International consensus on nomenclature and classification of atrial fibrillation. A collaborative project of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology

Lévy, Samuel; Camm, A. John; Saksena, Sanjeev; Aliot, Étienne; Breithardt, Günter; Crijns, Harry J.G.M.; Davies, William; Kay, Neal; Prystowsky, Eric N.; Sutton, Richard; Waldo, Albert L.; Wyse, D. George

doi:10.1053/eupc.2002.0300

Cited by 105 publications

(37 citation statements)

References 15 publications

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“…A panel of experts has recently characterized the definition and position of AF within this group of tachyarrhythmias. 3 Nonetheless, this family of tachyarrhythmias is closely interrelated, and the individual tachyarrhythmias often coexist in the same patient. Although the present discussion focuses on AF, many of the points made with regard to AF apply to these other tachyarrhythmias to varying degrees.…”

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confidence: 99%

Atrial Fibrillation: A Perspective

Wyse

Gersh

2004

Circulation

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A trial fibrillation (AF) is a common clinical problem that is increasing in prevalence 1 and is inextricably linked to another burgeoning cardiovascular problem, namely, congestive heart failure. 2 There is increasing evidence that AF, at least in some population subsets, may be part of a spectrum of atherosclerotic vascular disease, hypertension, inflammation, diastolic dysfunction, and the metabolic syndromes. AF is part of a family of atrial tachyarrhythmias (Figure 1). A panel of experts has recently characterized the definition and position of AF within this group of tachyarrhythmias. 3 Nonetheless, this family of tachyarrhythmias is closely interrelated, and the individual tachyarrhythmias often coexist in the same patient. Although the present discussion focuses on AF, many of the points made with regard to AF apply to these other tachyarrhythmias to varying degrees.Recently, international panels of experts have also created clinical practice guidelines 4 and perspectives on future research directions 5 for AF. These documents are a rich source of reference to the vast literature on AF. It is not the intention of the present article to review this literature, and, in particular, it is not intended that the reader will use the present article as a manual for managing AF. However, the perspective is intended to provide a framework for rational thinking about the management of AF. Inside the Basic Scientist's BoxA schema of how a basic scientist might currently view AF is presented in Figure 2. In this schema, modulating factors surround the basic elements of arrhythmogenesis, and the focus is on the mechanisms for initiation and perpetuation of AF. In this particular paradigm, a trigger and substrate interact to form a reentrant circuit or circuits, but provision is also provided for a trigger to lead directly to AF. The consequences of the interaction between triggers and substrate are dependent in part on the milieu created by multiple modulating factors and in particular the autonomic nervous system. The relative influence of these pathways in the pathogenesis of AF has always been controversial, and their deemed importance has waxed and waned over the years. Until recently, reentry based on the multiple wavelet hypothesis, attributed to Moe and Abildskov, 6 has held predominance, partly because of the mapping experiments of Allessie and colleagues. 7 However, the multiple wavelet hypothesis was preceded by hypotheses that invoked single or multiple rapidly firing foci and other reentry concepts (see Waldo 8 for a review). Recent observations on the initiation of AF from the area of the pulmonary veins 9 and the concepts of fibrillatory conduction and of rotors 10 have rekindled consideration of some of the older concepts, presented some new options, and lessened the dominance of the multiple wavelet hypothesis. However, the relative roles of abnormal automaticity and reentry in the pulmonary vein region for initiation and perpetuation, respectively, of AF are entirely unclear at the present time. Furth...

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confidence: 99%

Atrial Fibrillation: A Perspective

Wyse

Gersh

2004

Circulation

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“…This is reflected by the broadband spectra and space filling loops in AF. Since AF itself represents an organizational spectrum that relates to the ease of cardioversion [8] and chronicity [9], it remains to be studied whether AF patients with narrower band spectra will better respond to attempts to maintain sinus rhythm [10].…”

Section: Discussionmentioning

confidence: 99%

Segregating non-isthmus dependent atrial flutter from organized atrial fibrillation using spectral and spatial phase analysis of the electrocardiogram

Narayan

Feld

Hassankhani

et al. 2003

Computers in Cardiology, 2003

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“…Persistent/permanent AF (or chronic AF) was defined by the presence of all the following: i) serial ECGs (at least 2) showing AF only and no interim evidence of sinus rhythm; ii) documentation by physician as having "chronic" or "permanent" AF from clinical assessment. Because the definitions for persistent and permanent AF were established years after the start of the study period 10 , the 2 terms were considered interchangeable for the purpose of this study. Myocardial infarction was defined by at least 2 of the 3 diagnostic criteria: compatible clinical presentation, diagnostic cardiac enzyme levels, and consistent electrocardiographic changes.…”

Section: Methodsmentioning

confidence: 99%

Changing Trends of Hospital Utilization in Patients After Their First Episode of Atrial Fibrillation

Miyasaka

Barnes

Gersh

et al. 2008

The American Journal of Cardiology

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A marked increase in hospitalization for patients with AF has previously been noted. Whether this increase was related to a change in the prevalence of AF, or change in the pattern of practice with respect to the management of AF remains unclear. To determine the trends in hospital utilization after first atrial fibrillation (AF) in a community-based setting, Olmsted County, Minnesota residents diagnosed with first AF during 1980-2000 were identified and followed until 2004. The primary outcome of interest was hospital admission for cardiovascular reasons. Of a total of 4,498 subjects (73±14 years old, 51% men), 2,503 (56%) were admitted to the hospital for cardiovascular causes for at least once during a mean follow-up of 5.5±5.0 years. The risk of first hospitalization was greatest during the first year of AF [cumulative incidence 31%, 95% confidence interval (CI) 30-32%]. First hospitalization was strongly related to age (P<0.0001), but not with sex (P=0.38). During 1980-2000, the age-and sex-adjusted rate of first hospitalization increased, on average, by 2.5% a year (95% CI 1.8-3.2%, P<0.0001), even after multivariable adjustment for comorbidities. When we excluded all hospital admissions for the purposes of AF management, the increase in hospitalization was only 0.8% per year (95% CI 0.05-1.6%, P=0.04), which was no longer significant after multivariable adjustment for comorbidities (P=0.25). In conclusion, the marked increase in hospitalization after first AF diagnosis during 1980-2000 appeared to be largely driven by the changing practice pattern in AF management.

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International consensus on nomenclature and classification of atrial fibrillation. A collaborative project of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology

Cited by 105 publications

References 15 publications

Atrial Fibrillation: A Perspective

Atrial Fibrillation: A Perspective

Segregating non-isthmus dependent atrial flutter from organized atrial fibrillation using spectral and spatial phase analysis of the electrocardiogram

Changing Trends of Hospital Utilization in Patients After Their First Episode of Atrial Fibrillation

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