Clinical assessment of AF pattern is poorly correlated with AF burden and post ablation outcomes: A CIRCA-DOSE sub-study
Clinical assessment of AF pattern is poorly correlated with AF burden and post ablation outcomes: A CIRCA-DOSE sub-study
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DOI：
10.1016/j.jelectrocard.2020.03.008
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发表时间：
2020-05-01
影响因子：
1.3
通讯作者：
Khairy, Paul
中科院分区：
文献类型：
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作者：
Andrade, Jason G.;Yao, Robert R. J.;Khairy, Paul
背景：当代指南建议根据临床评估将房颤（AF）分为阵发性和持续性房颤，这些分类构成了治疗建议的基础。虽然实用，临床评估可能会引入误分类错误，这可能会影响治疗决策。我们试图确定房颤分类、基线房颤负担和消融后心律失常结果之间的关系。设计：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。所有参加CIRCA-DOSE的346例患者在消融前平均72天接受植入式心脏监护仪。根据植入器械前的临床评估，将房颤分为低负荷阵发性、高负荷阵发性和持续性。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、房颤负担和消融后心律失常结局之间的相关性。结果：临床和基于器械的房颤分类不一致（Cohen’s kappa: 0.192）。消融前连续监测得出的房颤分类反映基线和消融后房颤负担的准确性更高，房颤分类之间的重叠较少（所有分类比较P < 0.01）。通过持续监测数据客观归类为“低负担”发作的患者与归类为“高负担”发作（AF/AT/AFL复发的风险比[HR] 0.57）或持续性AF （AF/AT/AFL复发的HR 0.19）的患者相比，AF/AT/AFL复发的自由度显著增加。结论：基于消融前持续心律监测的房颤模式分类能更好地预测房颤负担和消融后房颤复发的自由程度。尽管使用了标准化的定义，但基于临床评估的房颤分类并不能预测房颤的基线负担、消融后房颤负担或消融后房颤复发的自由。(C) 2020爱思唯尔公司版权所有。
Background: 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.Design: 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.Results: 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 andwith 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).Conclusions: 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. (C) 2020 Elsevier Inc. All rights reserved.