Abstract 16430: Clinical Classification of Atrial Fibrillation Poorly Reflects the Temporal Persistence of Atrial Fibrillation: Insights From 1196 Patients Continuously Monitored With Implantable Devices
Introduction: The clinical classification of atrial fibrillation (AF) is employed to communicate the persistence and severity of AF, to select appropriate therapeutic options as well as a criterion for inclusion in clinical trials.
Aims: In 1196 patients continuously monitored via implantable devices (CM) we aimed to identify how accurately the currently used clinical AF classification reflects the temporal persistence and severity of AF.
Methods: Cardiac rhythm histories of 1196 patients (73.0±10.1 years, 757 male, follow-up 353±58 days, range:106-730) enrolled in the OMNI and TRENDS clinical trials (ClinicalTrials.gov ID: NCT00277524, NCT00279981) were reconstructed and analyzed. At the time of inclusion all patients were classified as having paroxysmal or persistent AF by a physician according to the current guidelines. Atrial fibrillation burden, measured as the proportion of time a patient is in AF, was obtained from the CM device. We evaluated the agreement between the clinical AF classification and the severity of AF as measured by the CM device.
Results: There was a poor agreement between the clinical AF classification and the device derived data (Cohen’s kappa 0.12, 95% CI 0.05-0.18, Table). Clinical patient characteristics influenced the decision to classify a patient into paroxysmal or persistent AF. Lower ejection fraction (Odds Ratio (OR) 0.97; 95%CI: 0.96-0.98; p<0.0001) and presence of coronary artery disease (OR 0.54; 95%CI 0.33-0.89; p=0.01) were independently associated with lower probability of being classified as persistent AF for the same level of AF burden.
Conclusions: The clinical AF classification poorly reflects the temporal persistence and severity of AF. Patient characteristics and demographics significantly influence the categorization of AF. Our results demonstrate that patients classified in the same traditional clinical AF categories may be inherently inhomogeneous with regards to AF severity and temporal persistence.
- © 2013 by American Heart Association, Inc.