The DOI matches its Crossref record, with a small difference in title or year; 35 of the 35 references it cites were found in a registry or an index.
Clinical Classifications of Atrial Fibrillation Poorly Reflect Its Temporal Persistence
Open accessAbstract
Objectives This study aimed to identify how accurately the current clinical atrial fibrillation (AF) classifications reflect its temporal persistence.Background Clinical classification of AF is employed to communicate its persistence, to select appropriate therapies, and as inclusion criterion for clinical trials.Methods Cardiac rhythm histories of 1,195 patients (age 73.0 ± 10.1 years, follow-up: 349 ± 40 days) with implantable devices were reconstructed and analyzed. Patients were classified as having paroxysmal or persistent AF by physicians at baseline in accordance with current guidelines. AF burden, measured as the proportion of time spent in AF, was obtained from the device. Additionally we evaluated the agreement between clinical and device-derived AF classifications.Results Patients within the same clinical class were highly heterogeneous with regards to AF temporal persistence. Agreement between the clinical AF classification and the objective device-derived assessments of AF temporal persistence was poor (Cohen's kappa: 0.12 [95% CI: 0.05 to 0.18]). Patient characteristics influenced the clinical decision to classify AF as paroxysmal or persistent. Higher ejection fraction (odds ratio: 0.97/per unit [95% CI: 0.95 to 0.98/per unit]; p < 0.0001) and presence of coronary artery disease (odds ratio: 0.53 [95% CI: 0.32 to 0.88]; p = 0.01) were independently associated with a lower probability of being classified as persistent AF for the same AF burden level.Conclusions The currently used clinical AF classifications poorly reflect AF temporal persistence. Patient characteristics significantly influence the physician's classification of AF. Patients classified in identical clinical categories may be inherently heterogeneous with regard to AF temporal persistence. Further study is required to determine if patient selection on the basis of objective criteria derived from rigorous AF monitoring can improve reported outcomes and better identify responders and non-responders to treatments. (OMNI Study-Assessing Therapies in Medtronic Pacemaker, Defibrillator, and Cardiac Resynchronization Therapy Devices; NCT00277524; TRENDS: A Prospective Study of the Clinical Significance of Atrial Arrhythmias Detected by Implanted Device Diagnostics; NCT00279981).
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Reliance on symptoms alone (by patient or physician) may be misleading-both over and underestimating the presence of AF (Charitos et al., 2014).”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Charitos et al., 2014
Experimental — accuracy not yet measuredIn the citing paper
“Clinically determined AF patterns do not correspond well to the AF burden measured by long-term ECG monitoring.163”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [163]
In the citing paper
“Asymptomatic AF is often undiagnosed41 and is likely underdiagnosed in this study as well.”
From Twelve-single nucleotide polymorphism genetic risk score identifies individuals at increased risk for future atrial fibrillation and stroke (2014) · cites this paper as [41]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,893
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H. G., Cigarroa, J. E., Cleveland, J. C., CONTI, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000041 · Cited by 7,145
Guidelines for the management of atrial fibrillation
Authors/Task Force Members, Camm, A. J., Kirchhof, P. F., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Gelder, I. C. V., Al‐Attar, N., Hindricks, G., et al. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq278 · Cited by 5,924
Atrial Fibrillation Begets Atrial Fibrillation
WIJFFELS, M. C. E. F., Kirchhof, C. J. H. J., Dorland, R., & Allessie, M. A. (1995) · Circulation · doi:10.1161/01.cir.92.7.1954 · Cited by 3,500
Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Le Heuzey, J.-Y., Kay, G. N., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177292 · Cited by 2,805
Cryoballoon Ablation of Pulmonary Veins for Paroxysmal Atrial Fibrillation
Packer, D. L., Kowal, R. C., Wheelan, K. R., Irwin, J. M., Champagne, J., Guerra, P. G., Dubuc, M., Reddy, V. Y., Nelson, L., Holcomb, R. G., et al. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.11.064 · Cited by 919
Glotzer, T. V., Daoud, E. G., Wyse, D. G., Singer, D. E., Ezekowitz, M. D., Hilker, C., Miller, C., Qi, D., & Ziegler, P. D. (2009) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.109.849638 · Cited by 879 · cited 1×
“For the device-derived AF classification, we used the following definitions: no AF: no day with >5 min of AF (11,13,14); paroxysmal AF: at least 1 day with >5 min of AF but <7 consecutive days with >23 h of AF; persistent AF: at least 7 consecutive days with >23 h of AF (15,16); permanent AF: All days with >23 h of AF…”
MethodSelf-citationRadiofrequency ablation as initial therapy in paroxysmal atrial fibrillation
Cosedis Nielsen, J., Johannessen, A., Raatikainen, P., Hindricks, G., Walfridsson, H., Kongstad, O., Pehrson, S., Englund, A., Hartikainen, J., Mortensen, L. S., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1113566 · Cited by 720
Page, R. L., Wilkinson, W. E., Clair, W. K., McCarthy, E. A., & Pritchett, E. L. (1994) · Circulation · doi:10.1161/01.cir.89.1.224 · Cited by 627 · cited 1×
“It is well established that these brief monitoring snapshots do not accurately capture the true arrhythmia status (5,6,29) and that relying on patient symptoms can lead to both under-reporting and over-reporting of AF (3,4,30).”
