Atrial fibrillation classification: Difference between revisions

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Latest revision as of 18:37, 19 August 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2] Anahita Deylamsalehi, M.D.[3]

Overview

Although several clinical classification plans and protocols have been proposed, none of them fully account for all aspects of atrial fibrillation. Previously the American Heart Association (AHA), American College of Cardiology (ACC), and the European Society of Cardiology (ESC) had proposed a classification system based on simplicity and clinical relevance. More recently, another classification has been proposed by a task force writing group which composed of experts representing seven organizations: the American College of Cardiology (ACC), the American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), the European Cardiac Arrhythmia Society (ECAS), the European Heart Rhythm Association (EHRA), the Society of Thoracic Surgeons (STS), and the Heart Rhythm Society (HRS). Still there are some shared definitions in almost all classification systems. Atrial fibrillation that terminates spontaneously or with intervention within 7 days of onset is considered a paroxysmal atrial fibrillation. On the other hand atrial fibrillation that lasts more than 7 days is named persistent atrial fibrillation. Long standing (or permanent) atrial fibrillation is referred to a atrial fibrillation that lasts for more than a year.

2014 AHA/ACC/HRS Classification

Based on the duration of atrial fibrillation (AF) episodes, AHA/ACC/HRS published a simplified classification scheme given in the table below:^[1]^[2]

Lone AF is a historical term which refers to atrial fibrillation in younger individuals (<60 years of age) without clinical or echocardiographic evidence of cardio pulmonary disease, hypertension, or diabetes mellitus. Because of its variable definitions, the term is potentially confusing and should not be used to guide therapeutic decisions.^[3]

Term	Definition
Paroxysmal AF	Atrial fibrillation that terminates spontaneously or with intervention within 7 d of onset. Episodes may recur with variable frequency.
Persistent AF	Continuous AF that is sustained >7 d.
Longstanding Persistent AF	Continuous AF of >12 mo duration.
Permanent AF	Permanent AF is used when there has been a joint decision by the patient and clinician to cease further attempts to restore and/or maintain sinus rhythm. Acceptance of AF represents a therapeutic attitude on the part of the patient and clinician rather than an inherent pathophysiological attribute of the AF. Acceptance of AF may change as symptoms, the efficacy of therapeutic interventions, and patient and clinician preferences evolve.
Nonvalvular AF	AF in the absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair.

AHA/ACC/ESC Classification

The classification that was proposed by the joint task force of AHA, ACC and ESC in 2006 is as follows:^[1]

AF Category	Defining Characteristics
First detected	Only one diagnosed episode.
Paroxysmal	Recurrent episodes that self-terminate in less than 7 days (most episodes are brief and last < 24 hours).
Persistent	Recurrent episodes that last more than 7 days and may require pharmacologic or electrical intervention.
Permanent	An ongoing long-term episode that lasts for more than a year despite attempts at cardioversion.

First Detected Atrial Fibrillation

Any patient with newly diagnosed AF is in this category, as the exact onset and chronicity of the disease is often uncertain. The patient may have been symptomatic or asymptomatic.

Recurrent Atrial Fibrillation

Two or more identified episodes of atrial fibrillation are named as recurrent form of atrial fibrillation. This is further classified into paroxysmal and persistent based on when the episode terminates without therapy.

Paroxysmal Atrial Fibrillation

Atrial fibrillation is said to be paroxysmal when it terminates spontaneously within 7 days, most commonly within 24 hours.^[4]^[5]
This type includes 20-30% of cases that have been diagnosed with atrial fibrillation.^[6]

Persistent Atrial Fibrillation

Persistent atrial fibrillation is defined as episodes of atrial fibrillation of more than 7 days duration.^[1]^[7]^[8]^[5]
Both the terms persistent and chronic are used if diagnosis of atrial fibrillation established for more than seven days.
Differentiation of the paroxysmal type from chronic or established AF is based on the history of recurrent episodes and the duration of the current AF episode.^[1]^[9]^[10]
Persistent type includes 20-30% of cases that have been diagnosed with atrial fibrillation.^[6]

Permanent Atrial Fibrillation

Permanent atrial fibrillation is defined as atrial fibrillation that persists for more than a year. Cardioversion has either failed in these patients or has not yet been attempted.^[6]^[5]
This type is the most common diagnosed type of atrial fibrillation (40-50%).^[6]^[4]

