Atrial fibrillation Persistence Shouldn't Be Based on 7-Day
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Contemporary guidelines recommend that atrial fibrillation (AF) be classified based on episode duration, with these categories forming the basis of therapeutic recommendations. While pragmatic, these classifications are not based on pathophysiologic processes and may not reflect clinical outcomes.

The current study is a secondary analysis of a prospective, parallel-group, multicenter, single-masked randomized clinical trial (the Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double Short vs Standard Exposure Duration [CIRCA-DOSE] study), which took place at 8 Canadian centers. Patients older than 18 years with symptomatic AF referred for first catheter ablation were enrolled. All patients received an implantable cardiac monitor at least 30 days before ablation.

Results The study included 346 patients (mean age, 59 years; 231 men). Overall, 263 patients had AF episode duration of less than 24 hours; 25, 24 to 48 hours; 40, 2 to 7 days; and 18, more than 7 days. Documented recurrence of any atrial tachyarrhythmia following ablation was significantly lower in patients with baseline AF episode duration of less than 24 continuous hours compared with those with longer AF episodes. Patients with preablation AF episodes limited to less than 24 continuous hours had a significantly lower median postablation AF burden compared with those with AF preablation episodes lasting 2-7 days and those with AF preablation episodes lasting more than 7 days. There was no significant difference in arrhythmia recurrence or AF burden between the 3 groups with a baseline AF episode duration of longer than 24 hours.

Conclusively, patients with AF episodes limited to less than 24 continuous hours had a significantly lower incidence of arrhythmia recurrence following AF ablation. This suggests that current guidelines for classification of AF may not reflect clinical outcomes.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767826
Like
Comment
Share