF recurrence. |
Half of all patients report symptoms after AF ablation. Using cluster analysis, 5 symptom-based AF subphenotypes were identified, each with distinct clinical characteristics, biomarker profiles, AF recurrence, AF pattern, AF and symptom burden, and symptom-rhythm correlation. Symptom clusters empowered by digital health may facilitate individualized AF management strategies following AF ablation. |
| Prolonged Smartphone-Based Photoplethysmography for Heart Rhythm Monitoring After Repeat Ablation of Atrial Fibrillation — A 6-Month Prospective Study on mHealth Compliance, Motivation and Arrhythmia Recurrence | 2026 |
Photoplethysmography (PPG) enables mobile health (mHealth) heart rhythm monitoring (HRM). This study aimed to assess patient experience and detection rates of arrhythmia recurrence with a mHealth HRM after repeat ablation of atrial fibrillation (AF). | Patients undergoing repeat ablation of AF have high compliance for participating in a prolonged mHealth HRM over 6 months. The detection rate of atrial arrhythmia recurrences was higher in the mHealth compared to conventional FU. |
| Feasibility of a decentralised trial of sleep apnoea screening in patients with atrial fibrillation | 2025 |
This study evaluated the feasibility of a decentralised clinical trial for home-based sleep apnoea (SA) screening, activity tracking and heart rhythm monitoring in patients with AF. | The study reports the feasibility of a decentralised digital platform for comprehensive AF patient monitoring. High patient engagement and data completeness suggest that digital health technologies can effectively integrate into clinical trials for patients with AF. |
| Smartphone application-based heart rhythm management around cardioversion in patients with presumed persistent atrial fibrillation: feasibility substudy of TeleConvert-AF | 2025 | This substudy of the TeleConvert-AF study assesses the feasibility of the smartphone application-based heart rhythm monitoring to detect paroxysmal AF patterns and spontaneous conversion of AF to SR in patients on the waiting list of an elective ECV. | The TeleConvert-AF approach is feasible. PPG can accurately detect spontaneous conversion to SR and paroxysmal AF in patients waiting for an elective ECV. The effect of the TeleConvert-AF approach on ECV cancelation and the integration into AF treatment plans is currently investigated in the ongoing prospective TeleConvert-AF study. |
| 2025 | This study evaluates the utility of a PPG-based smartphone app in detecting AF recurrence after catheter ablation compared to conventional Holter monitoring. | PPG-based smartphone app demonstrated a higher detection rate of AF recurrence post-ablation compared to concurrent Holter monitoring, including a significant proportion of asymptomatic cases. The ability to detect recurrences early enabled timely clinical interventions, highlighting the potential of smartphone-based apps to complement traditional monitoring methods in post-ablation care. | |
| Evaluation of photoplethysmography-based smartphone app accuracy for detecting atrial fibrillation after ablation | 2025 | This study aims to assess the accuracy of a PPG-based smartphone app (FibriCheck) in detecting AF recurrence after catheter ablation with head-to-head comparison with conventional Holter monitoring. | PPG-based smartphone app demonstrated high accuracy and excellent diagnostic performance for detecting AF recurrence after catheter ablation, with results comparable to conventional Holter monitoring. The app's robust sensitivity, specificity, and ease of use highlight its potential as a reliable and accessible tool for post-ablation rhythm monitoring in real-world clinical settings. |
| Is a virtual atrial fibrillation pathway using a smartphone application effective? A single centre experience | 2025 | To determine whether an acute AF service using a smartphone app is clinically safe and cost effective. | The article suggest that an acute virtual AF service is both clinically safe and cost effective. These models of care should be further developed to provide care that is fit for the future. |
| Patients perspectives on integrating eHealth in regular care pathways for atrial fibrillation: evaluating photoplethysmography for remote self-assessment | 2025 | The aim of this study is to evaluate patients’ perspectives on the use of remote PPG-based electronical health (eHealth) integrated in regular care pathways for AF. |
The use of a PPG-based eHealth application with the ability to self-assess heart rhythm and rate is positively received by patients with atrial fibrillation. Patients find the integration of eHealth into regular care pathways for atrial fibrillation positive, and see its incremental value when combined with personalized face-to-face care. |
| Improving atrial fibrillation or flutter detection and management by smartphone-based photoplethysmography rhythm monitoring following cardiac surgery: a pragmatic randomized trial | 2025 |
This study aims to determine whether photoplethysmography (PPG)-based smartphone monitoring to detect AF or AFL after hospital discharge following cardiac surgery improves AF management. | In unselected patients discharged home following cardiac surgery, PPG-based smartphone monitoring revealed significantly more AF/AFL which led to significantly more optimization of AF management. |
| Feasibility of repeated on-demand smartphone app–based approximation of time spent with atrial fibrillation and symptoms in patients after catheter ablation: Data from the ISOLATION study | 2025 | The purpose of this study was to assess the feasibility of repeated on-demand heart rhythm and symptom monitoring and analyze time spent with AF and symptoms over 12 months after AF ablation. | Repeated on-demand smartphone-based monitoring is feasible after AF ablation. Patient adherence declined slightly over 12 months. At 3 months, high AF and symptom load reliably predicted the following year while low AF and symptom load necessitate repeated monitoring. |
| Smartphone app-based approximation of time spent with atrial fibrillation and symptoms in patients after catheter ablation: data from the TeleCheck-AF project | 2024 | Reduction of atrial fibrillation (AF) burden is the preferred outcome measure over categorical AF rhythm recurrence after AF ablation. In this sub-analysis of the TeleCheck-AF project, we tested the feasibility of smartphone app-based approximation of time spent with AF and/or symptoms. | On-demand, app-based simultaneous rhythm and symptom assessment provides objective proxies of time spent with AF and/or symptoms and SRC, which may assist in assessing AF and symptom outcomes after AF ablation. |
| Effectiveness of photoplethysmography-based rhythm monitoring after atrial fibrillation ablation using a smartphone application | 2024 | 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. |
| Remote Rhythm Monitoring using a Photoplethysmography Smartphone Application after Cardioversion for Atrial Fibrillation | 2024 | 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.
