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Atrial Fibrillation (AF)FAST-AFNCT07486739

Functional And STructural Assesment of the Heart by Artificial Intelligence-enabled Electrocardiogram for the Management of Atrial Fibrillation

A study testing Artificial intelligence-enabled electrocardiography and Transthoracic Echocardiography-Guided Assessment in people with Atrial Fibrillation (AF), run by Seoul National University Hospital at 28 sites in South Korea.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The objective of this study is to evaluate whether an AI-ECG based screening strategy for detecting cardiac functional and structural abnormalities preserves clinical effectiveness and safety, compared with a conventional strategy of routine echocardiography in patients with AF, thereby demonstrating the… Read more about this study

Who is it for?
Ages 19 years and older
Conditions the study is for
Atrial Fibrillation (AF)
What is being tested?
Artificial intelligence-enabled electrocardiography and Transthoracic Echocardiography-Guided Assessment
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,724 participants
Where
28 sitesSouth Korea
Study dates
29 Jul 2026to 31 Dec 2030
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 19 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • AF documented by electrocardiography within the past 12 months
  • AF documented on a 12-lead electrocardiogram or recorded for ≥30 seconds on a single-lead or multi-lead electrocardiogram.
  • Patients for whom an initial or repeat transthoracic echocardiographic evaluation is clinically indicated.
  • A CHA₂DS₂-VA score of ≥2.
  • Aged ≥19 years at the time of enrollment and able to provide written informed consent voluntarily.

Who cannot join

  • Transthoracic echocardiography performed within the past 6 months.
  • Ventricular rate ≥110 beats per minute during atrial fibrillation.
  • Atrial fibrillation due to a reversible cause.
  • New York Heart Association (NYHA) functional class IV or European Heart Rhythm Association (EHRA) class IV symptoms.
  • Known history of structural heart disease or clinical findings suggestive of structural heart disease based on medical history and physical examination. (e.g., presence of a cardiac murmur of Levine scale grade 3 or higher on auscultation, or murmurs suggestive of moderate to severe mitral stenosis, such as an opening snap or diastolic rumbling murmur).
  • Baseline electrocardiographic conduction abnormalities or significant electrocardiographic findings suggestive of clinically meaningful structural heart disease (e.g., Mobitz type II second-degree atrioventricular block, third-degree atrioventricular block, or QTc ≥480 ms).
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  • History of prior cardiac surgery.
  • History of acute coronary syndrome or coronary revascularization within the past 90 days.
  • History of intracardiac thrombosis or systemic thromboembolism within the past 90 days.
  • History of transient ischemic attack, ischemic stroke, or intracranial hemorrhage within the past 90 days.
  • History of ventricular tachycardia or ventricular fibrillation.
  • Severe liver disease associated with coagulopathy (e.g., AST or ALT >3× the upper limit of normal, or total bilirubin >2× the upper limit of normal).
  • Severe chronic kidney disease (stage V), requiring or imminently requiring dialysis.
  • Contraindication to anticoagulation therapy.
  • Pregnancy, breastfeeding, or planning pregnancy during the study period.
  • Life expectancy of less than 1 year.
  • Current participation in another randomized clinical trial.

Trial locations and contacts

28 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Eue-Keun Choi, MD, PhD contact

82-2-2072-0688

choiek417@gmail.com

28 sites in 1 country

South Korea28 sites
  • Korea University Ansan Hospital

    Ansan

    Seung-Yong Shin, theshin04@korea.ac.kr

  • Hallym University Sacred Heart Hospital

    Anyang

    Sang-Jin Han, medhan69@hallym.or.kr

  • Dong-A University Hospital

    Busan

    Jong-Sung Park, thinkmed@naver.com

  • Samsung Changwon Hospital

    Changwon

    Kwak Hye-Bin, tgfbk@naver.com

  • Dankook University Hospital

    Cheonan

    Dong-Min Kim, kdongmin@yahoo.com

  • Daegu Catholic University Medical Center

    Daegu

    Young-Soo Lee, mdleeys@cu.ac.kr

  • Keimyung University Dongsan Hospital

    Daegu

    Hyung-Sup Park, drparkgyver@gmail.com

  • Kyungpook National University Chilgok Hospital

    Daegu

    Park Yoon-Jung, blue8685@gmail.com

  • Chonnam National University Hospital

    Gwangju

    Yoon Nam-Sik, nsaids77@daum.net

  • Gachon University Gil Medical Center

    Incheon

    Ye-Min Park, ypruimin@gilhospital.com

  • Jeonbuk National University Hospital

    Jeonju

    Jung Rae-Young, youngjoin@naver.com

  • Presbyterian Medical Center (Jesus Hospital)

