Impact of re-definition of paroxysmal and persistent atrial fibrillation in the 2012 and 2016 European Society of Cardiology atrial fibrillation guidelines on outcomes after pulmonary vein isolation

Karolina Weinmann,Tillman Dahme,Tilman Stephan,Wolfgang Rottbauer,Alexander Pott,Manuel Rattka,Carlo Bothner,Deniz Aktolga

doi:10.1007/s10840-020-00710-4

Karolina Weinmann, Tillman Dahme + Show 6 more

Open Access

https://doi.org/10.1007/s10840-020-00710-4

Copy DOI

Abstract

PurposeIn the 2016 European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF), the definition of AF type has been modified compared with the 2010 guidelines and its 2012 focused update. We compared the difference of single procedure outcomes using the definitions before and after 2016 on a cohort of patients with AF undergoing AF ablation.MethodsConsecutive AF ablation patients with paroxysmal or persistent AF were retrospectively reclassified applying the 2010, 2012, and 2016 ESC definitions on AF type.ResultsWe included a total of 628 patients. Applying the 2010 ESC AF guidelines definition, 68% of patients were paroxysmal while according to the 2016 ESC AF guidelines, the proportion increased to 87%. Applying the 2010 ESC guidelines definition, recurrence rates of paroxysmal and persistent AF patients differ significantly (log-rank p < 0.001). Applying the 2012 focused update and the 2016 ESC AF guidelines, recurrence rates do not differ significantly. In a cox regression model applying the 2010 guidelines, persistent AF is the only independent predictor of AF recurrence in our cohort. However, when applying the 2016 guidelines, persistent AF is no longer a predictor of AF recurrence.ConclusionsThe revised definition of AF types in the 2016 ESC AF guidelines leads to a marked shift from persistent to paroxysmal AF. It appears that the old definition provided a better separator to predict rhythm outcome after AF ablation.

Highlights

Guidelines summarize and evaluate current knowledge on a particular topic to determine evidence-based standards and serve as guidance for physicians for therapeutic management
In the 2016 European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF), the definition of AF type has been modified compared with the 2010 guidelines for the management of AF and its 2012 focused update
In the 628 patients, we identified 2476 pulmonary veins; all of these were isolated with the cryoballoon without any additional touch-up ablations

Summary

Introduction

Guidelines summarize and evaluate current knowledge on a particular topic to determine evidence-based standards and serve as guidance for physicians for therapeutic management. AF in patients with spontaneous conversion into sinus rhythm within 7 days is defined as paroxysmal, whereas patients without spontaneous conversion into sinus rhythm within 7 days or need for cardioversion are labeled persistent in the 2010 ESC guidelines [2]. In the 2012 focused update, patients with active conversion into sinus rhythm either with drugs or by direct current cardioversion within 48 h that would have been persistent according to the 2010 guidelines were labeled paroxysmal [2]. In the 2016 ESC guidelines, all patients with AF lasting up to 7 days and spontaneous conversion or termination by cardioversion either with drugs or by direct current cardioversion are labeled paroxysmal. Patients with active conversion to sinus rhythm within 7 days after onset of AF are labeled paroxysmal in the 2016 ESC guidelines because their probability of

Methods

Results

Conclusion