Fr., 24.04.2026

AI-driven analysis of atrial fibrillation burden in pacemaker patients reveals no effect of AF burden on stroke

Press release

An analysis of the NOAH – AFNET 6 trial used large language models to extract AF burden from pacemaker data in patients with device-detected atrial fibrillation. This approach enables to evaluate the impact of AF burden on cardiovascular outcome and on the effectiveness and safety of anticoagulation in pacemaker patients. The AF burden in the population was 0.4%, with 20% of patients showing a baseline AF burden of more than 1%. In these patients, there was no effect of AF burden on stroke or other cardiovascular events. Today, the findings were presented by AFNET board member Prof. Ulrich Schotten, Maastricht, as a hotline at the Heart Rhythm congress 2026 in Chicago (1).

Patients with device-detected atrial fibrillation (DDAF) have a lower risk of stroke than patients with ECG-diagnosed atrial fibrillation (AF) and comparable stroke risk factors. AF burden – the amount of time a patient spends in AF – has emerged as an important factor linked to stroke risk and outcomes, yet it remains difficult to capture at scale in clinical research and practice.  

The primary analysis of NOAH – AFNET 6 (Non vitamin K antagonist Oral anticoagulants in patients with Atrial High-rate episodes), an investigator-initiated trial conducted by the AFNET, revealed: In patients with DDAF, anticoagulation slightly reduces the relatively low risk of stroke but also increases the risk of major bleeding. The trial was terminated early due to the expected increase in bleeding events in patients with DDAF while the stroke preventing effect was smaller than expected. The weak effects of anticoagulation were also found in several subgroups. (2-10)

This substudy of NOAH – AFNET 6 shows that AI-driven models using natural language processing can reliably automatically extract AF burden information from routine pacemaker reports supporting more individualized risk assessment and helping clinicians make more informed decisions about therapies such as anticoagulation. This approach was applied to NOAH – AFNET 6 to better understand how AF burden relates to clinical outcomes and response to the anticoagulant edoxaban.

Researchers analysed 11,964 pacemaker reports from 2,534 patients with device-detected AF enrolled in NOAH – AFNET 6. AF burden or mode switch burden was successfully identified in more than 70% of reports, demonstrating broad applicability to real-world data. The large language model-extracted AF burden was identical to manual review in more than 98% in a validation subcohort. In addition, AF burden and mode switch burden showed high concordance, reinforcing the reliability of device-based measures. Across the study population, baseline AF burden remained low, highlighting the importance of more precise measurement to better understand patient risk and treatment response.

The baseline AF burden was then correlated to cardiovascular events during 19 months median follow-up in the NOAH – AFNET 6 trial. Baseline AF burden did not modify thrombo-embolic risk, with low rates of stroke even in the small number of patients with a high AF burden. AF burden did not interact with the effectiveness of anticoagulation therapy in this detailed analysis. As expected, anticoagulation increased the risk of bleeding and death independent of AF burden.

“With atrial fibrillation on the rise worldwide, we must find better ways to leverage the latest technology to better understand not just whether patients have atrial fibrillation, but how much it affects them over time,” says Prof. Schotten, lead author and presenter of the data in Chicago. “This AI-driven large language model approach allows us to unlock meaningful insights from data we already collect and use them to advance research and improve patient care.”

“These results highlight the need to determine the effects of low-burden AF on stroke risk. The signal from this robust analysis is clear: A low AF burden translates into a low stroke risk. We need similar analyses in larger data sets to define which AF burden justifies anticoagulation therapy, and which burden requires rhythm control therapy. Together with international partners, we started to combine relevant data sets earlier this year (www.afburden.org)” states Paulus Kirchhof, the senior author of the analysis.

References

(1) Schotten U et al. Distribution of atrial fibrillation burden, relation to outcomes, and effectiveness and safety of anticoagulation based on device reports: The NOAH-AFNET 6 trial. 2026. HRS congress abstract

(2) Kirchhof P, Toennis T, Goette A, et al. Anticoagulation with Edoxaban in Patients with Atrial High-Rate Episodes. N Engl J Med 2023; 389:1167-1179. DOI:10.1056/NEJMoa2303062.

(3) Toennis T, Bertaglia E, Brandes A, et al. The influence of Atrial High Rate Episodes on Stroke and Cardiovascular Death – An update. Europace. 2023 Jul 4;25(7). DOI:10.1093/europace/euad166.