    Jeonju

    Sun-Hwa Kim, epcardiokim@gmail.com

  • CHA Bundang Medical Center

    Seongnam

    Jung-Hoon Sung, atropin5@cha.ac.kr

  • Asan Medical Center

    Seoul

    Cho Min-Soo, d070294@gmail.com

  • Boramae Medical Center

    Seoul

    Woo-Hyun Lim, woosion@gmail.com

  • Eunpyeong St. Mary's Hospital

    Seoul

    Sung-Jin Park, ferryst@naver.com

  • Ewha Womans University Seoul Hospital

    Seoul

    Ye-Ji Kim, lexie6169@gmail.com

  • Gangnam Severance Hospital

    Seoul

    Kim In-Soo, insooya1203@yuhs.ac

  • Hanyang University Hospital

    Seoul

    Jin-Kyu Park, cardiohy@hanyang.ac.kr

  • Kangbuk Samsung Hospital

    Seoul

    Min Kim, minpupets01.kim@samsung.com

  • Korea University Guro Hospital

    Seoul

    Kyung-Yeon Lee, managingheart@gmail.com

  • Kyung Hee University Hospital at Gangdong

    Seoul

    Eun-Sun Jin, esjin@khu.ac.kr

  • Kyung Hee University Medical Center

    Seoul

    Jin-Bae Kim, jinbbai@khu.ac.kr

  • Samsung Medical Center

    Seoul

    Young-Keun Ohn, yk.on@samsung.com

  • Seoul National University Hospital

    Seoul

    Eue-Keun Choi, MD, PhD, choiek417@gmail.com

  • Severance Hospital

    Seoul

    Dae-Hoon Kim, kimdhoon@yuhs.ac

  • Ajou University Hospital

    Suwon

    Do-Young Kim, sneeze_kr@naver.com

  • Pusan National University Yangsan Hospital

    Yangsan

    Hwang Ki-Won, korea.hwang@gmail.com

Other trials in South Korea

About this study

The objective of this study is to evaluate whether an AI-ECG based screening strategy for detecting cardiac functional and structural abnormalities preserves clinical effectiveness and safety, compared with a conventional strategy of routine echocardiography in patients with AF, thereby demonstrating the non-inferiority of AI-ECG guided care.

Read the detailed description

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with its prevalence having more than doubled over the past decade. AF is associated with an increased risk of stroke, heart failure, and mortality, thereby imposing a substantial burden on both patients and healthcare systems. Accordingly, contemporary clinical guidelines emphasize accurate diagnosis and early, integrated management of AF. In this context, transthoracic echocardiography has become a standard diagnostic tool for the assessment of structural heart disease and cardiac function.

Despite being non-invasive and relatively low-cost, echocardiography is subject to several system-level limitations in routine clinical practice, including dependence on specialized equipment and trained personnel, scheduling delays, and inefficiencies related to repeated examinations. These constraints may create bottlenecks in the timely initiation and optimization of AF management.

In real-world practice, a considerable proportion of patients with AF undergo echocardiography primarily to confirm the absence of significant structural heart disease or impaired function. A uniform strategy of performing echocardiography in all patients with AF may not be optimal from the perspectives of patient convenience and healthcare resource utilization. Moreover, depending on healthcare system capacity, access to echocardiography may delay the timely selection of optimal AF management. Conversely, selectively performing echocardiography in patients with a higher likelihood of structural or functional cardiac abnormalities may allow for a more efficient, timely, and targeted diagnostic approach.

Artificial intelligence-enabled electrocardiography (AI-ECG) offers several practical advantages, including very short acquisition time, patients' convenience, substantially lower cost, and feasibility for repeated assessments during follow-up. AI-ECG may enable sensitive detection of changes in a patient's cardiac status over time. Positioning AI-ECG as an initial screening tool to identify patients with suspected structural or functional heart disease could facilitate a "screening-confirmation" diagnostic pathway, in which echocardiography is reserved for patients with abnormal or suspicious findings on AI-ECG. Such an approach has the potential to streamline initial and follow-up evaluations while maintaining patient safety.

Being tested
Artificial intelligence-enabled electrocardiography, Transthoracic Echocardiography-Guided Assessment
Keywords
atrial fibrillation, artificial intelligence, structural heart disease, electrocardiogram
Medical subject headings
Atrial Fibrillation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Artificial intelligence-enabled electrocardiographyDiagnostic test

    An artificial intelligence algorithm applied to standard 12-lead electrocardiography designed to predict cardiac structural or functional abnormalities. This tool guides the decision to perform or withhold downstream echocardiography.

  • Transthoracic Echocardiography-Guided AssessmentDiagnostic test

    Standard Transthoracic Echocardiography used to assess cardiac structure and function, serving as the reference standard for guiding clinical management in this study arm.

