Telemedicine for diagnosing and managing paroxysmal atrial fibrillation in outpatients. the phone in the pocket

Background: Individuals who experience paroxysmal atrial fibrillation (PAF) are at risk of serious sequelae, including stroke. PAF episodes usually occur in out-of-hospital settings, and patients seek emergency services for differential diagnosis and treatment. Methods: Medical records of all subscribers to a telemedical system ('SHL'-Telemedicine) who had one or more episodes of recurrent PAF managed by the call center between 2/2002 and 8/2009 were retrieved. Treatment protocol consisted of initial electrocardiographic confirmation of PAF and repeat electrocardiograms within 24 h. Management was exclusively by telephonically transmitted recommendations (Group A) or also included intervention by the attending physician of a 'SHL'-Telemedicine mobile intensive care unit (Group B). Results: A total of 649 cardiac patients (1886 PAF episodes) were enrolled. The leading complaint was palpitation (57%). The 576 Group A patients had 1667 objectively documented PAF episodes, of which 1326 (79.5%) were converted into sinus rhythm by following telephonically delivered instructions. Their mean heart rate decreased from 85 ± 15 to 66 ± 10 beats per minute (bpm) (P < 0.001). Heart rate remained unchanged (86 ± 15 bpm) for those who remained in PAF. The 160 Group B patients (218 PAF episodes) had a conversion rate of 70% (153/218). The heart rate in converted cases decreased from 92 ± 24 bpm to 68 ± 21 bpm compared to a decrease from 90 ± 21 bpm to 87 ± 21 bpm in non-converted cases (P < 0.001). Conclusions: Telemedicine for rapid out-of-hospital diagnosis and provision of objective documentation and instructions for appropriate management of PAF is feasible and could avoid potential PAF-associated complications and unnecessary emergency room visits and hospitalizations.