(4) Becher N, Toennis T, Bertaglia E, et al. Anticoagulation with edoxaban in patients with long Atrial High-Rate Episodes ≥24 hours. Eur Heart J. 2024 Mar 7;45(10):837-849. DOI:10.1093/eurheartj/ehad771

(5) Lip YH, Nikorowitsch J, Sehner S et al. Oral anticoagulation in device-detected atrial fibrillation: effects of age, sex, cardiovascular comorbidities, and kidney function on outcomes in the NOAH-AFNET 6 trial. Eur Heart J. 2024 April 9. DOI:10.1093/eurheartj/ehae225

(6) Diener HC, Becher N, Sehner S, Toennis T et al. Anticoagulation in patients with device-detected atrial fibrillation with and without a prior stroke or transient ischemic attack. The NOAH-AFNET 6 trial. J Am Heart Assoc. 2024 Sep 3;13(17):e036429. DOI:10.1161/JAHA.124.036429

(7) McIntyre WF, Benz AP, Becher N, et al. Direct Oral Anticoagulants for Stroke Prevention in Patients with Device-Detected Atrial Fibrillation: A Study-Level Meta-Analysis of the NOAH-AFNET 6 and ARTESiA Trials. Circulation. 2024 Mar 26;149(13):981-988. DOI:10.1161/CIRCULATIONAHA.123.067512

(8) Schnabel RB, Benezet-Mazuecos J, Becher N, McIntyre WF et al. Anticoagulation in patients with device-detected atrial fibrillation with and without concomitant vascular disease – A combined secondary analysis of the NOAH-AFNET 6 and ARTESiA trials. Eur Heart J. 2024 Dec 7;45(46):4902-4916. DOI:10.1093/eurheartj/ehae596

(9) Becher N, Koellner G, Blomstrom-Lundqvist C, Camm AJ et al. Effects of anticoagulation in patients with device-detected atrial fibrillation and multiple stroke risk factors: A Win Ratio analysis of the NOAH-AFNET 6 trial. Eur Heart J Qual Care Clin Outcomes. 2025 Dec 19;11(8):1351-1358. DOI:10.1093/ehjqcco/qcaf087

(10) Goette A, Lemoine MD, Fierenz A et al. Kidney disease increases the risk of cardiovascular events in patients with device-detected atrial fibrillation: NOAH-AFNET 6. Europace. 2026. DOI:10.1093/europace/euag083

About the Atrial Fibrillation NETwork (AFNET)

The Atrial Fibrillation NETwork is an interdisciplinary research network comprising scientists and physicians from hospitals and practices dedicated to improving the management of atrial fibrillation through coordinated research in Germany, Europe, and worldwide. Its main objective is to conduct high quality investigator-initiated clinical trials and registries on a national and international level as well as translational research projects. The AFNET continues the long-term activities of the network which has been funded by the German Federal Ministry of Research and Education over a decade. Since January 2015, specific projects and infrastructures of the AFNET are funded by the German Centre for Cardiovascular Research (DZHK), and some projects by EU research grants. AFNET has long expertise in the management of atrial fibrillation, but also provides support for work in other fields informing cardiovascular care. The results of 20 years of clinical and translational research improved the lives of patients with cardiovascular diseases and influenced treatment guidelines.

https://www.af-net.eu

Funding of the NOAH trial: AFNET, DZHK, Daiichi Sankyo. This analysis was partially funded by the European Union AF-B-STEP (grant agreement 101252780, www.afburden.org).

NOAH registration: NCT 02618577, ISRCTN 17309850

Press Contact

Angelika Leute, PhD
Phone: +49 202 2623395
a.leute@t-online.de

Mo, 20.04.2026

3rd AFNET DGK Young Investigator Award – Atrial Fibrillation 2026

Once again, four young scientists were honored with the AFNET-sponsored “DGK AFNET Young Investigator Award” for their current research on atrial fibrillation. AFNET Board Member and this year’s DGK Conference President Prof. Dr. Stephan Willems congratulated the award recipients during the award ceremony on April 10, 2026 at the DGK Annual Congress.

DGK-AFNET Young Investigator Award – Atrial Fibrillation

From left to right: Prof. Dr. Stephan Willems, 2nd place winner Felicitas Lemmer, Prof. Dr. Larissa Fabritz, 1st place winner Vivien Weisheit, 2nd place winner Christian Gold, Prof. Dr. Stefan Blankenberg (not in the picture: 2nd place winner Julian Segolsson) (©DGK/Thomas Hauss)

Read more

Mo, 20.04.2026

3rd AFNET Lecture Award 2026

As part of the “23 Years of AFNET” session, Prof. Steinbeck presented the AFNET Lecture titled “EP Studies Revisited.” For his long-standing commitment, he received this year’s DGK-AFNET Lecture Award, which was presented for the third time. Prof. Sinner presented the results of the 10th AFNET-EHRA Consensus Conference.

DGK-AFNET Lecture on Arrhythmias Award

From left to right: Prof. Dr. Renate Schnabel, Prof. Dr. Reza Wakili, award recipient Prof. Dr. Gerhard Steinbeck, Dr. Ines Gröner, Prof. Dr. Paulus Kirchhof (©DGK/Thomas Hauss) (©DGK/Thomas Hauss)

The entire session “23 Years of AFNET: Current AF Therapy – Rhythm Control and Prevention of Thromboembolism” was recorded.

