Three days of monitoring predicts whether atrial fibrillation needs treatment
A study of nearly 12,000 patients shows that doctors can forecast a patient's atrial fibrillation burden within just 72 hours of monitoring—a finding that could reshape how hospitals decide who needs aggressive intervention. The work suggests many patients flagged as having irregular heartbeats actually carry such minimal disease burden that treatment may be unnecessary, cutting costs and avoiding overtreatment.
Originaltitel: Estimation of atrial fibrillation burden as a function of monitoring time without atrial fibrillation
BACKGROUND: Atrial fibrillation (AF) burden is associated with adverse outcomes; in some patients, very low AF burden may not be actionable. OBJECTIVE: This study aimed to model AF burden as a function of monitoring time without AF. METHODS: We included 11,639 US patients (median age 62 years [interquartile range 46‒73], 40.6% male) without permanent/persistent AF, monitored for ≥14 days in 2021 with the PocketECG device (MEDICALgorithmics). The overall 14-day AF burden was modeled as a function of monitoring duration without AF episodes lasting ≥30 seconds to <6 minutes, ≥6 minutes to 1 hour, and ≥1 hour. Results are presented as 95th percentiles of AF burden. Confidence intervals (CIs) were bootstrapped with 10,000 replications. RESULTS: AF with a median burden of 2.6% (interquartile range 0.00‒0.13) was detected in 1186 patients (10.4%), of whom 985 had ≥1 episode ≥6 minutes, and 769 had ≥1 episode ≥1 hour. AF burden decreased rapidly with increasing monitoring time without AF. After 3 days, the 95th percentile of AF burden was 0.00% (95% CI 0.00%‒0.00%) in patients without any ≥30-second episodes, 0.008% (95% CI 0.00%‒0.02%) without any ≥6-minute episodes, and 0.08% (95% CI 0.03%‒0.18%) without any ≥1-hour episodes. The probability of an AF burden ≥0.1% after 3 days without ≥30 seconds AF was 3.1% (95% CI 2.7%‒3.4%). CONCLUSION: Monitoring time without AF can be used to predict 14-day AF burden and rule out AF burdens above certain thresholds. In this unselected patient sample, 3 days of monitoring without AF episodes ≥30 seconds exclude AF burdens ≥0.1% in 97% of patients.