Deep Learning-based Handheld Device-Enabled Symptom-driven Recording: A Pragmatic Approach for the Detection of Post-ablation Atrial Fibrillation Recurrence

Objective: Symptom-driven electrocardiogram (ECG) recording plays a significant role in the detection of post-ablation atrial fibrillation recurrence (AFR). However, making timely medical contact whenever symptoms occur may not be practical. Herein, a deep learning (DL)-based handheld device was deployed to facilitate symptom-driven monitoring. Methods: A cohort of patients with paroxysmal atrial fibrillation (AF) was trained to use a DL-based handheld device to record ECG signals whenever symptoms presented after the ablation. Additionally, 24-hour Holter monitoring and 12-lead ECG were scheduled at 3, 6, 9, and 12 months post-ablation. The detection of AFR by the different modalities was explored. Results: A total of 22 of 67 patients experienced AFR. The handheld device and 24-hour Holter monitor detected 19 and 8 AFR events, respectively, five of which were identified by both modalities. A larger portion of ECG tracings was recorded for patients with than without AFR [362(330) vs. 132(133), P=0.01)], and substantial numbers of AFR events were recorded from 18:00 to 24:00. Compared to Holter, more AFR events were detected by the handheld device in earlier stages (HR=1.6, 95% CI 1.2–2.2, P<0.01). Conclusions: The DL-based handheld device-enabled symptom-driven recording, compared with the conventional monitoring strategy, improved AFR detection and enabled more timely identification of symptomatic episodes.