BackgroundMinimizing Ventricular Pacing to Reduce Atrial Fibrillation in Sinus-Node Disease
Sweeney, M. O., Bank, A. J., Nsah, E., Koullick, M., Zeng, Q. C., Hettrick, D. A., Sheldon, T., & Lamas, G. A. (2007) · New England Journal of Medicine · doi:10.1056/nejmoa071880 · Cited by 518
Flagged first, then by citations
Research works printed but not linked: 1
- Charitos, 2013, Atrial fibrillation density: A novel measure of atrial fibrillation temporal aggregation for the characterization of atrial fibrillation recurrence pattern, Appl Cardiopulm Pathophys, 17, 3
Cited by
Sorted by citations
Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström‐Lundqvist, C., Boriani, G., Castella, M., Dan, G.-A., Dilaveris, P., et al. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehaa612 · Cited by 10,550
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418
“by long-term ECG monitoring.(163) Even less is known about the response to therapy in patients with long-standing persistent AF or long-standing paroxysmal AF.”
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403
Tzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · EP Europace · doi:10.1093/europace/euae043 · Cited by 724
Self-citationAndrade, J. G., Aguilar, M., Atzema, C. L., Bell, A., Cairns, J. A., Cheung, C. C., Cox, J. L., Dorian, P., Gladstone, D. J., Healey, J. S., et al. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.09.001 · Cited by 593
Brundel, B. J. J. M., Ai, X., Hills, M. T., Kuipers, M. F., Lip, G. Y. H., & de Groot, N. M. S. (2022) · Nature Reviews Disease Primers · doi:10.1038/s41572-022-00347-9 · Cited by 545
Brieger, D. B., Amerena, J. V., Attia, J., Bajorek, B. V., Chan, K. H., Connell, C., Freedman, B., Ferguson, C., Hall, T. L., Haqqani, H. M., et al. (2018) · Heart Lung and Circulation · doi:10.1016/j.hlc.2018.06.1043 · Cited by 335
“While classifying patterns of AF has some clinical value, it is often inaccurate and underestimates the temporal persistence of AF captured by continuous ECG monitoring [47].”
Tzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · Heart Rhythm · doi:10.1016/j.hrthm.2024.03.017 · Cited by 323
Self-citationSteinberg, J. S., Varma, N., Cygankiewicz, I., Aziz, P., Balsam, P., Baranchuk, A., Cantillon, D. J., Dilaveris, P., Dubner, S. J., El-Sherif, N., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.038 · Cited by 303
“Reliance on symptoms alone (by patient or physician) may be misleading—both over and underestimating the presence of AF (Charitos et al., 2014).”
BackgroundKrittanawong, C., Rogers, A. J., Johnson, K. W., Wang, Z., Turakhia, M. P., Halperin, J. L., & Narayan, S. M. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-00445-9 · Cited by 248
Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation
Pluymaekers, N. A. H. A., Dudink, E. A. M. P., LUERMANS, J. G. L. M., Meeder, J. G., Lenderink, T., Widdershoven, J. W. M. G., Bucx, J. J. J., Rienstra, M., Kamp, O., van Opstal, J. M., et al. (2019) · New England Journal of Medicine · doi:10.1056/nejmoa1900353 · Cited by 220
Stroke and Mortality Risk in Patients With Various Patterns of Atrial Fibrillation
Link, M. S., Giugliano, R. P., Ruff, C. T., Scirica, B. M., Huikuri, H., Oto, A., Crompton, A. E., Murphy, S. A., Lanz, H., Mercuri, M. F., et al. (2017) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.116.004267 · Cited by 181
Aguilar, M., Macle, L., Deyell, M. W., Yao, R., Hawkins, N. M., Khairy, P., & Andrade, J. G. (2021) · Circulation · doi:10.1161/circulationaha.121.056109 · Cited by 169
Catheter ablation in patients with persistent atrial fibrillation
Kirchhof, P. F., & Calkins, H. G. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw260 · Cited by 156
“vices suggests that the AF pattern (or ‘AF burden’) does not differ too much between patients who have been clinically diagnosed with ‘paroxysmal’ or ‘persistent’ AF.(17) Hence, the mere clinical clas-”
BackgroundAtrial fibrillation burden: a new outcome predictor and therapeutic target
Becher, N., Metzner, A., Toennis, T., Kirchhof, P. F., & Schnabel, R. B. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae373 · Cited by 169
“24 Still, the AF burden is ∼ 10-fold higher in persistent AF than in paroxysmal AF ( Figures 1 and 2 ).”
