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

Introduction: 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. Methods: 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). Results: 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. Conclusion: 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.