Study groups in NCT07486739
Study groupRoleWhat they receive
Transthoracic Echocardiography-Guided Assessment Group (TTE group)Active comparatorParticipants in this group will receive a standard-of-care evaluation. Cardiac function and structure will be evaluated using Transthoracic Echocardiography (TTE) regardless of ECG findings. Management (anticoagulation, rate/rhythm control) is initiated or adjusted based on TTE parameters. TTE is performed at least once annually during follow-up.
Receives: Diagnostic Test: Transthoracic Echocardiography-Guided Assessment
AI-ECG-Guided Assessment Group (AI-ECG group)ExperimentalParticipants in this group will undergo a conditional diagnostic strategy. Cardiac function and structure are initially screened using an AI-enabled ECG. 1. Predicted Normal: TTE is withheld. Management is based on clinical evaluation and AI-ECG results. 2. Predicted Abnormal: Verification TTE is performed. Management is guided by TTE findings. Safety Note: Protocol-defined rescue TTE is permitted at the investigator's discretion for worsening symptoms or prior to procedures (cardioversion, ablation), regardless of AI-ECG results.
Receives: Diagnostic Test: Artificial intelligence-enabled electrocardiography

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Composite of all-cause Mortality, Stroke, CV Hospitalization, and AAD-Related SAEs

    Evaluation of the effectiveness of the strategy based on a composite endpoint comprising the following clinical events:

    1. All-cause mortality;
    2. Stroke or systemic thromboembolism;
    3. Hospitalization due to worsening heart failure or acute coronary syndrome;
    4. Serious adverse events related to antiarrhythmic drug therapy. The endpoint is defined as the time to the first occurrence of any of these components.

    Measured: up to 10 years

Secondary outcomes (15)
  1. All-cause mortality

    Measured: up to 10 years

  2. Stroke or systemic thromboembolism

    Measured: up to 10 years

  3. Heart failure worsening

    Heart failure worsening:

    An outpatient heart failure episode requiring intravenous diuretic therapy or initiation or escalation of oral diuretics, or hospitalization for heart failure (defined as heart failure being the primary reason for admission or requiring treatment in a healthcare facility for ≥12 hours with intravenous diuretics).

    Measured: up to 10 years

  4. Hospitalization due to acute coronary syndrome

    Measured: up to 10 years

  5. Serious adverse events related to antiarrhythmic drug therapy

    Serious adverse events related to antiarrhythmic drug therapy:

    Hypotension, symptomatic drug-induced bradycardia, atrioventricular block, drug-induced atrial flutter or atrial tachycardia, torsade de pointes, ventricular tachycardia, ventricular fibrillation, or syncope.

    Measured: up to 10 years

  6. Proportion of patients receiving rhythm control therapyc after the initial diagnosis of AF

    Rhythm control therapy:

    Use of antiarrhythmic drugs, electrical cardioversion, or catheter ablation for AF.

    Measured: up to 10 years

  7. Time from initial diagnosis of AF to first rhythm control therapy

    Rhythm control therapy:

    Use of antiarrhythmic drugs, electrical cardioversion, or catheter ablation for AF.

    Measured: up to 10 years

  8. Changes in oral anticoagulation from warfarin to a DOAC or vice versa, based on the reassessment of cardiac function and structure

    Measured: up to 10 years

  9. Changes in the class of antiarrhythmic drugs (AADs) prescribed, based on the reassessment of cardiac function and structure

    i.e., modification of Class Ic AAD to Class III AAD. Changes in antiarrhythmic drug therapy due solely to inadequate AF rate or rhythm control are not included.

    Measured: up to 10 years

  10. Changes in heart failure medications resulting from reassessment of cardiac function and structure

    Initiation, dose escalation, or dose reduction of heart failure medication classes including beta-blockers, mineralocorticoid receptor antagonists (MRAs), renin-angiotensin-aldosterone system (RAAS) inhibitors or angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 inhibitors (SGLT2i), or other agents (e.g., ivabradine, vericiguat, hydralazine/nitrate

    Measured: up to 10 years

  11. The proportion of patients maintaining sinus rhythm

    Measured: up to 10 years

  12. Quality of life assessed by European Quality of Life-5 Dimensions (EQ-5D) at baseline, 12 months, and 24 months

    EQ-5D scores range from 0 to 100, with higher scores indicating better health status.

    Measured: up to 10 years

  13. NT-proBNP levels at baseline, 12 months, and 24 months

    Measured: up to 10 years

  14. Diagnostic performance of the AI-ECG algorithm for detecting cardiac functional and structural abnormalities

    Assessment of the AI-ECG algorithm's ability to detect functional and structural cardiac abnormalities. Performance metrics will include Accuracy, Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value.

    Measured: up to 10 years

  15. Investigator satisfaction with the use of AI-ECG

    Measured: up to 10 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Mar 2026
  2. Study start29 Jul 2026 (estimated)
  3. Primary completion31 Dec 2030 (estimated)
  4. Study completion31 Dec 2030 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,724 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07486739
Sponsor's protocol ID
FAST-AF
Acronym
FAST-AF
Status last verified
Jul 2026
First submitted
10 Feb 2026
Last updated
23 Jul 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Artificial intelligence-enabled electrocardiography and Transthoracic Echocardiography-Guided Assessment in people with Atrial Fibrillation (AF), run by Seoul National University Hospital at 28 sites in South Korea.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 23 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 28 sites in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Eue-Keun Choi, MD, PhD (82-2-2072-0688, choiek417@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Composite of all-cause Mortality, Stroke, CV Hospitalization, and AAD-Related SAEs (time frame: up to 10 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Jul 2026.

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