Benefits of patient-managed ECGs to verify the time of recurrent atrial fibrillation after electrical cardioversion in the PRE-ELECTRIC study

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Vestre Viken Hospital Trust. Background Electrical cardioversion (ECV) is a common procedure to terminate persistent atrial fibrillation (AF). The recurrence rate after ECV is high, and recurrence is often unrecognized by the patients. Purpose To investigate the benefits of patient-managed out-of-hospital electrocardiography (ECG) to diagnose recurrence of AF after ECV. Methods PRE-ELECTRIC (predictors for recurrence of atrial fibrillation after electrical cardioversion) is a prospective, observational study. We included 200 adult patients with persistent AF referred for ECV at Bærum Hospital between 2018 and 2022. Time to recurrence of AF was verified by digital thumb ECG, recorded twice daily and whenever experiencing symptoms. The observation period was 28 days. We defined patient motivation as expected number of days with ECG recordings minus missed days with ECG recordings divided by expected number of days with ECG recordings. Shortly after recurrence of AF, we called the patients and investigated their awareness of recurrence. Results Mean age was 66.2 (± 9.3) years, and 42 (21.0%) were women. The most frequent comorbidities were hypertension (n=94, 47.0%) and heart failure (n=51, 25.5%). A total of 164 patients underwent ECV of AF, and the procedure was initially successful for 90.6%. Recurrence of AF had occurred in 50.3% of the successfully cardioverted patients after 4 weeks, and median time to recurrence was 5 days. Of all the cardioverted patients, 123 patients (75%) had 100% motivation with no missed days of measured thumb ECGs during the observation period. Nearly 97% of the patients had above 89% motivation with three or less missed days. More than 37% of the patients with recurrence of AF were not aware of the recurrence at the time of contact. Conclusions Recurrence of AF after ECV was frequent. Patients showed high motivation to self-managed out-of-hospital ECG-recordings, and this was useful for diagnosing recurrence of AF.