Atrial fibrillation classification: Difference between revisions
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==Overview== | ==Overview== | ||
==Classification== | ==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.<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> | |||
==AHA/ACC/ESC Classification== | |||
The classification proposed by the joint task force of AHA, ACC and ESC 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:#f0f0f0 " |'''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 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. | |||
===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. | |||
====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> | |||
===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. | |||
===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). | |||
==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 is as follows<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> | |||
{| {{table}} | {| {{table}} | ||
| align="center" style="background:#f0f0f0" | '''AF Category''' | | align="center" style="background:#f0f0f0" | '''AF Category''' | ||
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|- | |- | ||
| 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 electrical or 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. | ||
Revision as of 20:16, 10 September 2013
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Atrial fibrillation classification On the Web | |
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Risk calculators and risk factors for Atrial fibrillation classification | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.[1] 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).[2]
AHA/ACC/ESC Classification
The classification proposed by the joint task force of AHA, ACC and ESC 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 new 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.
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.[1][3][4]
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.
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.[1] Patients in this group are young individuals (less than 60 years old).
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 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 cardiovert the patient 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 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) - ↑ 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