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| Insights from a single centre implementation of a digitally-enabled atrial fibrillation virtual ward | 2024 | 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. |
| Changes in healthcare utilisation during implementation of remote atrial fibrillation management: TeleCheck-AF project | 2024 | 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. |
| Prolonged photoplethysmography-based heart rhythm monitoring in patients undergoing re-ablation of atrial fibrillation - compliance, motivation, and experience | 2023 | 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. |
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Transforming our post-atrial fibrillation ablation follow up patient pathway using FibriCheck: A smartphone digital app used for remote monitoring |
2023 | 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. | 2023 |
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.
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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.
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| 2023 |
This study compared procedural and outcome data for PFA-PVI to VHPSD-PVI in patients with paroxysmal or persistent atrial fibrillation (PAF/persAF). |
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. | |
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Transforming our post-atrial fibrillation ablation follow up patient pathway using FibriCheck: |
2023 |
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. This is an easily replicated and cost-efficient service. |
| Photoplethysmography-documented atrial fibrillation in the first week after catheter ablation is associated with lower success rates | 2023 | To test the feasibility of postprocedural photoplethysmography (PPG) rhythm telemonitoring during the first week after atrial fibrillation (AF) ablation and its predictive value for later AF recurrence. | 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. |
| Changes in healthcare utilisation and declarable care products during the implementation of a remote atrial fibrillation management pathway: The TeleCheck-AF project | 2023 | To evaluate changes in healthcare utilisation and declarable care products during the implementation of the TeleCheck-AF approach in a Dutch AF-clinic. | 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 | 2023 | 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. |
| Photoplethysmography telemonitoring during the first week after atrial fibrillation ablation: Feasibility and clinical implications | 2022 | To assess the feasibility and clinical implications of PPG telemonitoring specifically during the first week after atrial fibrillation ablation is unknown. | Rhythm monitoring with a PPG-based mHealth application was feasible and often resulted in clinical interventions. Due to its high availability, PPG-based follow-up actively involving patients after AF ablation may close a diagnostic and prognostic gap and increase active patient-involvement |
| Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation | 2022 | To introduce a novel mobile app-based simultaneous symptom and rhythm monitoring approach to assess symptom-rhythm correlation in patients with persistent AF | In persistent AF patients, simultaneous mobile app-based symptom and rhythm monitoring revealed a relatively low overall SRC, which was mainly driven by a majority of AF recordings which were asymptomatic. Extrasystoles can explain a minority of symptomatic non-AF PPG recordings. Pulse rate, but not pulse variability, is the main determinant of reported symptoms during AF and non-AF PPG recordings. Further studies are required to test whether mobile app-based SRC assessment can be implemented in current workflows and integrated into a personalized symptom and rhythm control AF management approach. |
| On-Demand Mobile Health Infrastructure for Remote Rhythm Monitoring within a Wait-and-See Strategy for Recent-Onset Atrial Fibrillation- TeleWAS-AF | 2021 | To describe the implementation of the TeleWAS-AF approach, an on-demand mHealth-based heart rate and rhythm monitoring infrastructure to support a WAS strategy for patients presenting with recent-onset AF at the ED | While maintaining the delivery of comprehensive treatment, the approach has a potential to reduce the burden on EDs and enhance the capacity for health-care utilization. However, given the change in the treatment approach, redesign of care delivery and reimbursement models may be warranted. Obviously, patients’ role in the decision-making process and the communication between patients and the treatment team is crucial. This approach will be implemented in all participating centers of the TeleCheckAF project |
| App based monitoring of heart rate via FibriCheck to facilitate teleconsultations: from COVID-19 to clinical practice? | 2021 |
Evaluation of the feasibility to initiate remotely PPG recordings with FibriCheck and of the value of using FibriCheck before and after teleconsultation to substitute in-person arrhythmia consultations in three Belgian hospitals. |
During the COVID-19 pandemic, cardiologists were able to obtain important additional information using the FibriCheck application when performing teleconsultations. The possibility to successfully complete teleconsultations using the FibriCheck data, and its broad applicability, create opportunities to implement FibriCheck in standard clinical practice as an easy tool to monitor patients before or after in-person consultations or even hospitalisations. |
| Impact of photoplethysmography on therapeutic decisions in atrial fibrillation | 2021 | Rapid identification and implementation of remote healthcare delivery methods in time of COVID-19 pandemic. Three months after discharge, and therefore after blanking period, the patient was included in a novel pan-European project TeleCheck-AF, designed to facilitate the remote management of patients with AF | This case highlights the feasibility of PPG applications in monitoring patients after ablation and shows how the results can be used to guide and inform further therapeutic decisions. Whether PPG technology can be used as routine rhythm monitoring for the follow-up after AF ablation warrants further study |
| Post-ablation outcome monitoring using a pulse-deriving smartphone application | 2018 | To investigate whether the implementation of a pulse-deriving smartphone application in this population offers the potential to detect early as well as late recurrence in order to initiate proper treatment in a timely manner. | Pulse-deriving smartphone applications implemented in combination with a structured care path proved to be a promising methodology for short-and long-term outcome monitoring of post-ablation patients and are capable in the detection of silent intermittent atrial fibrillation episodes. |
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