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Aims: To test the feasibility of postprocedural photoplethysmography (PPG) rhythm telemonitoring during the first week after atrial fibrillation (AF) ablation and its predictive value for later AF recurrence., Methods: PPG rhythm telemonitoring during the first week after the ablation procedure was offered to a total of 382 consecutive patients undergoing AF ablation. Patients were instructed to perform 1 min PPG recordings by a mobile health application 3 times per day and in case of symptoms. Clinicians assessed the PPG tracings via a secured cloud and the information was remotely integrated into the therapeutic pathway via teleconsultation (TeleCheck-AF approach)., Results: 119 patients (31%) agreed to perform PPG rhythm telemonitoring after ablation. Patients included in the TeleCheck-AF approach were younger compared to those who declined participation (58 ± 10 vs. 62 ± 10 years, p  < 0.001). Median follow up duration was 544 (53-883) days. 27% of patients had PPG tracings suggestive of AF in the week following the ablation. In 24% of patients, the integration of PPG rhythm telemonitoring resulted in a remote clinical intervention during teleconsultation. During follow-up of one year, 33% of patients had ECG-documented AF recurrences. PPG recordings suggestive of AF in the week after ablation were predictive of late recurrences ( p  < 0.001)., Conclusion: PPG rhythm telemonitoring during the first week after AF ablation often triggered clinical interventions. Due to its high availability, PPG-based follow-up actively involving patients after AF ablation may close a diagnostic and prognostic gap in the blanking period and increase active patient-involvement., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Manninger, Hermans, Caracioni, Rohrer, Eberl, Vernooy, Zirlik, Linz and Scherr.)

Aim: To propose a standardized workflow for 3D-electroanatomical mapping guided pulmonary vein isolation in pigs., Materials and Methods: Danish female landrace pigs were anaesthetized. Ultrasound-guided puncture of both femoral veins was performed and arterial access for blood pressure measurement established. Fluoroscopy- and intracardiac ultrasound-guided passage of the patent foramen ovale or transseptal puncture was performed. Then, 3D-electroanatomical mapping of the left atrium was conducted using a high-density mapping catheter. After mapping all pulmonary veins, an irrigated radiofrequency ablation catheter was used to perform ostial ablation to achieve electrical pulmonary vein isolation. Entrance- and exit-block were confirmed and re-assessed after a 20-min waiting period. Lastly, animals were sacrificed to perform left atrial anatomical gross examination., Results: We present data from 11 consecutive pigs undergoing pulmonary vein isolation. Passage of the fossa ovalis or transseptal puncture was uneventful and successful in all animals. Within the inferior pulmonary trunk 2-4 individual veins as well as 1-2 additional left and right pulmonary veins could be cannulated. Electrical isolation by point-by-point ablation of all targeted veins was successful. However, pitfalls including phrenic nerve capture during ablation, ventricular arrhythmias during antral isolation close to the mitral valve annulus and difficulties in accessing right pulmonary veins were encountered., Conclusion: Fluoroscopy- and intracardiac ultrasound-guided transseptal puncture, high-density electroanatomical mapping of all pulmonary veins and complete electrical pulmonary vein isolation can be achieved reproducibly and safely in pigs when using current technologies and a step-by-step approach., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hertel, Jerltorp, Hansen, Isaksen, Sattler, Linz, Chaldoupi, Jespersen, Saljic, Gang, Manninger and Linz.)

