Beyond burden metrics: Wearable photoplethysmography-derived spatiotemporal progression of atrial fibrillation linked to clinical outcomes.

Background: Traditional atrial fibrillation (AF) classification lacks dynamic quantification. Current AF burden assessment is constrained by intermittent monitoring and simplistic metrics. Objective: This study aimed to establish a continuous, multidimensional AF progression model using wearable photoplethysmography (PPG) for real-world, dynamic burden quantification. Methods: In this prospective cohort, 110 patients with paroxysmal AF underwent synchronized PPG (Huawei Watch GT3) and 24-hour Holter monitoring. We developed a multiscale fusion AF algorithm and a 5-dimensional spatiotemporal progression model quantifying episode frequency, duration, clustering, circadian rhythm, and tachycardia burden. Results: The fusion algorithm achieved an accuracy of 0.97. The 5-dimensional model showed strong concordance with Holter monitoring, with near-perfect correlation for episode duration (r = 0.97) and high interchangeability (intraclass correlation coefficient >0.75). It demonstrated excellent diagnostic performance for burden trajectories (area under the curve 0.98). A composite AF burden score of ≥0.59 identified patients at high risk of AF-related symptoms or heart rate issues. Clinically, AF burden increased with worsening European Heart Rhythm Association symptoms ( Conclusion: Continuous PPG-based spatiotemporal modeling robustly quantified dynamic AF progression, enabled precise phenotyping, and may support early intervention in high-risk patients.