Prospective study on photopletysmographic and electroencephalographic signals for the monitoring of candidates to electrical cardioversion of atrial arrhythmias (ppeeg-af pilot study)

Atrial fibrillation (AF) is the most common arrhythmia, and its incidence is constantly increasing. It is associated with higher stroke risk and the presence of sleep disorders and dementia. The choice between rhythm and rate control in AF patients remains a debated topic, and it should be tailored on specific patient characteristics. In specific situations, electrical cardioversion (ECV) for rhythm control represents the preferred choice; in particular, in patients affected by cardiopathy and/or heart failure. Because of relevant AF social costs, there is a growing interest in developing new devices for large-scale screening and monitoring programs in patients affected or at risk of AF, to reduce the incidence of disabling events. The aim of this study was to evaluate the feasibility of the use of a set-up for multi-parametric monitoring of candidates to AF ECV. In particular, new technologies were exploited for photoplethysmographic (PPG) and electroencephalographic (EEG) signal registration, integrated with clinical and instrumental data. We analyzed the effect of AF ECV on heart rate variability (HRV) and vascular age parameters derived from PPG signals registered with Empatica (CE 1876/MDD 93/42/EEC; Empatica S.r.l, Milan, Italy), and on EEG sleep pattern registered with Neurosteer (IEC 60601-1-2; Neurosteer Inc., Herzliya, Israel). 24 patients were enrolled, 75% males, mean age 65.6 +/- 8.5 years. HRV analyses considering time frames registered before and after ECV showed a significant reduction of most variables (p<0.001), only LF/HF ratio did not differ significantly. Considering HRV parameters, comparisons between PPG signals registered during day or night before and after ECV showed a significant difference in SD1/SD2 ratio (p=0.035) and HF (p=0.002). Regarding vascular age parameters, a significant reduction was observed in both turning point ratio (TPR) and a wave after ECV (p < 0.001). Moreover, we observed that patients with Mini-Mental State Examination (MMSE) <= 28 presented higher values of TPR (65.9 +/- 1.6 versus 64.2 +/- 1.4, p=0.035) and CHA(2)DS(2)-VASc score (congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age, sex category) (2.9 +/- 0.9 versus 1.7 +/- 1.2, p=0.022). Considering sleep patterns, a tendency to higher coherence was observed in registrations acquired during AF than in presence of sinus rhythm, or considering signals registered before and after ECV for each patient. In conclusion, the use of this new setup of multiparametric monitoring of candidates to ECV showed significant modifications on vascular age parameters derived from PPG signals measured before and after ECV. Moreover, a possible AF effect on sleep pattern registered with Neurosteer was noticed, but more data are necessary to confirm these preliminary results.