Lone Atrial Fibrillation (LAF)

Lone atrial fibrillation is defined as atrial fibrillation in the absence of clinical or echocardiographic findings of cardio pulmonary disease including hypertension. Patients in this group are young individuals (less than 60 years old).^[1]

AHA/ACC/APHRS/ECAS/EHRA/STS/HRS Classification

The newer classification proposed by the joint task force of AHA, ACC, APHRS, ECAS, EHRA, STS and HRS in 2012 is as follows^[2]

AF Category	Defining Characteristics
Atrial fibrillation episode	Atrial fibrillation with duration of at least 30 seconds or if less than 30 seconds, is present continuously throughout the ECG monitoring tracing. Sinus rhythm is documented in between AF episodes.
Paroxysmal atrial fibrillation	Recurrent episodes (≥two episodes) that self-terminate in less than 7 days. Episodes of AF of ≤48 hours duration that are terminated with electrical or pharmacologic cardioversion are also included.
Persistent atrial fibrillation	Recurrent episodes (≥two episodes) that last more than 7 days and may require pharmacologic or electrical intervention. Episodes of AF of ≥48 hours duration, but prior to 7 days, which are terminated with electrical or pharmacologic cardioversion are also included.
Longstanding persistent atrial fibrillation	Continuous atrial fibrillation of greater than 12 months duration.
Permanent atrial fibrillation	Atrial fibrillation which has been decided not to be restored or maintained in sinus rhythm by any means, including catheter or surgical ablation.

The term "chronic atrial fibrillation" has no standardized definition.

Atrial Fibrillation Episode

An atrial fibrillation episode is defined as AF which is documented by ECG monitoring and has a duration of at least 30 seconds, or if less than 30 seconds, is present continuously throughout the ECG monitoring tracing. The presence of subsequent episodes of AF requires that sinus rhythm be documented by ECG monitoring between AF episodes.

Paroxysmal Atrial Fibrillation

Paroxysmal atrial fibrillation is defined as recurrent episodes (≥two episodes) of AF that self-terminate in less than 7 days. Most episodes are brief and last < 24 hours. Episodes of AF of ≤48 hours duration that are terminated with electrical or pharmacologic cardioversion are also included.

Persistent Atrial Fibrillation

Recurrent episodes (≥two episodes) that last more than 7 days that may require pharmacologic or electrical intervention are called as persistent atrial fibrillation. Episodes of AF in which a decision is made to electrically or pharmacologically cardioversion after ≥48 hours of AF, but prior to 7 days, are also classified as persistent AF.

Longstanding Persistent Atrial Fibrillation

Longstanding persistent atrial fibrillation is a continuous atrial fibrillation of greater than 12 months duration. Continuous AF is an AF that is documented to be present on all ECG monitoring performed during a defined period of time.

Permanent Atrial Fibrillation

Permanent atrial fibrillation is an atrial fibrillation in patients in whom a decision has been made not to restore or maintain sinus rhythm by any means, including catheter or surgical ablation. If a patient who was previously classified as having permanent AF is to undergo catheter or surgical ablation, then AF should be reclassified.

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 Fuster V, Rydén LE, Cannom DS; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (7): e257–354. doi:10.1161/CIRCULATIONAHA.106.177292. PMID 16908781.
↑ ^2.0 ^2.1 Calkins, H.; Kuck, KH.; Cappato, R.; Brugada, J.; Camm, AJ.; Chen, SA.; Crijns, HJ.; Damiano, RJ.; Davies, DW. (2012). "2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design". Europace. 14 (4): 528–606. doi:10.1093/europace/eus027. PMID 22389422. Unknown parameter |month= ignored (help)
↑ January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.
↑ ^4.0 ^4.1 Di Pasquale G, Mathieu G, Maggioni AP, Fabbri G, Lucci D, Vescovo G; et al. (2013). "Current presentation and management of 7148 patients with atrial fibrillation in cardiology and internal medicine hospital centers: the ATA AF study". Int J Cardiol. 167 (6): 2895–903. doi:10.1016/j.ijcard.2012.07.019. PMID 22884698.
↑ ^5.0 ^5.1 ^5.2 Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ; et al. (2001). "Pathophysiology and prevention of atrial fibrillation". Circulation. 103 (5): 769–77. doi:10.1161/01.cir.103.5.769. PMID 11156892.
↑ ^6.0 ^6.1 ^6.2 ^6.3 Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014). "Epidemiology of atrial fibrillation: European perspective". Clin Epidemiol. 6: 213–20. doi:10.2147/CLEP.S47385. PMC 4064952. PMID 24966695.
↑ Levy S (1998). "Epidemiology and classification of atrial fibrillation". J Cardiovasc Electrophysiol. 9 (8 Suppl): S78–82. PMID 9727680
↑ Levy S (2000). "Classification system of atrial fibrillation". Curr Opin Cardiol. 15 (1): 54–7. PMID 10666661
↑ Levy S (1998). "Epidemiology and classification of atrial fibrillation". J Cardiovasc Electrophysiol. 9 (8 Suppl): S78–82. PMID 9727680
↑ Levy S (2000). "Classification system of atrial fibrillation". Curr Opin Cardiol. 15 (1): 54–7. PMID 10666661

