{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T14:00:22Z","timestamp":1768226422796,"version":"3.49.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty patients (mean age 52.6\u2009\u00b1\u200910.3 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%\u201325%). AFEQT improved significantly over time (+1.71 points\/month; 95% Credible Interval: 0.78\u20132.65), with 69% achieving a clinically meaningful improvement. Unlike atrial fibrillation recurrence, higher atrial fibrillation burden was associated with smaller AFEQT gains (interaction estimate: \u22120.23; 95% Credible Interval: \u22120.40 to \u22120.06). Each 1% increase in atrial fibrillation burden corresponded to an estimated 2.8-point lower AFEQT at 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2025.1695891","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:54:27Z","timestamp":1768215267000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Continuous smartwatch monitoring after atrial fibrillation ablation: feasibility of burden estimation and association with quality of life"],"prefix":"10.3389","volume":"12","author":[{"given":"Jo\u00e3o G.","family":"Almeida","sequence":"first","affiliation":[]},{"given":"Duarte","family":"Dias","sequence":"additional","affiliation":[]},{"given":"Rafael","family":"Silva-Teixeira","sequence":"additional","affiliation":[]},{"given":"Mafalda","family":"Carrington","sequence":"additional","affiliation":[]},{"given":"Paulo","family":"Fonseca","sequence":"additional","affiliation":[]},{"given":"Marco","family":"Oliveira","sequence":"additional","affiliation":[]},{"given":"Helena","family":"Gon\u00e7alves","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o","family":"Primo","sequence":"additional","affiliation":[]},{"given":"Ricardo","family":"Fontes-Carvalho","sequence":"additional","affiliation":[]},{"given":"Lu\u00eds","family":"Azevedo","sequence":"additional","affiliation":[]},{"given":"S\u00e9rgio","family":"Barra","sequence":"additional","affiliation":[]},{"given":"Juan Pablo","family":"Mart\u00ednez","sequence":"additional","affiliation":[]},{"given":"Rute","family":"Almeida","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS)","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1016\/j.jval.2023.12.015","article-title":"The cost of atrial fibrillation: a systematic review","volume":"27","author":"Buja","year":"2024","journal-title":"Value Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1056\/NEJMoa2019422","article-title":"Early rhythm-control therapy in patients with atrial fibrillation","volume":"383","author":"Kirchhof","year":"2020","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1056\/NEJMoa2029980","article-title":"Cryoablation or drug therapy for initial treatment of atrial fibrillation","volume":"384","author":"Andrade","year":"2021","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1001\/jama.2024.17921","article-title":"Pulmonary vein isolation vs sham intervention in symptomatic atrial fibrillation: the SHAM-PVI randomized clinical trial","volume":"332","author":"Dulai","year":"2024","journal-title":"JAMA"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1161\/CIRCULATIONAHA.119.042622","article-title":"Cryoballoon or radiofrequency ablation for atrial fibrillation assessed by continuous monitoring: a randomized clinical trial","volume":"140","author":"Andrade","year":"2019","journal-title":"Circulation"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1161\/CIRCEP.114.003057","article-title":"Atrial fibrillation burden and short-term risk of stroke: case-crossover analysis of continuously recorded heart rhythm from cardiac electronic implanted devices","volume":"8","author":"Turakhia","year":"2015","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"euae104","DOI":"10.1093\/europace\/euae104","article-title":"Comprehensive atrial fibrillation burden and symptom reduction post-ablation: insights from DECAAF II","volume":"26","author":"Noujaim","year":"2024","journal-title":"Europace"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1056\/NEJMoa2306037","article-title":"Catheter ablation in end-stage heart failure with atrial fibrillation","volume":"389","author":"Sohns","year":"2023","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2824","DOI":"10.1093\/eurheartj\/ehae373","article-title":"Atrial fibrillation burden: a new outcome predictor and therapeutic target","volume":"45","author":"Becher","year":"2024","journal-title":"Eur Heart J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e623","DOI":"10.1161\/CIR.0000000000000568","article-title":"Atrial fibrillation burden: moving beyond atrial fibrillation as a binary entity: a scientific statement from the American Heart Association","volume":"137","author":"Chen","year":"2018","journal-title":"Circulation"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2474","DOI":"10.1111\/jce.16451","article-title":"Smart watch applications in atrial fibrillation detection: current state and future directions","volume":"35","author":"Vyas","year":"2024","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1093\/europace\/euac038","article-title":"How to use digital devices to detect and manage arrhythmias: an EHRA practical guide","volume":"24","author":"Svennberg","year":"2022","journal-title":"Europace"},{"key":"B14","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/j.hroo.2025.04.004","article-title":"Digital monitoring and electronic patient-reported outcomes collection following atrial fibrillation ablation","volume":"6","author":"Almeida","year":"2025","journal-title":"Heart Rhythm O2"},{"key":"B15","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1161\/CIRCEP.110.958033","article-title":"Development and validation of the atrial fibrillation effect on QualiTy-of-life (AFEQT) questionnaire in patients with atrial fibrillation","volume":"4","author":"Spertus","year":"2011","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e005358","DOI":"10.1161\/CIRCOUTCOMES.118.005358","article-title":"Defining clinically important difference in the atrial fibrillation effect on quality-of-life score","volume":"12","author":"Holmes","year":"2019","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1002\/pon.3522","article-title":"Self-reported cognitive concerns and abilities: two sides of one coin?","volume":"23","author":"Lai","year":"2014","journal-title":"Psychooncology"},{"key":"B18","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/j.jclinepi.2013.10.024","article-title":"The