Key result
AF burden correlates with stroke, heart failure, and mortality, highlighting its role as a therapeutic target.
Why the study?
Traditional categorical patterns and binary recurrence endpoints do not fully reflect AF frequency, duration, temporal distribution, or progression, whereas AF burden provides a more granular measure.
AF burden provides a more granular measure of disease activity than binary recurrence endpoints and is increasingly recognized as a continuous risk factor for stroke, heart failure, and cognitive decline, with implications for rhythm control and anticoagulation.
May refine AF risk stratification in monitored patients; extends binary recurrence data but leaves therapeutic thresholds open.
Atrial fibrillation (AF) is traditionally classified using categorical clinical patterns and binary recurrence endpoints. However, these measures do not fully reflect arrhythmia frequency, duration, temporal distribution, or progression. AF burden, defined as the proportion of monitored time spent in AF, provides a more granular measure of disease activity and therapeutic response. Recent advances in cardiac implantable electronic devices, insertable cardiac monitors, wearable technologies, and digital platforms have significantly improved burden assessment, although considerable heterogeneity remains in monitoring methods, definitions, and clinically relevant thresholds. This review examines contemporary approaches to AF burden measurement and its associations with thromboembolic risk, heart failure, hospitalization, symptoms, quality of life, disease progression, and mortality. We particularly discuss the reduction of AF burden as a potential therapeutic target following antiarrhythmic drug therapy and catheter ablation, and the limitations of conventional recurrence definitions based on episodes lasting more than 30 s. This review also focuses on the implications for rhythm-control selection, post-ablation monitoring, anticoagulation, and clinical-trial design, while proposing priorities for standardized burden-based assessment.
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Grigoriou et al. (2026) conducted a review in Atrial Fibrillation. Atrial fibrillation burden was evaluated. Atrial fibrillation burden provides a granular measure of disease activity that correlates with thromboembolic risk, heart failure, and mortality, and represents a potential therapeutic target.
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