Template:WikiDoc Sources CME Category::Cardiology

[pmid16908781-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 Fuster V, Rydén LE, Cannom DS; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (7): e257–354. doi:10.1161/CIRCULATIONAHA.106.177292. PMID 16908781.

[Calkins-2012-2] 2.0 ^2.1 Calkins, H.; Kuck, KH.; Cappato, R.; Brugada, J.; Camm, AJ.; Chen, SA.; Crijns, HJ.; Damiano, RJ.; Davies, DW. (2012). "2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design". Europace. 14 (4): 528–606. doi:10.1093/europace/eus027. PMID 22389422. Unknown parameter |month= ignored (help)

[JanuaryWann2014-3] January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.

[pmid22884698-4] 4.0 ^4.1 Di Pasquale G, Mathieu G, Maggioni AP, Fabbri G, Lucci D, Vescovo G; et al. (2013). "Current presentation and management of 7148 patients with atrial fibrillation in cardiology and internal medicine hospital centers: the ATA AF study". Int J Cardiol. 167 (6): 2895–903. doi:10.1016/j.ijcard.2012.07.019. PMID 22884698.

[pmid11156892-5] 5.0 ^5.1 ^5.2 Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ; et al. (2001). "Pathophysiology and prevention of atrial fibrillation". Circulation. 103 (5): 769–77. doi:10.1161/01.cir.103.5.769. PMID 11156892.

[pmid24966695-6] 6.0 ^6.1 ^6.2 ^6.3 Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014). "Epidemiology of atrial fibrillation: European perspective". Clin Epidemiol. 6: 213–20. doi:10.2147/CLEP.S47385. PMC 4064952. PMID 24966695.

[7] Levy S (1998). "Epidemiology and classification of atrial fibrillation". J Cardiovasc Electrophysiol. 9 (8 Suppl): S78–82. PMID 9727680

[8] Levy S (2000). "Classification system of atrial fibrillation". Curr Opin Cardiol. 15 (1): 54–7. PMID 10666661

[9] Levy S (1998). "Epidemiology and classification of atrial fibrillation". J Cardiovasc Electrophysiol. 9 (8 Suppl): S78–82. PMID 9727680

[10] Levy S (2000). "Classification system of atrial fibrillation". Curr Opin Cardiol. 15 (1): 54–7. PMID 10666661