PROMIS physical function item bank was calibrated to a standardized metric and shown to improve measurement efficiency","volume":"67","author":"Rose","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1177\/1073191111411667","article-title":"Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS\u00ae): depression, anxiety, and anger","volume":"18","author":"Pilkonis","year":"2011","journal-title":"Assessment"},{"key":"B20","doi-asserted-by":"publisher","first-page":"euae043","DOI":"10.1093\/europace\/euae043","article-title":"2024 European heart rhythm association\/heart rhythm society\/Asia Pacific heart rhythm society\/Latin American heart rhythm society expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"26","author":"Tzeis","year":"2024","journal-title":"Europace"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e37280","DOI":"10.2196\/37280","article-title":"Atrial fibrillation detection with an analog smartwatch: prospective clinical study and algorithm validation","volume":"6","author":"Campo","year":"2022","journal-title":"JMIR Form Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1093\/europace\/eux013","article-title":"Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis","volume":"20","author":"Njoku","year":"2017","journal-title":"EP Europace"},{"key":"B23","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.hrthm.2014.12.034","article-title":"The impact of risk score (CHADS2 versus CHA2DS2-VASc) on long-term outcomes after atrial fibrillation ablation","volume":"12","author":"Jacobs","year":"2015","journal-title":"Heart Rhythm"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1001\/jama.2019.0692","article-title":"Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial","volume":"321","author":"Mark","year":"2019","journal-title":"JAMA"},{"key":"B25","doi-asserted-by":"publisher","first-page":"f312","DOI":"10.1093\/europace\/euy038","article-title":"Continuous monitoring after atrial fibrillation ablation: the LINQ AF study","volume":"20","author":"Wechselberger","year":"2018","journal-title":"Europace"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1001\/jama.2019.0693","article-title":"Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial","volume":"321","author":"Packer","year":"2019","journal-title":"JAMA"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/j.cjca.2013.06.006","article-title":"Relationship of quality of life with procedural success of atrial fibrillation (AF) ablation and postablation AF burden: substudy of the STAR AF randomized trial","volume":"29","author":"Mantovan","year":"2013","journal-title":"Can J Cardiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1161\/circulationaha.121.056109","article-title":"Influence of monitoring strategy on assessment of ablation success and postablation atrial fibrillation burden assessment: implications for practice and clinical trial design","volume":"145","author":"Aguilar","year":"2022","journal-title":"Circulation"},{"key":"B29","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1093\/ehjdh\/ztad039","article-title":"Determine atrial fibrillation burden with a photoplethysmographic mobile sensor: the atrial fibrillation burden trial: detection and quantification of episodes of atrial fibrillation using a cloud analytics service connected to a wearable with photoplethysmographic sensor","volume":"4","author":"Reissenberger","year":"2023","journal-title":"Eur Heart J Digit Health"},{"key":"B30","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.ijcard.2020.12.077","article-title":"Long-term intermittent versus short continuous heart rhythm monitoring for the detection of atrial fibrillation recurrences after catheter ablation","volume":"329","author":"Hermans","year":"2021","journal-title":"Int J Cardiol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"20552076251314105","DOI":"10.1177\/20552076251314105","article-title":"Continuous atrial fibrillation monitoring using a wearable smartwatch: using long-term holter as reference","volume":"11","author":"Pan","year":"2025","journal-title":"Digit Health"},{"key":"B32","doi-asserted-by":"publisher","first-page":"euaf019","DOI":"10.1093\/europace\/euaf019","article-title":"Atrial fibrillation burden in clinical practice, research, and technology development: a clinical consensus statement of the European Society of Cardiology council on stroke and the European heart rhythm association","volume":"27","author":"Doehner","year":"2025","journal-title":"Europace"},{"key":"B33","doi-asserted-by":"publisher","first-page":"ii29","DOI":"10.1093\/europace\/euab318","article-title":"Reflections on the usefulness of today\u2019s atrial fibrillation ablation procedure endpoints and patient-reported outcomes","volume":"24","author":"Blomstrom-Lundqvist","year":"2022","journal-title":"Europace"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1001\/jama.2019.0335","article-title":"Effect of catheter ablation vs antiarrhythmic medication on quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial","volume":"321","author":"Blomstrom-Lundqvist","year":"2019","journal-title":"JAMA"},{"key":"B35","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1093\/eurheartj\/ehac692","article-title":"Healthcare utilization and quality of life for atrial fibrillation burden: the CIRCA-DOSE study","volume":"44","author":"Andrade","year":"2023","journal-title":"Eur Heart J"},{"key":"B36","doi-asserted-by":"publisher","first-page":"122","DOI":"10.3390\/jcdd12040122","article-title":"Wearable devices for quantifying atrial fibrillation burden: a systematic review and Bayesian meta-analysis","volume":"12","author":"Anagnostopoulos","year":"2025","journal-title":"J Cardiovasc Dev Dis"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e035181","DOI":"10.1161\/JAHA.124.035181","article-title":"Representation of women in atrial fibrillation ablation randomized controlled trials: systematic review","volume":"14","author":"Khaing","year":"2025","journal-title":"J Am Heart Assoc"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1695891\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:54:28Z","timestamp":1768215268000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1695891\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":37,"alternative-id":["10.3389\/fcvm.2025.1695891"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1695891","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1695891"}}