Estimation of atrial fibrillation burden as a function of monitoring time without atrial fibrillation

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=11639). Intervention: PocketECG device monitoring. Primary outcome: 14-day AF burden as a function of monitoring duration without AF episodes.

Linda S. Johnson; William F. McIntyre; Albin Edegran; Jason G. Andrade; Alexander P. Benz; Taya Glotzer; Jeffrey S. Healey; Emma Svennberg

doi:10.1016/j.hrthm.2026.03.1955

April 1, 2026Heart RhythmOpen Access

Estimation of atrial fibrillation burden as a function of monitoring time without atrial fibrillation

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Key result

Three days of monitoring without AF episodes excludes significant fourteen-day AF burden in ~97% of patients.

n=11,639

Why the study?

AF burden is linked to adverse outcomes, but very low AF burden may not be clinically actionable in some patients.

Can monitoring time without AF predict overall 14-day AF burden in patients without permanent/persistent AF?

Key Points

The aim is to model atrial fibrillation burden based on the duration of monitoring without AF episodes.
Included 11,639 US patients aged 62 years without permanent AF, monitored for 14 days.
Used the PocketECG device to assess AF episodes of various durations.
Analyzed AF burden and bootstrapped confidence intervals with 10,000 replications.
AF was detected in 1,186 patients (10.4%) with a median burden of 2.6%.
After 3 days of monitoring without episodes, the 95th percentile of AF burden was 0.00% for 30-second episodes.
Probability of AF burden >0.1% after 3 days without 30-second episodes was just 3.1%.

Study Design

Type

Observational (n=11,639)

Structured PICO

Can monitoring time without AF predict overall 14-day AF burden in patients without permanent/persistent AF?

P

Population

11,639 US patients without permanent/persistent AF, median age 62 years (IQR 46-73), 40.6% male, monitored for 14 days in 2021 with the PocketECG device.

I

Intervention

14-day continuous ECG monitoring to model AF burden based on monitoring duration without AF episodes.

O

Outcome

Overall 14-day AF burden modeled as a function of monitoring duration without AF episodes lasting 30 seconds to <6 minutes, 6 minutes-1 hour and >1 hour.surrogate

Three days of continuous ECG monitoring without AF episodes ≥30 seconds can reliably exclude an overall 14-day AF burden >0.1% in 97% of patients.

Implication

May support limiting monitoring after 3 AF-free days without 30-s episodes; extends evidence linking monitoring time to overall burden prediction.

Discussion

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Cite This Study

Johnson et al. (2026) conducted an observational in Atrial fibrillation (n=11,639). PocketECG device monitoring was evaluated on 14-day AF burden as a function of monitoring duration without AF episodes. Three days of monitoring without AF episodes ≥30 seconds excludes a 14-day AF burden ≥0.1% in 97% of patients (probability 3.1%, 95% CI 2.7-3.4%).

synapsesocial.com/papers/69d895206c1944d70ce061e7 https://doi.org/10.1016/j.hrthm.2026.03.1955