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@@ Line 6: / Line 6: @@
 {{Atrial fibrillation}}
-{{CMG}}; {{AE}} {{VR}}
+{{CMG}}; {{AE}} {{VR}} {{Anahita}}
 ==Overview==
+Although several clinical classification plans and protocols have been proposed, none of them fully account for all aspects of [[atrial fibrillation]]. Previously the [[American Heart Association]] ([[AHA]]), [[American College of Cardiology]] ([[ACC]]), and the [[European Society of Cardiology]] ([[ESC]]) had proposed a classification system based on simplicity and clinical relevance. More recently, another classification has been proposed by a task force writing group which composed of experts representing seven organizations: the American College of Cardiology (ACC), the American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), the European Cardiac Arrhythmia Society (ECAS), the European Heart Rhythm Association (EHRA), the Society of Thoracic Surgeons (STS), and the Heart Rhythm Society (HRS). Still there are some shared definitions in almost all classification systems. [[Atrial fibrillation]] that terminates spontaneously or with intervention within 7 days of onset is considered a [[atrial fibrillation|paroxysmal atrial fibrillation]]. On the other hand [[atrial fibrillation]] that lasts more than 7 days is named [[atrial fibrillation|persistent atrial fibrillation]]. Long standing (or permanent) [[atrial fibrillation]] is referred to a [[atrial fibrillation]] that lasts for more than a year.
-Although several clinical classification plans and protocols have been proposed, none of them fully account for all aspects of atrial fibrillation.  Previously the [[American Heart Association]] ([[AHA]]), [[American College of Cardiology]] ([[ACC]]), and the [[European Society of Cardiology]] ([[ESC]]) had proposed a classification system based on simplicity and clinical relevance.<ref name="pmid16908781">{{cite journal |author=Fuster V, Rydén LE, Cannom DS, ''et al'' |title=ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society |journal=Circulation |volume=114 |issue=7 |pages=e257-354 |year=2006 |pmid=16908781 |doi=10.1161/CIRCULATIONAHA.106.177292}}</ref>  More recently, another classification has been proposed by a task force writing group which composed of experts representing seven organizations: the American College of Cardiology (ACC), the American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), the European Cardiac Arrhythmia Society (ECAS), the European Heart Rhythm Association (EHRA), the Society of Thoracic Surgeons (STS), and the Heart Rhythm Society (HRS).<ref name="Calkins-2012">{{Cite journal  | last1 = Calkins | first1 = H. | last2 = Kuck | first2 = KH. | last3 = Cappato | first3 = R. | last4 = Brugada | first4 = J. | last5 = Camm | first5 = AJ. | last6 = Chen | first6 = SA. | last7 = Crijns | first7 = HJ. | last8 = Damiano | first8 = RJ. | last9 = Davies | first9 = DW. | title = 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. | journal = Europace | volume = 14 | issue = 4 | pages = 528-606 | month = Apr | year = 2012 | doi = 10.1093/europace/eus027 | PMID = 22389422 }}</ref>
 ==2014 AHA/ACC/HRS Classification==
-* Based on the duration of [[Atrial fibrillation|atrial fibrillation (AF)]] episodes, AHA/ACC/HRS published a simplified classification scheme given in the table below:
+* Based on the duration of [[Atrial fibrillation|atrial fibrillation (AF)]] episodes, AHA/ACC/HRS published a simplified classification scheme given in the table below:<ref name="pmid16908781">{{cite journal |author=Fuster V, Rydén LE, Cannom DS, ''et al'' |title=ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society |journal=Circulation |volume=114 |issue=7 |pages=e257-354 |year=2006 |pmid=16908781 |doi=10.1161/CIRCULATIONAHA.106.177292}}</ref><ref name="Calkins-2012">{{Cite journal  | last1 = Calkins | first1 = H. | last2 = Kuck | first2 = KH. | last3 = Cappato | first3 = R. | last4 = Brugada | first4 = J. | last5 = Camm | first5 = AJ. | last6 = Chen | first6 = SA. | last7 = Crijns | first7 = HJ. | last8 = Damiano | first8 = RJ. | last9 = Davies | first9 = DW. | title = 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. | journal = Europace | volume = 14 | issue = 4 | pages = 528-606 | month = Apr | year = 2012 | doi = 10.1093/europace/eus027 | PMID = 22389422 }}</ref>
-* '''Lone AF''' is a historical term which refers to [[atrial fibrillation]] in younger individuals (<60 years of age) without clinical or echocardiographic evidence of cardiopulmonary disease, [[hypertension]], or [[diabetes mellitus]]. Because of its variable definitions, the term is potentially confusing and should not be used to guide therapeutic decisions.<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>
