TOPLINE:

Patients with atrial fibrillation (AF) or atrial flutter scheduled for cardioversion who used a smartphone photoplethysmography (PPG) monitoring app (CORAI Heart Monitor) had fewer same-day cancellations and fewer cancellations due to spontaneous conversion to sinus rhythm than those who received standard care, according to a brief report published in JAMA Cardiology.

METHODOLOGY:

• Researchers conducted a randomized, single-blinded trial at a tertiary hospital in Sweden between September 2022 and February 2025 to assess whether daily smartphone-based PPG monitoring reduced same-day cancellations of scheduled elective cardioversions for AF and atrial flutter.
• They included 206 adults with persistent AF or atrial flutter awaiting elective cardioversion (median age, 69.7 years; 72.3% men). In all, 203 patients completed the trial, including 104 in the intervention group and 99 in the control group.
• Patients in the intervention group started recording heart rhythm twice daily about 1-4 weeks before their scheduled cardioversion using a smartphone PPG app with ECG validation. They received reminders to facilitate adherence to an oral anticoagulation treatment protocol. Those in the control group received standard care without additional monitoring.
• Researchers reviewed all recordings daily, canceled cardioversion if sinus rhythm was detected, and contacted patients if heart rates dropped below 40 beats/min or exceeded 140 beats/min.
• The primary endpoint was same-day cancellation of cardioversion. Secondary endpoints were feasibility and safety.

TAKEAWAY:

• The intervention group had fewer same-day cancellations of cardioversions than the control group (4.8% vs 23.2%; P < .001).
• Cancellations due to spontaneous conversion to sinus rhythm occurred less often in the intervention group than in the control group (1.0% vs 18.2%; P < .001), yielding a relative risk reduction of 94.7% and an absolute risk reduction of 17.2%.
• Precardioversion sinus rhythm was detected in 30.8% of patients in the intervention group (leading to cancellation in most cases) and in 26.3% of patients in the control group.
• Participants logged 5226 precardioversion smartphone PPG recordings, with a median of 2.1 recordings per day. The automated algorithm classified all recordings as having sufficient quality for diagnosis.

IN PRACTICE:

“The findings of this study suggest that precardioversion monitoring using smartphone PPG represents an easy-to-use and highly scalable digital intervention that significantly reduced same-day cancellations,” the researchers wrote.

SOURCE:

The study was led by Jonatan Fernstad, MD, PhD, of Danderyd Hospital in Stockholm, Sweden. It was published online on June 3 as a brief report in JAMA Cardiology.

LIMITATIONS: 

The study was conducted at a single tertiary hospital, and so results could vary across centers. Participants were included largely through remote procedures after a screening visit, and adherence to smartphone recordings and signal quality may have differed in routine practice. Only one smartphone PPG system was evaluated.

DISCLOSURES:

The study received funding from Vinnova and the Swedish Heart-Lung Foundation. One author reported being the creator and founder of Corai, the company that developed the monitoring device. Several authors reported receiving scholarships, research grants, institutional support, and lecture or personal fees from commercial entities and/or the Swedish Heart-Lung Foundation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.