Atrial fibrillation burden: Stepping beyond the categorical characterization.

Traditional classifications categorize atrial fibrillation (AF) into paroxysmal, persistent, or permanent, but recent advancements in monitoring have revealed AF as a continuous variable, challenging existing paradigms. AF burden, defined basically as the amount of time spent in AF during a monitored period, has emerged as a crucial metric. This review assesses the evolving landscape of AF burden and its measurement methods, diagnostic modalities, and impact on outcomes. Guidelines suggest individualized approaches, combining AF burden with clinical scores (CHA ₂ DS ₂ -VASc), but studies have challenged this. Addressing the impact of AF burden on patients' quality of life before or after ablation is also crucial. Although continuous monitoring technologies offer promising avenues, the field faces challenges, such as defining clinically relevant thresholds. Future research should focus on refining these, designing trials centered around AF burden, and evaluating the efficacy of interventions in reducing AF burden, ultimately paving the way for personalized management strategies.
Competing Interests: Disclosures Dr Sorgente is a consultant for Biosense Webster, Medtronic, Biotronik, and MicroPort. Dr Sarkozy is a consultant for Biosense Webster, Medtronic, Biotronik, and MicroPort. Dr Boriani reported small speaker fees from Bayer, Boehringer Ingelheim, Boston Scientific, Daiichi Sankyo, Janssen, and Sanofi. Dr Boveda consults for Medtronic, Boston Scientific, MicroPort, and Zoll. Dr Chierchia received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, and Boston Scientific. Dr Tsiachris received compensation for teaching purposes and proctoring from AF Solutions, Medtronic, Boston Scientific, Biosense Webster, Pfizer, and Winmedica. Dr de Asmundis received research grants on behalf of the center from Biotronik, Medtronic, Abbott, LivaNova, Boston Scientific, and Philips and compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, LivaNova, Boston Scientific, and Daiichi Sankyo. The other authors have no conflicts of interest to disclose.
(Copyright © 2024. Published by Elsevier Inc.)