+* '''Lone AF''' is a historical term which refers to [[atrial fibrillation]] in younger individuals (<60 years of age) without clinical or [[Echocardiography|echocardiographic]] evidence of [[cardiology|cardio]][[respiratory disease|pulmonary disease]], [[hypertension]], or [[diabetes mellitus]]. Because of its variable definitions, the term is potentially confusing and should not be used to guide [[therapy|therapeutic decisions]].<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>
 {| style="border: 2px solid #696969;"
@@ Line 23: / Line 22: @@
 | style="font-size: 100%; padding: 0 5px; background: #F5F5F5" align=left valign=top |'''''Paroxysmal AF'''''
 | style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left|
-* AF that terminates spontaneously or with intervention '''within 7 d of onset'''.
+* [[Atrial fibrillation]] that terminates spontaneously or with intervention '''within 7 d of onset'''.
 * Episodes may recur with variable frequency.
 |-
 | style="font-size: 100%; padding: 0 5px; background: #F5F5F5" align=left |'''''Persistent AF'''''
 | style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left|
-* Continuous AF that is sustained '''>7 d'''.
+* Continuous [[AF]] that is sustained '''>7 d'''.
 |-
 | style="font-size: 100%; padding: 0 5px; background: #F5F5F5" align=left |'''''Longstanding Persistent AF'''''
 | style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left valign=top|
-* Continuous AF of '''>12 mo''' duration.
+* Continuous [[AF]] of '''>12 mo''' duration.
 |-
 | style="font-size: 100%; padding: 0 5px; background: #F5F5F5" align=left valign=top |'''''Permanent AF'''''
 | style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left|
-* Permanent AF is used when there has been a joint decision by the patient and clinician to '''cease further attempts to restore and/or maintain sinus rhythm'''.
+* Permanent [[AF]] is used when there has been a joint decision by the [[patient]] and clinician to '''cease further attempts to restore and/or maintain sinus rhythm'''.
-* Acceptance of AF represents a therapeutic attitude on the part of the patient and clinician rather than an inherent pathophysiological attribute of the AF.
+* Acceptance of [[AF]] represents a [[therapy|therapeutic]] attitude on the part of the [[patient]] and clinician rather than an inherent [[Pathophysiology|pathophysiological]] attribute of the [[AF]].
-* Acceptance of AF may change as symptoms, the efficacy of therapeutic interventions, and patient and clinician preferences evolve.
+* Acceptance of [[AF]] may change as [[symptoms]], the efficacy of [[therapy|therapeutic interventions]], and [[patient]] and clinician preferences evolve.
 |-
 | style="font-size: 100%; padding: 0 5px; background: #F5F5F5" align=left |'''''Nonvalvular AF'''''
 | style="font-size: 100%; padding: 0 5px; background: #DCDCDC" align=left|
-* AF in the absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair.
+* [[AF]] in the absence of [[Mitral stenosis pathophysiology|rheumatic mitral stenosis]], a mechanical or bioprosthetic [[heart valve]], or [[Heart valve|mitral valve]] repair.
 |-
 |}
 ==AHA/ACC/ESC Classification==
+The classification that was proposed by the joint task force of AHA, ACC and ESC in 2006 is as follows:<ref name="pmid16908781">{{cite journal |author=Fuster V, Rydén LE, Cannom DS, ''et al'' |title=ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society |journal=Circulation |volume=114 |issue=7 |pages=e257-354 |year=2006 |pmid=16908781 |doi=10.1161/CIRCULATIONAHA.106.177292}}</ref>
-The classification that was proposed by the joint task force of AHA, ACC and ESC in 2006 is as follows<ref name="pmid16908781">{{cite journal |author=Fuster V, Rydén LE, Cannom DS, ''et al'' |title=ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society |journal=Circulation |volume=114 |issue=7 |pages=e257-354 |year=2006 |pmid=16908781 |doi=10.1161/CIRCULATIONAHA.106.177292}}</ref>
 {| {{table}}
-| align="center" style="background:#f0f0f0" | '''AF Category'''
+! align="center" style="background: #4479BA; color: #FFFFFF; " | '''AF Category'''
-| align="center" style="background:#f0f0f0 " |'''Defining Characteristics'''
+! align="center" style="background: #4479BA; color: #FFFFFF; " |'''Defining Characteristics'''
 |-
   | First detected || Only one diagnosed episode.
@@ Line 58: / Line 56: @@
 | Paroxysmal || Recurrent episodes that self-terminate in less than 7 days (most episodes are brief and last < 24 hours).
 |-
-| Persistent || Recurrent episodes that last more than 7 days and may require pharmacologic or electrical intervention.
