I-STOP Atrial Fibrillation - I-STOP-AFib

Contribution To Literature:

The I-STOP-Afib trial showed that individual trigger testing did not result in improved AF-related quality of life, although these patients did report less AF episodes in the next 4 weeks.

Description:

The goal of the trial was to assess the efficacy of trigger-based testing for atrial fibrillation (AF) versus routine tracking alone among patients with AF.

Study Design

Patients were enrolled via a mobile application. They were randomized in a 1:1 fashion to either trigger testing (n = 251) or tracking alone (n = 248). The top three triggers selected for testing were caffeine, alcohol, and reduced sleep.

  • Total number of enrollees: 499
  • Duration of follow-up: 10 weeks
  • Mean patient age: 58 years
  • Percentage female: 42%

Inclusion criteria:

  • Adult symptomatic AF patients
  • Owned a smartphone (either Android or iOS)
  • Interested in testing a presumed AF trigger they could readily introduce or withhold

Exclusion criteria:

  • Those who planned to change their AF management (e.g., with catheter ablation or medication changes) in the subsequent 6 months
  • Did not speak English
  • A history of an atrioventricular (AV) junction ablation

Other salient features/characteristics:

  • White race: 93%
  • Taking Vaughn-Williams class I or III drug at baseline: 25%
  • Baseline Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) for trigger-testing vs. monitoring only: 76.1 vs. 72.4

Principal Findings:

The primary outcome, change in AFEQT at week 10 compared with baseline, for trigger testing vs. monitoring only, was 1.7% vs. 0.5% (p = 0.17).

Secondary outcomes:

Those randomized to N-of-1 testing self-reported 40% fewer AF events in the 4 weeks following receiving the results of their N-of-1 study compared to monitoring-only participants during the same time frame (adjusted relative risk 0.60, 95% confidence interval 0.43-0.83, p < 0.0001). This was driven by those testing alcohol, dehydration, and exercise.

Interpretation:

The results of this trial indicate that individual trigger testing did not result in improved AF-related quality of life, although these patients did report less AF episodes in the next 4 weeks. Alcohol exhibited consistent evidence of a near-term effect on self-reported AF episodes.

References:

Presented by Dr. Gregory M. Marcus at the American Heart Association Virtual Annual Scientific Sessions (AHA 2021), November 14, 2021.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Exercise, Sleep Apnea

Keywords: AHA Annual Scientific Sessions, AHA21, Alcohol Drinking, Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Atrial Fibrillation, Caffeine, Dehydration, Exercise, Mobile Applications, Quality of Life, Secondary Prevention, Sleep Deprivation, Smartphone


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