BackgroundMethodInfluentialProgression of Device-Detected Subclinical Atrial Fibrillation and the Risk of Heart Failure
Wong, J. A., Conen, D., Gelder, I. C. V., McIntyre, W. F., Crijns, H. J. G. M., Wang, J., Gold, M. R., Hohnloser, S. H., Lau, C., Capucci, A., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.03.519 · Cited by 152
“Finally, prior studies are also based on a clinical classification for the pattern of AF, which has been found to correlate poorly with the temporal persistence of the arrhythmia (38).”
MethodFabritz, L., Guasch, E., Antoniades, C. A., Bardinet, I., Benninger, G., Betts, T. R., Brand, E., BREITHARDT, G. E., Suchánková, G., Camm, A. J., et al. (2015) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2015.194 · Cited by 144
Kirchhof, P. F., BREITHARDT, G. E., Bax, J. J., Benninger, G., Blomström‐Lundqvist, C., Boriani, G., Brandes, A., Brown, H., Brueckmann, M., Calkins, H. G., et al. (2015) · EP Europace · doi:10.1093/europace/euv304 · Cited by 143
“Furthermore, the clinical differentiation between ‘paroxysmal’ and ‘persistent’ AF may be poor, suggesting that this differentiation is not reflecting different biology.(110) Clinical conditions that are associated with AF and AF-related complications may vary substantially by AF aetiology, but will overlap.”
BackgroundDoehner, W., Boriani, G., Potpara, T., Blomström‐Lundqvist, C., PASSMAN, R. S., Sposato, L. A., Dobrev, D., Freedman, B., Gelder, I. C. V., Glotzer, T. V., et al. (2025) · EP Europace · doi:10.1093/europace/euaf019 · Cited by 157
Self-citationPathophysiology of Paroxysmal and Persistent Atrial Fibrillation: Rotors, Foci and Fibrosis
Lau, D. H., Linz, D., Schotten, U., Mahajan, R., Sanders, P., & Kalman, J. M. (2017) · Heart Lung and Circulation · doi:10.1016/j.hlc.2017.05.119 · Cited by 140
“implantable device, current clinical AF classification has been shown to poorly reflect the temporal persistence of the arrhythmia.[6] In addition, patients with AF may be asymptomatic, rendering the classification irrelevant.”
BackgroundAssociation of of Atrial Fibrillation Clinical Phenotypes With Treatment Patterns and Outcomes
Inohara, T., Shrader, P. J., Pieper, K. S., Blanco, R. G., Thomas, L. E., Singer, D. E., Freeman, J. V., Allen, L. A., Fonarow, G. C., Gersh, B. J., et al. (2017) · JAMA Cardiology · doi:10.1001/jamacardio.2017.4665 · Cited by 132
Natural History of Subclinical Atrial Fibrillation Detected by Implanted Loop Recorders
Diederichsen, S. Z., Haugan, K., Brandes, A., Lanng, M. B., Graff, C., Krieger, D. W., Kronborg, C., Holst, A. G., Køber, L., Højberg, S., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.09.050 · Cited by 129
Boriani, G., Glotzer, T. V., Ziegler, P., Melis, M. D., Stefano, L. M. D. S., Sepši, M., Landolina, M., Lunati, M., Lewalter, T., & Camm, A. J. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.11.007 · Cited by 120
Self-citationProgress in atrial fibrillation ablation during 25 years of Europace journal
Boersma, L. V. A., Andrade, J. G., Betts, T. R., Duytschaever, M. F., Pürerfellner, H., Santoro, F., Tzeis, S. E., & Verma, A. (2023) · EP Europace · doi:10.1093/europace/euad244 · Cited by 119
“However, when continuous monitoring is employed, patients with assumed PeAF may be found to have paroxysmal AF and vice versa.(93,94) Late gadolinium-enhanced magnetic resonance imaging (MRI) has also shown that the degree of fibrotic remodelling of the atrium correlates little to whether the patient has paroxysmal, p…”
BackgroundSelf-citationSteinberg, J. S., Varma, N., Cygankiewicz, I., Aziz, P. F., Balsam, P., Baranchuk, A. M., Cantillon, D. J., Dilaveris, P., Dubner, S., El‐Sherif, N., et al. (2017) · Annals of Noninvasive Electrocardiology · doi:10.1111/anec.12447 · Cited by 123
“Reliance on symptoms alone (by patient or physician) may be misleading—both over and underestimating the presence of AF (Charitos et al., 2014).”