Introduction: The TeleCheck-AF approach is an on-demand mobile health (mHealth) infrastructure incorporating mobile app-based heart rate and rhythm monitoring through teleconsultation. We evaluated feasibility and accuracy of self-reported mHealth-based AF risk factors and CHA 2 DS 2 -VASc-score in atrial fibrillation (AF) patients managed within this approach., Materials and Methods: Consecutive patients from eight international TeleCheck-AF centers were asked to complete an app-based 10-item questionnaire related to risk factors, associated conditions and CHA 2 DS 2 -VASc-score components. Patient's medical history was retrieved from electronic health records (EHR)., Results: Among 994 patients, 954 (96%) patients (38% female, median age 65 years) completed the questionnaire and were included in this analysis. The accuracy of self-reported assessment was highest for pacemaker and anticoagulation treatment and lowest for heart failure and arrhythmias. Patients who knew that AF increases the stroke risk, more often had a 100% or ≥80% correlation between EHR- and app-based results compared to those who did not know (27 vs. 14% or 84 vs. 77%, P = 0.001). Thromboembolic events were more often reported in app (vs. EHR) in all countries, whereas higher self-reported hypertension and anticoagulant treatment were observed in Germany and heart failure in the Netherlands. If the app-based questionnaire alone was used for clinical decision-making on anticoagulation initiation, 26% of patients would have been undertreated and 6.1%-overtreated., Conclusion: Self-reported mHealth-based assessment of AF risk factors is feasible. It shows high accuracy of pacemaker and anticoagulation treatment, nevertheless, displays limited accuracy for some of the CHA 2 DS 2 -VASc-score components. Direct health care professional assessment of risk factors remains indispensable to ensure high quality clinical-decision making., Competing Interests: DSc has received speaker honoraria and/or travel grants from Bayer, Biosense Webster, Biotronik, BMS/Pfizer, Boehringer Ingelheim, Boston Scientific, Daiichi Sankyo, Medtronic, Zoll Medical, as well as research grants from Biosense Webster, Boston Scientific, and Zoll Medical. KV consultancy agreement with Boston, Medtronic, Biosense Webtster, Philips, and Abbott, Received educational grants from Medtronic, Abbott and Biosense Webster. JH declares that Flinders University has received speaker honoraria on his behalf from Biotronik. MM has received speaker honoraria and/or travel grants from Abbott, AOP Orphan, Bayer, Biotronik, Boston Scientific, Daiichi Sankyo, Pfizer, Zoll. DD has received speaker honoraria and/or travel grants from Abbott, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Medtronic, Pfizer, Zoll. NK has received research grants from the Swiss National Science Foundation P400PM-194477, Gottfried und Julia Bangerter-Rhyner-Stiftung. The author acknowledges funding received from the European Society of Cardiology in form of an ESC Training Grant. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hermans, Gawałko, Hillmann, Sohaib, van der Velden, Betz, Verhaert, Scherr, Meier, Sultan, Steven, Terentieva, Pisters, Hemels, Voorhout, Lodziński, Krzowski, Gupta, Kozhuharov, Gruwez, Vernooy, Pluymaekers, Hendriks, Manninger, Duncker and Linz.)

Aims: This study aims to compare the performance of physicians to detect atrial fibrillation (AF) based on photoplethysmography (PPG), single-lead ECG and 12-lead ECG, and to explore the incremental value of PPG presentation as a tachogram and Poincaré plot, and of algorithm classification for interpretation by physicians. Methods and Results: Email invitations to participate in an online survey were distributed among physicians to analyse almost simultaneously recorded PPG, single-lead ECG and 12-lead ECG traces from 30 patients (10 in sinus rhythm (SR), 10 in SR with ectopic beats and 10 in AF). The task was to classify the readings as 'SR', 'ectopic/missed beats', 'AF', 'flutter' or 'unreadable'. Sixty-five physicians detected or excluded AF based on the raw PPG waveforms with 88.8% sensitivity and 86.3% specificity. Additional presentation of the tachogram plus Poincaré plot significantly increased sensitivity and specificity to 95.5% ( P < 0.001) and 92.5% ( P < 0.001), respectively. The algorithm information did not further increase the accuracy to detect AF (sensitivity 97.5%, P = 0.556; specificity 95.0%, P = 0.182). Physicians detected AF on single-lead ECG tracings with 91.2% sensitivity and 93.9% specificity. Diagnostic accuracy was also not optimal on full 12-lead ECGs (93.9 and 98.6%, respectively). Notably, there was no significant difference between the performance of PPG waveform plus tachogram and Poincaré, compared to a single-lead ECG to detect or exclude AF (sensitivity P = 0.672; specificity P = 0.536). Conclusion: Physicians can detect AF on a PPG output with equivalent accuracy compared to single-lead ECG, if the PPG waveforms are presented together with a tachogram and Poincaré plot and the quality of the recordings is high., Competing Interests: SE and TP are employed by Qompium NV. DD received speaker honoraria and/or travel grants from Abbott, Astra-Zeneca, Bayer, Biotronic, Boehringer-Ingelheim, Boston Scientific, Medtronic, Pfizer and Zoll. HH did receive personal fees from Biotronik and Pfizer-BMS. He received unconditional research grants through the University of Antwerp and/or the University of Hasselt from Bayer, Boehringer-Ingelheim, Bracco Imaging Europe, Abbott, Medtronic, Biotronik, Daicchi-Sankyo, Pfizer- BMS, and Boston-Scientific, all outside the scope of this work. MM received speaker honoraria and/or travel grants from Biosense Webster, Abbott, Biotronik, Zoll, Boston Scientific, Daiichi Sankyo, Bayer, Pfizer, Amomed as well as research grants from Biosense Webster, none of which are relevant to the manuscript. PV holds stock in Qompium NV. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Gruwez, Evens, Proesmans, Duncker, Linz, Heidbuchel, Manninger, Vandervoort, Haemers and Pison.)