mHealth-based assessment of rate control during recurrent paroxysms after an emergency department visit for recent-onset atrial fibrillation: a subanalysis of the RACE 7 ACWAS trial
Authors: Van Der Velden R , Pluymaekers N A H A , Dudink E A M P , Luermans J G L M , Meeder J G , Lenderink T , Widdershoven J , Bucx J J J , Rienstra M , Van Gelder I C , Crijns H J G M , Linz D 
Published: October 2022

Abstract

Introduction
Achieving adequate rate control is a mainstay in the treatment of atrial fibrillation (AF). In the Rate Control versus Electrical Cardioversion Trial 7 – Acute Cardioversion versus Wait and See (RACE 7 ACWAS) trial, an early cardioversion approach was compared to a delayed cardioversion approach for patients with recent-onset symptomatic AF, followed by a four-week monitoring period using mobile health (mHealth).

Purpose
To assess the adequacy of rate control during recurrences of AF in the four weeks after an emergency department visit for recent-onset AF using mHealth.

Methods
After restoration of sinus rhythm (spontaneous or through cardioversion), patients (n=335) were asked to record one minute heart rate and rhythm recordings three times daily and in case of symptoms by using an electrocardiographic-based handheld device to monitor for recurrences for four weeks after the index visit. Recordings from the handheld device were collected at the end of the follow-up period. For this subanalysis, a cut-off for lenient rate control during AF recurrences was used and this was defined as a heart rate of &lt;110 beats per minute. A p-value of &lt;0.05 was considered statistically significant.

Results
mHealth-based monitoring identified 99 patients with a total of 314 recurrences (29.6% of the included patients; median age 67 [interquartile range (IQR) 13] years, 60.6% male, 49.5% delayed cardioversion group, median number of recurrences 2 [IQR 2]). Two recurrences in one patient were excluded from analysis because heart rate could not be adequately assessed due to too much interference. Rate control was always adequate during 126 recurrences (40.4%), always inadequate during 111 recurrences (35.6%) and varying between adequate and inadequate in the remaining 75 recurrences (24.0%). On a patient level, rate control was always adequate in 26 patients (26.5%), always inadequate in 20 patients (20.4%) and varying between or within recurrences in the remaining 52 patients (53.1%) (Figure 1). Although there were no differences in clinical characteristics of the patients based on their adequacy of rate control, there is a trend towards significance regarding randomisation group (p=0.051), with patients with adequate rate control being more often in the delayed cardioversion group compared to those with varying and inadequate rate control (18 (69.2%) vs 24 (46.2%) vs 7 (35.0%), respectively).

Conclusion
It is feasible to assess heart rate and the adequacy of rate control during recurrences of recent-onset AF using mHealth. Whether real time mHealth-based rate and rhythm monitoring can be integrated in a remote management pathway to adapt rate control in AF patients warrants further studies.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Netherlands Organization for Health Research and Development–Health Care Efficiency Research Program