Episodes of Atrial Fibrillation and Symptoms: A Temporal Analysis

BACKGROUND: Data on the relationship between symptoms and atrial fibrillation (AF) episodes are limited. OBJECTIVE: The objective of this study was to determine the strength of temporal association between AF episodes and symptoms. METHODS: This cross-sectional ambulatory assessment study was performed in a tertiary care center between June 2018 and December 2021. Patients with paroxysmal AF (1 episode of AF, burden not exceeding 95%) who used a mobile application and continuous wearable electrocardiogram monitor for 21 days were enrolled. The primary outcome was worse symptoms (symptoms above the mean score) over the study period. The association between worse symptoms and the presence of AF was evaluated for different time epochs. Multilevel mixed-effects models were used to quantify associations after accounting for confounders. RESULTS: Worse symptoms were more likely to be associated with the presence of AF episodes 15 minutes prior to the reporting of palpitations (OR, 2.8 [95% CI, 1.6–5.0]; P < .001), shortness of breath (OR, 2.2 [95% CI, 1.3–3.7]; P = .003), dizziness/lightheadedness (OR, 2.0 [95% CI, 1.0–3.7]; P = .04), and fatigue (OR, 1.7 [95% CI, 1.0–2.9]; P = .03). The correlation between the severity of symptoms and AF lessened as the time interval from AF events to symptoms increased. CONCLUSION: There is a significant relationship between onset of AF episodes and reporting of symptoms. This association diminishes over time and varies across different symptoms. If confirmed in larger studies, these findings may inform AF interventions that target symptoms just in time prior to a clinical visit.