Home > Electrophysiology, Journal Club > Journal Club 16 July 2014

Journal Club 16 July 2014


Clinical Classifications of Atrial Fibrillation Poorly Reflect Its Temporal Persistence Insights From 1,195 Patients Continuously Monitored With Implantable Devices





This study aimed to identify how accurately the current clinical atrial fibrillation (AF) classifications reflect its
temporal persistence.


Clinical classification of AF is employed to communicate its persistence, to select appropriate therapies, and as
inclusion criterion for clinical trials.
Methods Cardiac rhythm histories of 1,195 patients (age 73.0  10.1 years, follow-up: 349  40 days) with implantable
devices were reconstructed and analyzed. Patients were classified as having paroxysmal or persistent AF by
physicians at baseline in accordance with current guidelines. AF burden, measured as the proportion of time spent in
AF, was obtained from the device. Additionally we evaluated the agreement between clinical and device-derived AF


Patients within the same clinical class were highly heterogeneous with regards to AF temporal persistence.
Agreement between the clinical AF classification and the objective device-derived assessments of AF temporal
persistence was poor (Cohen’s kappa: 0.12 [95% CI: 0.05 to 0.18]). Patient characteristics influenced the clinical
decision to classify AF as paroxysmal or persistent. Higher ejection fraction (odds ratio: 0.97/per unit [95% CI: 0.95
to 0.98/per unit]; p < 0.0001) and presence of coronary artery disease (odds ratio: 0.53 [95% CI: 0.32 to 0.88];
p ¼ 0.01) were independently associated with a lower probability of being classified as persistent AF for the same
AF burden level.


The currently used clinical AF classifications poorly reflect AF temporal persistence. Patient characteristics
significantly influence the physician’s classification of AF. Patients classified in identical clinical categories may
be inherently heterogeneous with regard to AF temporal persistence. Further study is required to determine if
patient selection on the basis of objective criteria derived from rigorous AF monitoring can improve reported
outcomes and better identify responders and non-responders to treatments.

Related Material

Classifying AF

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