JACC. Clinical electrophysiology · 2026
Smartphone Application-Derived Clusters of Persistent Symptoms in Patients After Atrial Fibrillation Ablation: Data From the ISOLATION Study.
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Sandgren Emma, Betz Konstanze, Gawalko Monika, Hermans Astrid, Habibi Zarina, Verhaert Dominique, Philippens Suzanne, Vorstermans Bianca, Kessesl Mandy, Hendriks Jeroen M, den Uijl Dennis, Chaldoupi Sevasti-Maria, Luermans Justin, Lankveld Theo, Schotten Ulrich, Vernooy Kevin, Rienstra Michiel, Linz Dominik
Аннотация
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: In total, half of all patients (n = 313 of 614 [51%]) reported symptoms. Five symptom clusters were identified: nonspecified symptoms (n = 52 [17%]), AF with sparse symptoms (n = 93 [30%]), palpitations (n = 47 [15%]), fatigue with comorbidities (n = 63 [20%]), and sinus rhythm with severe symptoms (n = 58 [19%]). Frequency (P < 0.001) and pattern (P < 0.001) of symptom reporting as well as AF recurrence (P < 0.001), AF load (P < 0.001), AF pattern (P = 0.002 and P = 0.005), and symptom-rhythm correlation (P < 0.001) differed between clusters. Furthermore, age (P < 0.01), N-terminal pro-B-type natriuretic peptide levels (P < 0.01), CHA2DS2-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.
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: In total, half of all patients (n = 313 of 614 [51%]) reported symptoms. Five symptom clusters were identified: nonspecified symptoms (n = 52 [17%]), AF with sparse symptoms (n = 93 [30%]), palpitations (n = 47 [15%]), fatigue with comorbidities (n = 63 [20%]), and sinus rhythm with severe symptoms (n = 58 [19%]). Frequency (P < 0.001) and pattern (P < 0.001) of symptom reporting as well as AF recurrence (P < 0.001), AF load (P < 0.001), AF pattern (P = 0.002 and P = 0.005), and symptom-rhythm correlation (P < 0.001) differed between clusters. Furthermore, age (P < 0.01), N-terminal pro-B-type natriuretic peptide levels (P < 0.01), CHA2DS2-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.