What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=11639). Intervention: PocketECG device monitoring. Primary outcome: 14-day AF burden as a function of monitoring duration without AF episodes.

What question did this study set out to answer?

The aim is to model atrial fibrillation burden based on the duration of monitoring without AF episodes.

April 10, 2026Open Access

Estimation of atrial fibrillation burden as a function of monitoring time without atrial fibrillation

Key Result

Three days of monitoring without AF episodes ≥30 seconds excludes a 14-day AF burden ≥0.1% in 97% of patients (probability 3.1%, 95% CI 2.7-3.4%).

Key Points

The aim is to model atrial fibrillation burden based on the duration of monitoring without AF episodes.
Included 11,639 US patients aged 62 years without permanent AF, monitored for 14 days.
Used the PocketECG device to assess AF episodes of various durations.
Analyzed AF burden and bootstrapped confidence intervals with 10,000 replications.
AF was detected in 1,186 patients (10.4%) with a median burden of 2.6%.
After 3 days of monitoring without episodes, the 95th percentile of AF burden was 0.00% for 30-second episodes.
Probability of AF burden >0.1% after 3 days without 30-second episodes was just 3.1%.

Study Design

Type

Observational (n=11,639)

Structured PICO

Can monitoring time without AF predict overall 14-day AF burden in patients without permanent/persistent AF?

Population

11,639 US patients without permanent/persistent AF, median age 62 years (IQR 46-73), 40.6% male, monitored for 14 days in 2021 with the PocketECG device.

Intervention

14-day continuous ECG monitoring to model AF burden based on monitoring duration without AF episodes.

Outcome

Overall 14-day AF burden modeled as a function of monitoring duration without AF episodes lasting 30 seconds to <6 minutes, 6 minutes-1 hour and >1 hour.surrogate

Three days of continuous ECG monitoring without AF episodes ≥30 seconds can reliably exclude an overall 14-day AF burden >0.1% in 97% of patients.

Abstract

Background: Atrial fibrillation (AF) burden is associated with adverse outcomes; in some patients very low AF burden may not be actionable.Objective: To model AF burden as a function of monitoring time without AF.Methods: We included 11,639 US patients (median age 62 years (inter-quartile range (IQR) 46-73, 40.6% male) without permanent/persistent AF, monitored for 14 days in 2021 with the PocketECG device (MEDICALgorithmics).The overall 14-day AF burden was modelled as a function of monitoring duration without AF episodes lasting 30 seconds to <6 minutes, 6 minutes-1 hour and 1 hour.Results are presented as 95 th percentiles of AF burden.Confidence intervals (CIs) were bootstrapped with 10,000 replications.Results: AF with a median burden of 2.6% (IQR 0.00-0.13)was detected in 1,186 patients (10.4%), of whom 985 had 1 episode 6 minutes, and 769 had 1 episode 1 hour.AF burden decreased rapidly with increasing monitoring time without AF.After 3 days the 95 th percentile of AF burden was 0.00% (95%CI 0.00-0.00%) in patients without any 30 second episodes, 0.008% (95%CI 0.00-0.02%)without any 6 minute episode and 0.08% (95%CI 0.03-0.18%)without any 1 hour episodes.The probability of an AF burden 0.1% after 3 days without 30 seconds AF was 3.1% (95%CI 2.7-3.4%). J o u r n a l P r e -p r o o fConclusion: Monitoring time without AF can be used to predict 14-day AF burden, and rule out AF burdens above certain thresholds.In this unselected patient sample 3 days of monitoring without AF episodes 30 seconds excludes AF burdens 0.1% in 97% of patients.

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