{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:23:52Z","timestamp":1787304232247,"version":"build-2736575974"},"reference-count":191,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/life16081378","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:14:01Z","timestamp":1787300041000},"page":"1378","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Atrial Fibrillation Burden: Assessment, Clinical Significance, and Therapeutic Implications"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6739-1024","authenticated-orcid":false,"given":"Konstantinos","family":"Grigoriou","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Medical School, University of Athens, 75 Mikras Asias Avenue, 11527 Goudi, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Lamprou","sequence":"additional","affiliation":[{"name":"Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0995-7015","authenticated-orcid":false,"given":"Nikolaos","family":"Ktenopoulos","sequence":"additional","affiliation":[{"name":"First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9260-6306","authenticated-orcid":false,"given":"Panagiotis","family":"Theofilis","sequence":"additional","affiliation":[{"name":"First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5768-9125","authenticated-orcid":false,"given":"Panagiotis","family":"Iliakis","sequence":"additional","affiliation":[{"name":"First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"},{"name":"Department of Medicine, Division of Cardiology, Angiology and Internal Emergency Medicine, Ruhr University Bochum, Knappschaft Kliniken University Hospital Bochum, 44892 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0736-4942","authenticated-orcid":false,"given":"Panayotis K.","family":"Vlachakis","sequence":"additional","affiliation":[{"name":"First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2616-7952","authenticated-orcid":false,"given":"Anastasios","family":"Apostolos","sequence":"additional","affiliation":[{"name":"First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"},{"name":"Department of Cardiology, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, Harefield Hospital, London UB9 6JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6604-5581","authenticated-orcid":false,"given":"Antonios P.","family":"Antoniadis","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Medical School, University of Athens, 75 Mikras Asias Avenue, 11527 Goudi, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7158-4950","authenticated-orcid":false,"given":"Nikolaos","family":"Fragakis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-5713","authenticated-orcid":false,"given":"Paschalis","family":"Karakasis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1161\/CIRCRESAHA.120.316340","article-title":"Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights","volume":"127","author":"Kornej","year":"2020","journal-title":"Circ. 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