# Continuous smartwatch monitoring after atrial fibrillation ablation: feasibility of burden estimation and association with quality of life

## TL;DR

Smartwatches can track atrial fibrillation after ablation, and higher detected burden correlates with worse quality of life improvements.

## Contribution

Demonstrates the feasibility of using smartwatches to estimate atrial fibrillation burden post-ablation and links it to quality of life outcomes.

## Key findings

- Smartwatch monitoring collected 3,604 electrocardiograms over 12 months, detecting atrial fibrillation in 55%.
- Higher atrial fibrillation burden was associated with smaller quality of life improvements (AFEQT gains).
- Median atrial fibrillation burden was 1.4%, with 69% of patients showing clinically meaningful AFEQT improvement.

## Abstract

Continuous atrial fibrillation burden assessment is clinically relevant but often limited by the invasiveness of current tools. Wearables offer a non-invasive alternative, but evidence in the post-ablation setting is limited. We assessed the feasibility of smartwatch-based atrial fibrillation burden quantification after catheter ablation and its association with quality of life.

In this prospective, single-centre study, patients undergoing atrial fibrillation ablation entered a 12-month digital follow-up program using a smartwatch (daily electrocardiogram recommended). Atrial fibrillation burden was defined as the percentage of monitored days with atrial fibrillation-detected electrocardiograms. A Bayesian multivariable model examined the association between atrial fibrillation burden and quality-of-life score (AFEQT).

Twenty patients (mean age 52.6 ± 10.3 years; 10% female) were enrolled. Over 12 months, 3,604 electrocardiograms were collected (mean 180 per participant); atrial fibrillation was detected in 55%. Electrocardiograms were submitted on 36% of days. Median atrial fibrillation burden was 1.4% (range: 0%–25%). AFEQT improved significantly over time (+1.71 points/month; 95% Credible Interval: 0.78–2.65), with 69% achieving a clinically meaningful improvement. Unlike atrial fibrillation recurrence, higher atrial fibrillation burden was associated with smaller AFEQT gains (interaction estimate: −0.23; 95% Credible Interval: −0.40 to −0.06). Each 1% increase in atrial fibrillation burden corresponded to an estimated 2.8-point lower AFEQT at 12 months.

Smartwatch-based monitoring of atrial fibrillation burden is feasible after ablation. Higher atrial fibrillation burden was associated with reduced improvement in quality of life, supporting its value as a patient-centred outcome metric.