Patient-operated ECGs reveal AF burden predicts long-term outcomes during early rhythm control

An analysis of patient-operated ECGs from the EAST—AFNET 4 trial revealed: A low AF burden below 6% in the first year of early rhythm control therapy was associated with low cardiovascular event rates during the subsequent 4 years of follow-up. Patients with a higher AF burden on early rhythm control suffered more AF-related events. The findings were presented by AFNET board member Prof. Ulrich Schotten, Maastricht University, in a hotline session at the annual congress of the European Society of Cardiology (ESC) in Madrid.

Atrial fibrillation (AF) is a common arrhythmia leading to severe complications including stroke, heart failure and cardiovascular death. Currently AF is diagnosed by ECG, creating a lifelong, binary diagnosis based on presence of a single ECG showing AF. Recent data illustrated the shortcomings of this binary diagnosis and suggest that AF burden as a quantitative parameter, defined as the time spent in AF per monitored time, better reflects disease severity and modulates the risk of stroke and other cardiovascular events.

Prof. Schotten explained, “Intermittent monitoring using patient-operated ECGs or wearables enables estimates of AF burden that could refine the diagnosis and enable individualized therapy. If AF burden estimated by patient-operated ECGs were related to cardiovascular outcomes, this would invite their use for remote, digital patient management. To investigate this question, we analyzed ECG data from the EAST—AFNET 4 trial.”

The EAST—AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention) trial demonstrated that early rhythm control—with antiarrhythmic drugs or atrial fibrillation ablation—delivered within one year after AF diagnosis improves outcomes compared to usual care (UC) over a 5-year follow-up time. A series of sub-analyses of the EAST—AFNET 4 data set verified the results for different sub-groups (6–17).

In the present analysis, AF burden was estimated using artificial-intelligence-based rhythm classification of patient-operated telemetric ECGs in patients randomized to early rhythm control in the EAST—AFNET 4 trial.

1,178 patients (70 years, 47% women, CHA2DS2-VA 2·8±1·2) transmitted 303,308 ECGs over 5.1 years. The median AF burden was 6% in the first year of follow-up. AF burden below the median was associated with low rates of cardiovascular death, stroke, or unplanned hospitalization for heart failure or acute coronary syndrome. An AF burden above the median was associated with higher event rates, comparable to events with usual care.

Prof. Schotten concluded, “Our findings suggest that AF burden, estimated from patient-operated ECGs, is linked to AF-related events on rhythm control therapy. They call for further exploration of the role of AF burden and AF burden reduction for personalized rhythm-control therapy in patients with AF.”

Provided by
Kompetenznetz Vorhofflimmern e.V. (AFNET)

An analysis of patient-operated ECGs from the EAST—AFNET 4 trial revealed: A low AF burden below 6% in the first year of early rhythm control therapy was associated with low cardiovascular event rates during the subsequent 4 years of follow-up. Patients with a higher AF burden on early rhythm control suffered more AF-related events. The findings were presented by AFNET board member Prof. Ulrich Schotten, Maastricht University, in a hotline session at the annual congress of the European Society of Cardiology (ESC) in Madrid.

Atrial fibrillation (AF) is a common arrhythmia leading to severe complications including stroke, heart failure and cardiovascular death. Currently AF is diagnosed by ECG, creating a lifelong, binary diagnosis based on presence of a single ECG showing AF. Recent data illustrated the shortcomings of this binary diagnosis and suggest that AF burden as a quantitative parameter, defined as the time spent in AF per monitored time, better reflects disease severity and modulates the risk of stroke and other cardiovascular events.

Prof. Schotten explained, “Intermittent monitoring using patient-operated ECGs or wearables enables estimates of AF burden that could refine the diagnosis and enable individualized therapy. If AF burden estimated by patient-operated ECGs were related to cardiovascular outcomes, this would invite their use for remote, digital patient management. To investigate this question, we analyzed ECG data from the EAST—AFNET 4 trial.”

The EAST—AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention) trial demonstrated that early rhythm control—with antiarrhythmic drugs or atrial fibrillation ablation—delivered within one year after AF diagnosis improves outcomes compared to usual care (UC) over a 5-year follow-up time. A series of sub-analyses of the EAST—AFNET 4 data set verified the results for different sub-groups (6–17).

In the present analysis, AF burden was estimated using artificial-intelligence-based rhythm classification of patient-operated telemetric ECGs in patients randomized to early rhythm control in the EAST—AFNET 4 trial.

1,178 patients (70 years, 47% women, CHA2DS2-VA 2·8±1·2) transmitted 303,308 ECGs over 5.1 years. The median AF burden was 6% in the first year of follow-up. AF burden below the median was associated with low rates of cardiovascular death, stroke, or unplanned hospitalization for heart failure or acute coronary syndrome. An AF burden above the median was associated with higher event rates, comparable to events with usual care.

Prof. Schotten concluded, “Our findings suggest that AF burden, estimated from patient-operated ECGs, is linked to AF-related events on rhythm control therapy. They call for further exploration of the role of AF burden and AF burden reduction for personalized rhythm-control therapy in patients with AF.”

Provided by
Kompetenznetz Vorhofflimmern e.V. (AFNET)