Different age- and sex- related patterns of atrial fibrillation occurrence in continuous ECG monitoring

Introduction Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia, but its occurrence pattern differs according to the demographic characteristics. Purpose We analyzed the temporal patterns of atrial fibrillation (AF) occurrence and the preceding electrocardiographic changes according to sex and age groups using long-term ECG monitoring data. Method We analysed multiday wearable patch ECG monitor data from a total of 648 patients with paroxysmal AF. The circadian patterns of AF occurrence and sinus rhythm (SR) heart rate change were compared across different sex and age groups. Results During 2,457 person-days of monitoring, 25,292 AF events were detected. The occurrence of AF exhibited a U-shaped circadian pattern, peaking between midnight and 6 a.m. and declining during the daytime. observed that this pattern attenuates with increasing age. This pattern became attenuated with increasing age; however, it remained preserved in females even in those aged ≥75 years. The heart rate trend during SR showed an inverse relationship with the probability of AF occurrence (Figure 1). Changes in SR heart rate was observed 10 to 30 minutes before AF onset, however, the specific patterns varied by sex and age group (Figure 2). Conclusion In this study, multiday ECG monitoring in patients with paroxysmal AF revealed a U-shaped circadian pattern of AF occurrence, which closely mirrored the trend of SR heart rate. Moreover, both the AF occurrence pattern and SR heart rate trend varied by sex and age group. These findings support the rationale for personalized approaches incorporating demographics and temporal data in AF prediction, prevention, and management.Figure 1Figure 2