Smartphone rhythm monitoring optimises AF management following cardiac surgery

The results of the SURGICAL-AF 2 trial suggest that smartphone rhythm monitoring by photoplethysmography following cardiac surgery leads to a 12-fold increase in atrial fibrillation and atrial flutter detection and a 5-fold increase in atrial fibrillation monitoring compared with usual care.

SURGICAL-AF 2 (NCT05509517) is a pragmatic, open-label, multicentre, randomised clinical trial in participants with coronary artery bypass graft surgery (CABG) or valve surgery. Participants were randomised 1:1 to either photoplethysmography-based smartphone rhythm monitoring or usual care (which entailed no mandated rhythm monitoring), with physician follow-up after 21–91 days [1]. The primary endpoint was atrial fibrillation management (a composite of initiation of oral anticoagulation, cardioversion, up-titration or initiation of antiarrhythmic drugs, and implantation of a cardiac implantable electronic device) if this was required due to detection of post-operative atrial fibrillation or atrial flutter.

The intervention group included 238 participants and 212 participants were included in the usual care group. During the follow-up period, 1.9% of participants in the usual care group had detected atrial fibrillation or atrial flutter compared with 18.5% of participants in the intervention group (OR 11.8; 95% CI 4.2–33.3). The primary endpoint was met in 24 (10.1%) participants in the intervention group versus 5 (2.4%) participants in the usual care group (OR 5.1; 95% CI 1.8–14.4). This outcome was driven by the initiation of anticoagulation in 17 (7.1%) participants in the intervention group versus 3 (1.4%) participants in the usual care group (OR 5.4; 95% CI 1.5–18.5). No device implantation occurred during the study.

“Photoplethysmography-based smartphone monitoring increases the detection of atrial fibrillation or atrial flutter, which led to a 5-fold increase in atrial fibrillation management interventions,” concluded Dr Henri Gruwez (Hospital Oost-Limburg, Belgium).

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   1. Gruwez H, et al. Impact of photoplethysmography-based smartphone rhythm monitoring on atrial fibrillation detection and management after cardiac surgery: a pragmatic randomized trial. Atrial fibrillation: stroke - oral anticoagulants. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April 202429 April 2024