Abstract 4144315: Impact of Smartphone-based Atrial Fibrillation Burden (SMURDEN) on Quality-of-Life Improvement; Insights from DECAAF II

Background: While numerous studies and clinical trials utilize smartphone based 30-second electrocardiogram (ECG) strips to assess the outcome of AF treatment, the direct association of AF burden with the quality of life (QoL) is yet to be established. Purpose: To discover the influence of smartphone-based AF Burden on QoL and symptom improvement after catheter ablation. Methods: We study the AF burden collected from the DECAAF II trial. The trial consists of persistent AF patients who provided daily single-lead ECG strips after ablation. We defined AF burden as the ratio of days with AF detected to the number of days with submitted ECG strips. A total number of 230,892 single-lead ECG strips were submitted. The AFSS and SF-36 questionnaires were administered pre-ablation, at 3 months, and at 12 months post-ablation. Our analyses include all patients with AF burden and completed questionnaires and those who had arrhythmia recurrence. With the two groups, we assessed the associations amongst AF burden, AFSS symptom severity score improvement, and SF-36 improvement through multiple linear regression analysis, controlling for possible confounders. Results: 507 persistent AF patients with a mean of 62 ±9 met our inclusion criteria. Patients submitted ECG strips on most days each month throughout the follow-up period, suggesting high compliance as shown. AFSS symptom score was 12±8 at baseline and improved by 7±8 points on average. AF burden was 19%±7 in the follow-up period. After controlling for age, sex, comorbidities, baseline AFSS score, and left atrial volume, AF burden was found to be inversely associated with AFSS symptom score improvement (beta=-5.201 p=<0.001). This association was also significant in patients who recurred (Beta=-3.45 p=0.04). Similarly, AF burden was associated with improved functional status through SF-36 after ablation even after controlling for all the aforementioned factors including baseline SF-36(Beta= 20.641, p-value= <0.001). These results highlight the importance of AF burden as a measure of treatment success compared to the binary outcome of recurrence. Conclusion: Smartphone-based AF burden adversely affects symptom severity and functional status improvement after ablation in persistent AF patients even in patients who had a recurrence, highlighting to need to incorporate it in our definition of ablation success.