Arrhythmias & electrophysiology
Day–Night Patterns of Wearable-Derived Electrocardiographic Age and Left Atrial Remodeling in Atrial Fibrillation–Naïve Individuals
Authors' conclusion
Wearable-derived AI-ECG age exhibits a reproducible day-night pattern. A Disrupted phenotype is associated with adverse LA remodeling. Because reproducibility remains insufficient for individual-level classification, prospective outcome-based validation is warranted.
Study context
- Population
- Atrial fibrillation (AF)-naïve participants with ≥48-hour wearable ECG recordingsAF-naïve participants with ≥48-hour recordings, echocardiographic substudy n=122 · cross-sectional echocardiographic substudy 122
- Participants
- 499 participants
- Exposure
- Age- and sex-adjusted associations of binary and continuous ΔAge with left atrial (LA) volume index (LA volume index (LAVI))
- Outcome
- Day-night AI-ECG age trajectories
Methodological detailscontinuous wearable ECGs, unsupervised clustering, cross-sectional echocardiographic substudy
- Continuous wearable ECGs
- Unsupervised clustering
- Cross-sectional echocardiographic substudy
Main finding
As reported in the abstract
Restorative prevalence
47.6%-50.2%
Observational data: associations, not effects.
Further findings
| Outcome | Pooled mean difference (mL/m²) (95% CI) | P value | |
|---|---|---|---|
| LAVIHigher LAVI with Disrupted; age- and sex-adjusted | 5.54 (1.11–9.98) | P = 0.014 | |
| −50510Difference, mL/m² (linear scale) |
| Outcome | Pooled odds ratio (95% CI) | P value | |
|---|---|---|---|
| LA enlargement (LAVI ≥40 mL/m²) | 3.68 (1.45–9.29) | P = 0.006 | |
| 0.10.31310Pooled odds ratio (log scale) |
| Outcome | Estimate | P value |
|---|---|---|
| LAVI per 1-SD higher ΔAgeLAVI was lower | β −2.89 mL/m² | P = 0.007 |
| LA enlargement per 1-SD higher ΔAgeLA enlargement less likely | odds ratio 0.53 | P = 0.004 |
- LAVI: echocardiographic substudy (n=122)
Reproducibility of phenotype · two consecutive 48-hour periods; 6- to 8-day
- 6- to 8-day intraclass correlation coefficients
- 0.51-0.54
- Agreement between two consecutive 48-hour periods was 75.8% (κ = 0.516; 95% CI, 0.395-0.631)
Original publication
Day–Night Patterns of Wearable-Derived Electrocardiographic Age and Left Atrial Remodeling in Atrial Fibrillation–Naïve Individuals. Heart Rhythm. Published 22 October 2026. doi:10.
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