Laudatory by Prof. Ravens and Prof. Steinbeck, followed by his presentation “AFNET Lecture: EP studies revisited”

Prof. Moritz Sinner with his presentation “Outcomes of the 10th AFNET EHRA Consensus Paper”

Prof. Ingo Eitel with his presentation “Interventional stroke prevention in AF”

Fr, 17.04.2026

AFNET at the DGK Annual Conference 2026

Once again AFNET was present at the 2026 DGK Annual Meeting with a wide range of presentations and events.

The annual general meeting provided a comprehensive overview of the office’s current activities and developments. In addition to reports on ongoing projects and strategic priorities, the focus was on the regular election of the steering committee. We warmly welcome the newly elected members for the 2026–2030 term:

• Prof. Constanze Schmidt (Göttingen, DE)
• PD Dr. Verena Tscholl (Berlin, DE)
• Prof. Antonia Zapf (Hamburg, DE)

AFNET study meetings as well as other meetings in which AFNET served as a partner were held. Together with the DZHK, AFNET had a joint booth, providing a central hub for professional exchange and networking on site.

Tu., 14. April 2026

EHRA Congress 2026

At the EHRA 2026 Congress in Paris on 13 April 2026, Prof. Dr. Andreas Götte presented the results of “Kidney disease increases the risk of cardiovascular events in patients with device-detected atrial fibrillation: NOAH-AFNET 6.”

The manuscript is available here:
https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euag083/8652924

For more information, please read the AFNET press release:
https://www.af-net.eu/nierenerkrankungen-erhoehen-das-risiko-fuer-kardiovaskulaere-ereignisse-bei-device-detektiertem-vorhofflimmern/

Thu., April 23th 2026

DGK Heart Days 2026

The DGK Heart Days 2026 will take place from 24th to 26th of September 2026 in Hamburg (Germany) at the Congress Center Hamburg (CCH).

Organized by the German Society of Cardiology (DGK), this event is one of the most important cardiology conferences in the German-speaking region of Europe. It brings together five established formats: Kardiologie Aktuell, Deutsche Rhythmus Tage, AGIK Live, DGK Academy and the Basic Science Meeting.

The focus is on current scientific developments across all areas of cardiovascular medicine. The program features high-caliber lectures, case discussions, and interdisciplinary sessions, offering diverse opportunities for professional exchange and networking.

This congress create a central platform for knowledge transfer between research and clinical practice and promote direct exchange among experts from around the world.

AFNET will keep you updated here on all news related to the congress.

Further information about the event and the program can be found on the official congress website.

Thu., April 23th 2026

ESC Congress 2026

The ESC Congress 2026 will take place from 29th of August to 1st of September 2026 in Munich (Germany) at the International Congress Center Munich (ICM).

As one of the world’s most important congresses in the field of cardiology, the event brings together leading experts to present the latest scientific findings, innovative therapies and current guidelines.

The extensive program includes high-caliber scientific sessions, practical workshops and numerous opportunities for interdisciplinary exchange. The ESC Congress offers a central platform to learn about current developments in cardiac medicine and to promote their translation into clinical practice.

AFNET will keep you updated here on it’s contributions to the congress.

For more information, please visit the official congress website.

Thu., April 23th 2026

SKY AF Summit

Under the patronage of AFNET and DGK, the SKY AF Summit (Frankfurt am Main & online) will take place on May 27, 2026—an international scientific event featuring a diverse program.
The focus will be on the latest advances in the understanding and treatment of atrial fibrillation.

Renowned experts from clinical cardiology, electrophysiology, and cardiac surgery will present current study data, innovative technologies, and translational concepts that are significantly shaping the future of AF therapy.

The entire therapeutic spectrum will be comprehensively presented—from oral anticoagulation and stroke prevention to novel ablation procedures and hybrid strategies, as well as future developments in device-based therapy.

Special emphasis will also be placed on comorbidities such as heart failure, metabolic disorders, and renal dysfunction, particularly with regard to their impact on clinical outcomes.

The goal is to link scientific evidence with clinical experience and to promote the translation of innovative research into clinical practice.

Participation is free of charge both in person and online (registration required).

Further information on the program and registration can be found here.

Mo., 29.04.2024

AFNET Lecture Award – Lecture by Prof. Breithardt – DGK Annual Conference 2024

Prof Breithardt was honoured with the AFNET Lecture Award at the AFNET general meeting during the DGK 2024 annual conference in Mannheim. In this video you can see his lecture at the award ceremony.

Mo., 29.04.2024

AFNET Lecture Award – Lecture by Prof. Breithardt – DGK Annual Conference 2024

Prof Breithardt was honoured with the AFNET Lecture Award at the AFNET general meeting during the DGK 2024 annual conference in Mannheim. In this video you can see his lecture at the award ceremony.