+| Persistent || Recurrent episodes that last more than 7 days and may require [[Pharmacology|pharmacologic]] or [[Atrial fibrillation electrical cardioversion|electrical intervention]].
 |-
-| Permanent || An ongoing long-term episode that lasts for more than a year despite attempts at cardioversion.
+| Permanent || An ongoing long-term episode that lasts for more than a year despite attempts at [[Atrial fibrillation electrical cardioversion|cardioversion]].
 |-
 |}
@@ Line 66: / Line 64: @@
 ===First Detected Atrial Fibrillation===
-Any patient with new diagnosed [[Atrial fibrillation|AF]] is in this category, as the exact onset and chronicity of the disease is often uncertain.  The patient may have been symptomatic or asymptomatic.
+Any [[patient]] with newly [[diagnosis|diagnosed]] [[Atrial fibrillation|AF]] is in this category, as the exact onset and [[Chronic (medical)|chronicity]] of the [[disease]] is often uncertain. The [[patient]] may have been [[symptoms|symptomatic]] or [[symptoms|asymptomatic]].
 ===Recurrent Atrial Fibrillation===
-Two or more identified episodes of atrial fibrillation are named as recurrent form of atrial fibrillation.  This is further classified into paroxysmal and persistent based on when the episode terminates without therapy.
+Two or more identified episodes of [[atrial fibrillation]] are named as recurrent form of [[atrial fibrillation]]. This is further classified into paroxysmal and persistent based on when the episode terminates without [[therapy]].
 ====Paroxysmal Atrial Fibrillation====
-Atrial fibrillation is said to be paroxysmal when it terminates spontaneously within 7 days, most commonly within 24 hours.
+*[[Atrial fibrillation]] is said to be paroxysmal when it terminates spontaneously within 7 days, most commonly within 24 hours.<ref name="pmid22884698">{{cite journal| author=Di Pasquale G, Mathieu G, Maggioni AP, Fabbri G, Lucci D, Vescovo G | display-authors=etal| title=Current presentation and management of 7148 patients with atrial fibrillation in cardiology and internal medicine hospital centers: the ATA AF study. | journal=Int J Cardiol | year= 2013 | volume= 167 | issue= 6 | pages= 2895-903 | pmid=22884698 | doi=10.1016/j.ijcard.2012.07.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22884698  }} </ref><ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>
+*This type includes 20-30% of cases that have been [[diagnosis|diagnosed]] with [[atrial fibrillation]].<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref>
 ====Persistent Atrial Fibrillation====
-Persistent atrial fibrillation is defined as episodes of atrial fibrillation of more than seven days duration.  Both the terms persistent and chronic are used if diagnosis of atrial fibrillation established for more than seven days.  Differentiation of paroxysmal from chronic or established AF is based on the history of recurrent episodes and the duration of the current AF episode.<ref name="pmid16908781"/><ref>{{cite journal | author=Levy S | title=Epidemiology and classification of atrial fibrillation | journal=J Cardiovasc Electrophysiol | year=1998 | pages=S78-82 | volume=9 | issue=8 Suppl }} PMID 9727680</ref><ref>{{cite journal | author=Levy S | title=Classification system of atrial fibrillation | journal=Curr Opin Cardiol | year=2000 | pages=54-7 | volume=15 | issue=1 }} PMID 10666661</ref>
+*Persistent [[atrial fibrillation]] is defined as episodes of [[atrial fibrillation]] of more than 7 days duration.<ref name="pmid16908781"/><ref>{{cite journal | author=Levy S | title=Epidemiology and classification of atrial fibrillation | journal=J Cardiovasc Electrophysiol | year=1998 | pages=S78-82 | volume=9 | issue=8 Suppl }} PMID 9727680</ref><ref>{{cite journal | author=Levy S | title=Classification system of atrial fibrillation | journal=Curr Opin Cardiol | year=2000 | pages=54-7 | volume=15 | issue=1 }} PMID 10666661</ref><ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>
+*Both the terms persistent and [[Chronic (medical)|chronic]] are used if [[diagnosis]] of [[atrial fibrillation]] established for more than seven days.
+*Differentiation of the paroxysmal type from [[Chronic (medical)|chronic]] or established [[AF]] is based on the history of recurrent episodes and the duration of the current [[AF]] episode.<ref name="pmid16908781"/><ref>{{cite journal | author=Levy S | title=Epidemiology and classification of atrial fibrillation | journal=J Cardiovasc Electrophysiol | year=1998 | pages=S78-82 | volume=9 | issue=8 Suppl }} PMID 9727680</ref><ref>{{cite journal | author=Levy S | title=Classification system of atrial fibrillation | journal=Curr Opin Cardiol | year=2000 | pages=54-7 | volume=15 | issue=1 }} PMID 10666661</ref>
