(P133) PREVALENCE, BURDEN, AND MANIFESTATION OF ATRIAL FIBRILLATION: A LARGE-SCALE ANALYSIS OF CARDIAC PATCH MONITORS

Background: Atrial fibrillation (AF) can be associated with significant morbidity and mortality including heart failure, stroke, and cardiovascular death. Subtypes of AF, including paroxysmal and persistent AF, may have differing manifestations but current epidemiological studies are limited due to the paroxysmal nature of the arrhythmia, and inaccuracies in self-reporting. We sought to report arrhythmia characteristics and symptom manifestations across AF disease subtypes, using a large-scale cardiac patch monitoring dataset.

METHODS AND RESULTS: Patch monitors reports performed during the study period (May 2017-July 2023) were provided in a fully anonymized manner for analysis (iCentia CardioSTAT™, Quebec City, QC). Patients underwent clinical monitoring for varying durations (up to 14 days) and indications. Population demographics and summary statistics were calculated, stratified across 3 subgroups: (1) no AF burden (defined as AF burden=0%); (2) low-burden AF (AF burden≤10%); and (3) high-burden AF (AF burden=100%). AF burden was calculated as the time in AF divided by the total monitoring duration minus noise.

Patch monitor records from 130,042 patients (142,346 recordings) were analyzed. Patients had a mean age of 61.6±18.8 years with 50.5% female (43.7% male, 5.8% unspecified). On average, patients performed 1.09±0.36 patch monitors during the study period, lasting a median of 168 hours (range: 24-336 hours). The AF prevalence was 11.13%, with a mean AF burden of 58.5% and bimodal distribution among those with AF detected (Figure 1). Among those with AF detected, low-burden and high-burden AF had the greatest prevalence and was detected in 5013 patients (31.6%) and 6661 patients (42.0%), respectively.

Among the three subgroups, there were significant differences observed in patient-reported symptoms, including more symptoms potentially attributable to AF (i.e. palpitations, dizziness, shortness of breath) in the low-burden AF subgroup compared other subgroups (Table 1). When comparing AF arrhythmia characteristics, low-burden AF patients had higher mean, maximum and minimum heart rate during AF episodes (p < 0.001 for all).

Conclusion: While this analysis was conducted within a selected population undergoing cardiac monitoring, the measured prevalence of AF highlights the commonality of the condition. The differences between low-burden and high-burden AF patients indicate significant differences in arrhythmia characteristics and symptomatology, with low-burden patients having AF at faster heart rates and reporting more frequent symptoms than high-burden AF patients. These findings provide important insights into the detection and management of AF, with differences in arrhythmia characteristics and symptomatology based on arrhythmia subtype.