{"id":"e056ce12034a","type":"article","url":"https://hartvaat.nl/2022/02/01/geindividualiseerde-triggerstudies-bij-paroxysmaal-af-jama-i-stop-afib/","title":"Geïndividualiseerde triggerstudies bij paroxysmaal AF: JAMA I-STOP-AFib","title_en":"Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation: The I-STOP-AFib Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.5010","source_url":"https://doi.org/10.1001/jamacardio.2021.5010","authors":["Gregory M Marcus","Madelaine Faulkner Modrow","Christopher H Schmid","Kathi Sigona","Gregory Nah","Jiabei Yang","Tzu-Chun Chu","Sean Joyce","Shiffen Gettabecha","Kelsey Ogomori","Vivian Yang","Xochitl Butcher","Mellanie True Hills","Debbe McCall","Kathleen Sciarappa","Ida Sim","Mark J Pletcher","Jeffrey E Olgin"],"significance":7,"published":"2022-02-01","source_date":"2022-02-01","image":"","kennis":[],"congress":"","summary_en":"The I-STOP-AFib trial investigated whether individualized identification and avoidance of patient-reported AF triggers (alcohol, caffeine, exercise, sleep deprivation) reduces AF episode frequency, exploring a personalized behavioral approach to rhythm management.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA I-STOP-AFib gerandomiseerde trial naar geïndividualiseerde identificatie en vermijding van AF-triggers.","abstract_original":"IMPORTANCE: Atrial fibrillation (AF) is the most common arrhythmia. Although patients have reported that various exposures determine when and if an AF event will occur, a prospective evaluation of patient-selected triggers has not been conducted, and the utility of characterizing presumed AF-related triggers for individual patients remains unknown. OBJECTIVE: To test the hypothesis that n-of-1 trials of self-selected AF triggers would enhance AF-related quality of life. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial lasting a minimum of 10 weeks tested a smartphone mobile application used by symptomatic patients with paroxysmal AF who owned a smartphone and were interested in testing a presumed AF trigger. Participants were screened between December 22, 2018, and March 29, 2020. INTERVENTIONS: n-of-1 Participants received instructions to expose or avoid self-selected triggers in random 1-week blocks for 6 weeks, and the probability their trigger influenced AF risk was then communicated. Controls monitored their AF over the same time period. MAIN OUTCOMES AND MEASURES: AF was assessed daily by self-report and using a smartphone-based electrocardiogram recording device. The primary outcome comparing n-of-1 and control groups was the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) score at 10 weeks. All participants could subsequently opt for additional trigger testing. RESULTS: Of 446 participants who initiated (mean [SD] age, 58 [14] years; 289 men [58%]; 461 White [92%]), 320 (72%) completed all study activities. Self-selected triggers included caffeine (n = 53), alcohol (n = 43), reduced sleep (n = 31), exercise (n = 30), lying on left side (n = 17), dehydration (n = 10), large meals (n = 7), cold food or drink (n = 5), specific diets (n = 6), and other customized triggers (n = 4). No significant differences in AFEQT scores were observed between the n-of-1 vs AF monitoring-only groups. In the 4-week postintervention follow-up period, significantly fewer daily AF episodes were reported after trigger testing compared with controls over the same time period (adjusted relative risk, 0.60; 95% CI, 0.43- 0.83; P < .001). In a meta-analysis of the individualized trials, only exposure to alcohol was associated with significantly heightened risks of AF events. CONCLUSIONS AND RELEVANCE: n-of-1 Testing of AF triggers did not improve AF-associated quality of life but was associated with a reduction in AF events. Acute exposure to alcohol increased AF risk, with no evidence that other exposures, including caffeine, more commonly triggered AF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03323099."}