Atrial fibrillation classification: Difference between revisions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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, American College of Cardiology, and the European Society of Cardiology had proposed a classification system based on simplicity and clinical relevance.^[1] It contained four main categories of atrial fibrillation; first detected or diagnosed, paroxysmal, persistent, and permanent. More recently, a new classification was 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]

Classification

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

↑ 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, 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)

Template:WikiDoc Sources

[pmid16908781-1] 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] 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)

[1]

[2]

@@ Line 18: / Line 18: @@
 ==Overview==
-Although several clinical classification plans and protocols have been proposed, none of them fully account for all aspects of atrial fibrillation. The [[American Heart Association]], [[American College of Cardiology]], and the [[European Society of Cardiology]] have 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> It contains four main categories of atrial fibrillation; first detected or diagnosed, paroxysmal, persistent, and permanent.
+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]], [[American College of Cardiology]], and the [[European Society of Cardiology]] 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>  It contained four main categories of atrial fibrillation; first detected or diagnosed, paroxysmal, persistent, and permanent.  More recently, a new classification was 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>
 ==Classification==
 {| {{table}}
 | align="center" style="background:#f0f0f0" | '''AF Category'''
 | align="center" style="background:#f0f0f0 " |'''Defining Characteristics'''
 |-
-| First detected || Only one diagnosed episode.
+| 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 || Recurrent episodes that self-terminate in less than 7 days (most episodes are brief and last < 24 hours).
+| 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 || Recurrent episodes that last more than 7 days and may require pharmacologic or electrical intervention.
+| 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.
 |-
-| Permanent || An ongoing long-term episode that lasts for more than a year despite attempts at cardioversion.
+| 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.
 |-
 |}
-===First Detected Atrial Fibrillation===
+The term "chronic atrial fibrillation" has no standardized definition.
-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===
+===Atrial Fibrillation Episode===
-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. [[Atrial fibrillation]] is said to be paroxysmal when it terminates spontaneously within 7 days, most commonly within 24 hours.
+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.
-The term persistent or chronic is 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>
+===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===
-Persistent atrial fibrillation is defined as episodes of atrial fibrillation of more than seven days duration.
+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 defined as atrial fibrillation that persists for more than a year. [[Cardioversion]] has either failed in these patients or has not yet been attempted.
+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.
-===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).
 ==References==