+*Persistent type includes 20-30% of cases that have been [[diagnosis|diagnosed]] with [[atrial fibrillation]].<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref>
 ===Permanent Atrial Fibrillation===
+*Permanent [[atrial fibrillation]] is defined as [[atrial fibrillation]] that persists for more than a year. [[Cardioversion]] has either failed in these [[patients]] or has not yet been attempted.<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref><ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>
-Permanent atrial fibrillation is defined as atrial fibrillation that persists for more than a year.  [[Cardioversion]] has either failed in these patients or has not yet been attempted.
+*This type is the most common [[diagnosis|diagnosed]] type of [[atrial fibrillation]] (40-50%).<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue=  | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695  }} </ref><ref name="pmid22884698">{{cite journal| author=Di Pasquale G, Mathieu G, Maggioni AP, Fabbri G, Lucci D, Vescovo G | display-authors=etal| title=Current presentation and management of 7148 patients with atrial fibrillation in cardiology and internal medicine hospital centers: the ATA AF study. | journal=Int J Cardiol | year= 2013 | volume= 167 | issue= 6 | pages= 2895-903 | pmid=22884698 | doi=10.1016/j.ijcard.2012.07.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22884698  }} </ref>
 ===Lone Atrial Fibrillation (LAF)===
-Lone atrial fibrillation is defined as atrial fibrillation in the absence of clinical or echocardiographic findings of cardiopulmonary disease including [[hypertension]].<ref name="pmid16908781"/>  Patients in this group are young individuals (less than 60 years old).
+Lone [[atrial fibrillation]] is defined as [[atrial fibrillation]] in the absence of clinical or echocardiographic findings of [[cardiology|cardio]][[respiratory disease|pulmonary disease]] including [[hypertension]]. [[Patients]] in this group are young individuals (less than 60 years old).<ref name="pmid16908781">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA | display-authors=etal| title=ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=Circulation | year= 2006 | volume= 114 | issue= 7 | pages= e257-354 | pmid=16908781 | doi=10.1161/CIRCULATIONAHA.106.177292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16908781  }} </ref>
 ==AHA/ACC/APHRS/ECAS/EHRA/STS/HRS Classification==
@@ Line 93: / Line 95: @@
 {| {{table}}
-| align="center" style="background:#f0f0f0" | '''AF Category'''
+! align="center" style="background: #4479BA; color: #FFFFFF; " | '''AF Category'''
-| align="center" style="background:#f0f0f0 " |'''Defining Characteristics'''
+! align="center" style="background: #4479BA; color: #FFFFFF; " |'''Defining Characteristics'''
 |-
-| Atrial fibrillation episode || Atrial fibrillation with duration of at least 30 seconds or if less than 30 seconds, is present continuously throughout the ECG monitoring tracing.  Sinus rhythm is documented in between AF episodes.
+| [[Atrial fibrillation]] episode || [[Atrial fibrillation]] with duration of at least 30 seconds or if less than 30 seconds, is present continuously throughout the [[The electrocardiogram|ECG monitoring tracing]]. [[Sinus rhythm]] is documented in between [[AF]] episodes.
 |-
-| Paroxysmal atrial fibrillation || Recurrent episodes (≥two episodes) that self-terminate in less than 7 days.  Episodes of AF of ≤48 hours duration that are terminated with electrical or pharmacologic cardioversion are also included.
+| Paroxysmal [[atrial fibrillation]] || Recurrent episodes (≥two episodes) that self-terminate in less than 7 days.  Episodes of [[AF]] of ≤48 hours duration that are terminated with [[Atrial fibrillation electrical cardioversion|electrical]] or [[Pharmacology|pharmacologic]] [[cardioversion]] are also included.
 |-
-| Persistent atrial fibrillation || Recurrent episodes (≥two episodes) that last more than 7 days and may require pharmacologic or electrical intervention.  Episodes of AF of ≥48 hours duration, but prior to 7 days, which are terminated with electrical or pharmacologic cardioversion are also included.
+| Persistent [[atrial fibrillation]] || Recurrent episodes (≥two episodes) that last more than 7 days and may require pharmacologic or electrical intervention.  Episodes of AF of ≥48 hours duration, but prior to 7 days, which are terminated with [[Atrial fibrillation electrical cardioversion|electrical]] or [[Pharmacology|pharmacologic]] [[cardioversion]] are also included.
 |-
-| Longstanding persistent atrial fibrillation || Continuous atrial fibrillation of greater than 12 months duration.
