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Challenges in the classification of atrial fibrillation

Nature Reviews Cardiology volume 7, pages 451–460 (2010)Cite this article

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Abstract

The incidence and prevalence of atrial fibrillation (AF) are increasing worldwide. AF is of public health importance because it accounts for substantial morbidity, mortality, and health-care costs. AF may be transient initially, but many patients have progressive disease marked by increasing frequency and duration of episodes. Various classification schemes for AF have been proposed, although current guidelines are based on temporal rhythm-based patterns. We discuss existing schemes for the classification of AF, focusing on the advantages and limitations of the pattern-based scheme, in the context of new knowledge about AF pathophysiology, AF patterns, and clinical outcomes. Furthermore, we address gaps in knowledge that present opportunities to re-examine the current pattern-based classification of AF. A future classification scheme should ideally combine elements such as the risk of stroke, an assessment of symptoms, and the degree of impairment of the atrial substrate.

Key Points

  • The incidence and prevalence of atrial fibrillation (AF) are increasing worldwide

  • Substantial variability exists in the rhythm-based patterns and longitudinal history of AF

  • AF progresses to permanent disease in a considerable proportion of individuals

  • Gaps in our knowledge exist regarding the relationship between rhythm-based patterns of AF and both disease prognosis and management

  • Valid and clinically useful instruments that measure patient symptoms and quality of life may inform clinical practice

  • Emerging evidence for the pathogenesis and patterns of AF provides the opportunity to revise existing AF classification schemes

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Figure 1: Rhythm-based patterns of atrial fibrillation (AF), as defined in the 2006 AHA, ACC, and European Society of Cardiology guidelines for the management of patients with AF.
Figure 2: Proposed elements for inclusion in a unifying clinical classification scheme for AF.

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Acknowledgements

S. A. Lubitz is supported by a training grant in the epidemiology of cardiovascular disease from the NIH (T32HL007575). This work was supported by NIH grants HL092577 to P. T. Ellinor and E. J. Benjamin, AG028321 and RC1-HL01056 to E. J. Benjamin, and DA027021 to P. T. Ellinor.

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  1. Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, 4th Floor, Charlestown, MA 02129, USA,

    Steven A. Lubitz

  2. The Framingham Heart Study, 73 Mount Wayte Avenue, Framingham, 01702-5825, MA, USA

    Emelia J. Benjamin

  3. Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, GRB 109, Boston, 02114, MA, USA

    Jeremy N. Ruskin & Patrick T. Ellinor

  4. The Zena and Michael A. Wiener Cardiovascular Institute and Marie Josée and Henry R. Kravis Cardiovascular Health Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, 10029, NY, USA

    Valentin Fuster

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Lubitz, S., Benjamin, E., Ruskin, J. et al. Challenges in the classification of atrial fibrillation. Nat Rev Cardiol 7, 451–460 (2010). https://doi.org/10.1038/nrcardio.2010.86

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