Arrhythmia Burden (SMURDEN) after AF Ablation is Associated with improvement in Quality of Life (JCEP November 2025)-Article: Atrial Arrhythmia Burden (SMURDEN) after AF Ablation is Associated with improvement in Quality of Life

Article: Atrial Arrhythmia Burden (SMURDEN) after AF Ablation is Associated with improvement in Quality of Life

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This prespecified subanalysis of the DECAAF II trial assessed symptom and quality of life (QoL) changes in 750 patients with persistent atrial fibrillation (PeAF) undergoing catheter ablation (CA) with either pulmonary vein isolation (PVI) alone or combined with MRI-guided fibrosis ablation. Both AF-specific (Atrial Fibrillation Symptom Severity Scale, AFSS) and generic QoL (Short-Form 36, SF-36) instruments showed significant improvement from baseline to 12 months postablation, with most gains occurring within the first three months. However, no significant differences in symptom or QoL improvements were found between the two ablation strategies, supporting prior findings that MRI-guided fibrosis ablation offers no added benefit over PVI alone in PeAF.<br /><br />Atrial arrhythmia recurrence occurred in 44.4% of patients and was associated with less pronounced symptom and QoL improvements compared to those without recurrence. Despite recurrence, some symptom relief was still reported, underscoring the complexity of AF treatment outcomes. Importantly, the study introduced the smartphone-based electrocardiography device for single-lead AF burden assessment (SMURDEN) as a reliable noninvasive tool to measure AF burden dynamically over time.<br /><br />SMURDEN correlated strongly with symptom severity and QoL scores at all time points and emerged as the sole independent predictor of no improvement or worsening of symptoms after ablation, outperforming the traditional binary measure of AF recurrence. This suggests that AF burden, as quantified by SMURDEN, provides a more nuanced and clinically meaningful metric for evaluating patient outcomes post-ablation than arrhythmia recurrence alone.<br /><br />The study highlights that QoL improvement after CA in PeAF is multifactorial, with AF burden being a dominant determinant. The accessible smartphone-based monitoring offers a practical approach for continuous AF burden assessment, potentially guiding personalized management. Limitations include potential subjective bias from questionnaires and the need for further validation of SMURDEN against continuous monitoring devices.<br /><br />In conclusion, CA improves symptoms and QoL in PeAF patients, with AF burden measured via smartphone ECG being the strongest predictor of symptom outcomes. MRI-guided fibrosis ablation did not enhance these benefits beyond PVI alone. These findings advocate for incorporating AF burden monitoring into routine care to better tailor treatment and improve patient-centered outcomes.

Keywords

Persistent atrial fibrillation

Catheter ablation

Pulmonary vein isolation

MRI-guided fibrosis ablation

Quality of life improvement

Atrial fibrillation symptom severity scale

Short-Form 36

AF burden

Smartphone-based ECG monitoring

SMURDEN device