Clinical Classifications of Atrial Fibrillation Poorly Reflect its Temporal Persistence: Insights From 1195 Patients Continuously Monitored with Implantable Devices.
J Am Coll Cardiol. 2014 Apr 28;
Authors: Charitos EI, Pürerfellner H, Glotzer TV, Ziegler PD
OBJECTIVE: We aimed to identify how accurately the current clinical atrial fibrillation (AF) classifications reflect its temporal persistence.
BACKGROUND: 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 1195 patients (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 classifications.
RESULTS: 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[0.05-0.18]). Patient characteristics influenced the clinical decision to classify AF as paroxysmal or persistent. Higher ejection fraction (Odds Ratio (OR):0.97 [0.95-0.98];p<0.0001) and presence of coronary artery disease (OR:0.53[0.32-0.88];p=0.01) were independently associated with a lower probability of being classified as persistent AF for the same AF burden level.
CONCLUSIONS: 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 regards to AF temporal persistence. Further study is required to determine if patient selection based on objective criteria derived from rigorous AF monitoring can improve reported outcomes and better identify responders and non-responders to treatments.
CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00277524, NCT00279981.
PMID: 24814497 [PubMed - as supplied by publisher]