Key result
Post-AF ablation symptoms affect ~51% of patients and define five subphenotypes predicting recurrence risk.
Why the study?
Persistent symptoms following AF ablation are common independently of AF recurrence, but clinically relevant symptom-based subphenotypes had not been identified.
Cohort (n=614)
Yes
p-value: p=<0.001
Cluster analysis of smartphone-derived symptom and rhythm data identifies distinct AF subphenotypes after ablation, highlighting the complex relationship between persistent symptoms and actual AF recurrence.
Post-ablation symptoms may not reflect recurrence and warrant rhythm confirmation; leaves open whether these clusters can personalize follow-up.
BACKGROUND: Atrial fibrillation (AF) is characterized by a heterogeneous presentation of symptoms. AF ablation reduces symptom burden. However, persistent symptoms following AF ablation are common independently of AF recurrence. OBJECTIVES: This study sought to perform a cluster analysis to identify clinically relevant AF subphenotypes based on persistent symptoms following AF ablation and evaluate their associations with clinical characteristics and AF recurrence. METHODS: Patients were instructed to perform smartphone app-based simultaneous symptom and photoplethysmography heart rhythm monitoring 3 times daily for 1 week at the 3-month follow-up after AF ablation. A two-step cluster analysis including 7 categorical symptoms variables was performed in symptomatic patients. RESULTS: -VA score (P < 0.001), and left atrial volume index (P = 0.01) differed between clusters. CONCLUSIONS: Half of all patients report symptoms after AF ablation. Using cluster analysis, 5 symptom-based AF subphenotypes were identified, each with distinct clinical characteristics, biomarker profiles, AF recurrence, AF pattern, AF and symptom burden, and symptom-rhythm correlation. Symptom clusters empowered by digital health may facilitate individualized AF management strategies following AF ablation.
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Sandgren et al. (2026) conducted a cohort in Atrial Fibrillation (n=614). Smartphone application-derived symptom clusters vs. Asymptomatic patients or between different symptom clusters was evaluated on Differences in AF recurrence, AF load, and symptom-rhythm correlation between symptom clusters (p=<0.001). Half of all patients (51%) reported symptoms after AF ablation, which clustered into 5 distinct subphenotypes that differed significantly in AF recurrence (P < 0.001), AF load (P < 0.001), and symptom-rhythm correlation (P < 0.001).
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