Feasibility of atrial fibrillation burden quantification and its impact on quality-of-life after ablation procedure using continuous monitoring with a smartwatch

Abstract Background Continuous atrial fibrillation (AF) burden assessment is clinically relevant post-ablation but often limited by the invasiveness of current monitoring tools. Wearable technology may enable real-world AF burden tracking, but evidence in post-ablation patients is limited. Objective To assess the feasibility of smartwatch-based AF burden quantification after catheter ablation, including its association with quality-of-life. Methods This prospective, single-centre study enrolled a convenience sample of patients undergoing AF ablation. Participants used a smartwatch daily for 12 months within a digital follow-up program (daily smartwatch electrocardiogram (ECG) recommended). AF burden was defined as the percentage of monitored days with AF-detected ECGs. A Bayesian multilevel model examined the association between AF burden and quality-of-life score (AFEQT). Results Twenty patients (mean age 52.6 ± 10.3 years; 10% female) were enrolled. Over 12 months, 3604 smartwatch ECGs were collected (mean 180 per participant), with AF detected in 55% of patients. Patients submitted an ECG in 36% of days, and the median AF burden was 1.4% (IQR 4.6%), ranging from 0% to 25%. Quality-of-life improved significantly over time: AFEQT score increased 1.64 points per month (95% Credible Interval: 0.77 to 2.51), with 69% of patients achieving a clinically meaningful improvement. In contrast to AF recurrence as a binary variable, higher AF burden was associated with smaller improvements in AFEQT scores in the Bayesian model (interaction estimate: -0.22; 95% Credible Interval: -0.39 to -0.05). Each 1% increase in AF burden corresponded to an estimated 3.8-point reduction in AFEQT at 12 months. Conclusion Smartwatch-based monitoring is a feasible method for estimating AF burden after ablation. Higher AF burden was associated with smaller improvements in Qol, supporting its relevance as a meaningful outcome metric.Remote Monitoring Workflow12-Month Smartwatch AF burden