+| Longstanding persistent [[atrial fibrillation]] || Continuous [[atrial fibrillation]] of greater than 12 months duration.
 |-
-| Permanent atrial fibrillation || Atrial fibrillation which has been decided not to be restored or maintained in sinus rhythm by any means, including catheter or surgical ablation.
+| Permanent [[atrial fibrillation]] || [[Atrial fibrillation]] which has been decided not to be restored or maintained in [[sinus rhythm]] by any means, including catheter or [[surgery|surgical ablation]].
 |-
 |}
-The term "chronic atrial fibrillation" has no standardized definition.
+The term "[[Chronic (medical)|chronic]] [[atrial fibrillation]]" has no standardized definition.
 ===Atrial Fibrillation Episode===
-An atrial fibrillation episode is defined as AF which is documented by ECG monitoring and has a duration of at least 30 seconds, or if less than 30 seconds, is present continuously throughout the ECG monitoring tracing.  The presence of subsequent episodes of AF requires that [[sinus rhythm]] be documented by ECG monitoring between AF episodes.
+An [[atrial fibrillation]] episode is defined as [[AF]] which is documented by [[ECG]] monitoring and has a duration of at least 30 seconds, or if less than 30 seconds, is present continuously throughout the [[ECG]] monitoring tracing.  The presence of subsequent episodes of [[AF]] requires that [[sinus rhythm]] be documented by [[ECG]] monitoring between [[AF]] episodes.
 ===Paroxysmal Atrial Fibrillation===
-Paroxysmal atrial fibrillation is defined as recurrent episodes (≥two episodes) of AF that self-terminate in less than 7 days.  Most episodes are brief and last < 24 hours.  Episodes of AF of ≤48 hours duration that are terminated with electrical or pharmacologic cardioversion are also included.
+Paroxysmal [[atrial fibrillation]] is defined as recurrent episodes (≥two episodes) of [[AF]] that self-terminate in less than 7 days. Most episodes are brief and last < 24 hours. Episodes of [[AF]] of ≤48 hours duration that are terminated with [[Atrial fibrillation electrical cardioversion|electrical]] or [[Pharmacology|pharmacologic]] [[cardioversion]] are also included.
 ===Persistent Atrial Fibrillation===
-Recurrent episodes (≥two episodes) that last more than 7 days that may require pharmacologic or electrical intervention are called as persistent atrial fibrillation.  Episodes of AF in which a decision is made to electrically or pharmacologically cardiovert the patient after ≥48 hours of AF, but prior to 7 days, are also classified as persistent AF.
+Recurrent episodes (≥two episodes) that last more than 7 days that may require [[Pharmacology|pharmacologic]] or [[Atrial fibrillation electrical cardioversion|electrical intervention]] are called as persistent [[atrial fibrillation]]. Episodes of [[AF]] in which a decision is made to [[Atrial fibrillation electrical cardioversion|electrically]] or [[Pharmacology|pharmacologically]] [[cardioversion]] after ≥48 hours of [[AF]], but prior to 7 days, are also classified as persistent [[AF]].
 ===Longstanding Persistent Atrial Fibrillation===
-Longstanding persistent atrial fibrillation is a continuous atrial fibrillation of greater than 12 months duration.  Continuous AF is an AF that is documented to be present on all ECG monitoring performed during a defined period of time.
+Longstanding persistent [[atrial fibrillation]] is a continuous [[atrial fibrillation]] of greater than 12 months duration.  Continuous [[AF]] is an [[AF]] that is documented to be present on all [[ECG]] monitoring performed during a defined period of time.
 ===Permanent Atrial Fibrillation===
-Permanent atrial fibrillation is an atrial fibrillation in patients in whom a decision has been made not to restore or maintain sinus rhythm by any means, including catheter or surgical ablation.  If a patient who was previously classified as having permanent AF is to undergo catheter or surgical ablation, then AF should be reclassified.
+Permanent [[atrial fibrillation]] is an [[atrial fibrillation]] in [[patients]] in whom a decision has been made not to restore or maintain [[sinus rhythm]] by any means, including catheter or [[surgery|surgical ablation]]. If a [[patient]] who was previously classified as having permanent [[AF]] is to undergo catheter or [[surgery|surgical ablation]], then [[AF]] should be reclassified.
 ==References==


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Latest revision as of 18:37, 19 August 2021

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AHA/ACC/APHRS/ECAS/EHRA/STS/HRS Classification

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