Improving atrial fibrillation or flutter detection and management by smartphone-based photoplethysmography rhythm monitoring following cardiac surgery: a pragmatic randomized trial.

Summary

Among 450 post-cardiac surgery patients, 6-week smartphone PPG monitoring increased AF/AFL detection (18.5% vs 1.9%) and quintupled evidence-based interventions (10.1% vs 2.4%). New arrhythmia detections were substantially higher with PPG (9.2% vs 0.5%), highlighting the utility of digital rhythm surveillance after discharge.

Key Findings

• AF/AFL detection: 18.5% with PPG monitoring vs 1.9% usual care (OR 11.8; 95% CI 4.2–33.3; P<0.001).
• New AF/AFL detections: 9.2% vs 0.5% (OR 21.3; 95% CI 2.9–166.7; P=0.003).
• AF management interventions: 10.1% vs 2.4% (OR 5.1; 95% CI 1.8–14.4; P=0.002).

Clinical Implications

Implement structured smartphone PPG checks for 6 weeks after cardiac surgery to identify AF/AFL early and prompt anticoagulation, cardioversion, or antiarrhythmic therapy as appropriate.

Limitations

• Open-label design and reliance on smartphone access/engagement may introduce selection and performance bias
• Short monitoring window (6 weeks) and no long-term clinical outcomes (e.g., stroke) reported

Future Directions

Evaluate long-term clinical outcomes (stroke, hospitalization), cost-effectiveness, and integration into perioperative care pathways; assess applicability in older and digitally underserved populations.