Andrade Jason G, Yao Robert R J, Deyell Marc W, Hawkins Nathaniel M, Rizkallah Jacques, Jolly Umjeet, Khoo Clarence, Raymond Jean-Marc, McKinney James, Cheung Christopher, Steinberg Christian, Ha Andrew, Ramanathan Krishnan, Luong Christina, Glover Benedict, Verma Atul, Macle Laurent, Khairy Paul
Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada; Department of Medicine, University of British Columbia, Canada; Center for Cardiovascular Innovation, Vancouver, Canada.
Department of Medicine, University of British Columbia, Canada.
J Electrocardiol. 2020 May-Jun;60:159-164. doi: 10.1016/j.jelectrocard.2020.03.008. Epub 2020 Mar 21.
Contemporary guidelines recommend that atrial fibrillation (AF) be classified into paroxysmal and persistent AF based on clinical assessment, with these categorizations forming the basis of therapeutic recommendations. While pragmatic, clinical assessment may introduce misclassification errors, which may impact treatment decisions. We sought to determine the relationship between AF classification, baseline AF burden, and post-ablation arrhythmia outcomes.
The current study is a sub-analysis of a prospective, parallel-group, multicenter, single-blinded randomized clinical trial. All 346 patients enrolled in CIRCA-DOSE received an implantable cardiac monitor a median of 72 days prior to ablation. AF was classified as low burden paroxysmal, high burden paroxysmal, or persistent based on clinical assessment prior to device implantation. Prior to ablation patients were re-classified using the same definitions based on device monitoring data. Correlation between classifications, AF burden, and post-ablation arrhythmia outcomes were assessed.
There was poor agreement between clinical and device-based AF classification (Cohen's kappa: 0.192). AF classification derived from pre-ablation continuous monitoring reflected baseline and post-ablation AF burden with greater accuracy and with less overlap between the AF classes (P < 0.01 for all categorical comparisons). Patients objectively classified as "Low Burden" paroxysmal by continuous monitoring data had significantly greater freedom from recurrent AF/AT/AFL compared to those classified as "High Burden" paroxysmal (hazard ratio [HR] 0.57 for AF/AT/AFL recurrence) or persistent AF (HR 0.19 for AF/AT/AFL recurrence).
Classification of AF pattern based on pre-ablation continuous cardiac rhythm monitoring better predicted AF burden and freedom from recurrent AF post ablation. Despite the use of standardized definitions, classification of AF based on clinical assessment did not predict baseline AF burden, post ablation AF burden, or freedom from recurrent AF post ablation.
ClinicalTrials.govNCT01913522.
当代指南建议根据临床评估将心房颤动（AF）分为阵发性和持续性AF，这些分类构成治疗建议的基础。虽然实用，但临床评估可能会引入错误分类误差，这可能会影响治疗决策。我们试图确定AF分类、基线AF负荷与消融后心律失常结局之间的关系。
本研究是一项前瞻性、平行组、多中心、单盲随机临床试验的亚分析。CIRCA-DOSE研究中纳入的所有346例患者在消融前中位72天接受了植入式心脏监测仪。根据植入设备前的临床评估，AF被分类为低负荷阵发性、高负荷阵发性或持续性。在消融前，根据设备监测数据使用相同的定义对患者进行重新分类。评估分类、AF负荷与消融后心律失常结局之间的相关性。
基于临床和基于设备的AF分类之间的一致性较差（Cohen's kappa：0.192）。消融前连续监测得出的AF分类更准确地反映了基线和消融后AF负荷，且AF类别之间的重叠较少（所有分类比较P<0.01）。通过连续监测数据客观分类为“低负荷”阵发性的患者与分类为“高负荷”阵发性（AF/AT/AFL复发的风险比[HR]为0.57）或持续性AF（AF/AT/AFL复发的HR为0.19）的患者相比，无复发性AF/AT/AFL的自由度显著更高。
基于消融前连续心律监测的AF模式分类能更好地预测AF负荷和消融后无复发性AF。尽管使用了标准化定义，但基于临床评估的AF分类并不能预测基线AF负荷、消融后AF负荷或消融后无复发性AF。
ClinicalTrials.govNCT01913522。