BackgroundLinz, D., Andrade, J. G., Arbelo, E., Boriani, G., BREITHARDT, G. E., Camm, A. J., Caso, V., Nielsen, J. C., Melis, M. D., Potter, T. J. R. D., et al. (2024) · EP Europace · doi:10.1093/europace/euae070 · Cited by 124
“Refined classifications of AF patterns 73 and ideally AF burden should be incorporated in outcome trials investigating the efficacy of modern rhythm control strategies.”
BackgroundSelf-citationTada, H., Shiffman, D., Smith, J. G., Sjögren, M., Lubitz, S. A., Ellinor, P. T., Louie, J. Z., Catanese, J. J., Engström, G., Devlin, J. J., et al. (2014) · Stroke · doi:10.1161/strokeaha.114.006072 · Cited by 110
Incidence and predictors of atrial fibrillation progression: A systematic review and meta-analysis
Blum, S., Meyre, P. B., Aeschbacher, S., Berger, S., Auberson, C., Briel, M., Osswald, S., & Conen, D. (2018) · Heart Rhythm · doi:10.1016/j.hrthm.2018.10.022 · Cited by 94
Bonomi, A., Schipper, F., Eerikäinen, L. M., Margarito, J., van Dinther, R., Muesch, G., de Morree, H. M., Aarts, R. M., Babaeizadeh, S., McManus, D. D., et al. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.118.009351 · Cited by 86
Incidence and Predictors of Atrial Fibrillation Progression
Blum, S., Aeschbacher, S., Meyre, P. B., Zwimpfer, L., Reichlin, T., Beer, J. H., Ammann, P., Auricchio, A., Kobza, R., Erné, P., et al. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.119.012554 · Cited by 87
Boriani, G., & Pettorelli, D. (2016) · Vascular Pharmacology · doi:10.1016/j.vph.2016.03.006 · Cited by 85
Atrial Fibrillation Burden Signature and Near-Term Prediction of Stroke
Han, L., Askari, M., Altman, R. B., Schmitt, S. K., Fan, J., Bentley, J., Narayan, S. M., & Turakhia, M. P. (2019) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.118.005595 · Cited by 79
Chew, D. S., Li, Z., Steinberg, B. A., O’Brien, E. C., Pritchard, J. E., Bunch, T. J., Mark, D. B., Patel, M. R., Nabutovsky, Y., Greiner, M. A., et al. (2022) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.121.010304 · Cited by 79
Montserrat, S., Gabrielli, L., Bijnens, B. H., Borràs, R., Berruezo, A., Poyatos, S., Brugada, J., Mont, L., & Sitges, M. (2014) · Heart Rhythm · doi:10.1016/j.hrthm.2014.08.032 · Cited by 78
Tzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · Journal of Arrhythmia · doi:10.1002/joa3.13082 · Cited by 76
Self-citationPersistent atrial fibrillation: A systematic review and meta-analysis of invasive strategies
Berger, W. R., Meulendijks, E. R., Limpens, J., van den Berg, N. W. E., Neefs, J., Driessen, A. H. G., Krul, S. P. J., van Boven, W. J., & de Groot, J. R. (2018) · International Journal of Cardiology · doi:10.1016/j.ijcard.2018.11.127 · Cited by 66
Lee, R. J., & Mittal, S. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.09.009 · Cited by 65
Tzeis, S. E., Gerstenfeld, E. P., Kalman, J. M., Saad, E., Shamloo, A. S., Andrade, J. G., Barbhaiya, C. R., Baykaner, T., Bovéda, S., Calkins, H. G., et al. (2024) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-024-01771-5 · Cited by 66
Self-citationEHRA White Paper: knowledge gaps in arrhythmia management—status 2019
Goette, A., Auricchio, A., Boriani, G., Braunschweig, F., Brugada, J., Burri, H., Camm, A. J., Crijns, H. J. G. M., Dagres, N., Deharo, J., et al. (2019) · EP Europace · doi:10.1093/europace/euz055 · Cited by 57
“While this classification does carry some prognostic weight, for example regarding the risk of stroke as well as mortality, it falls short in many other regards.(30) Importantly, the success of AF ablation both in patients with paroxysmal as well as in persistent AF is highly variable.”
BackgroundSelf-citationAnticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h
Becher, N., Toennis, T., Bertaglia, E., Blomström‐Lundqvist, C., Brandes, A., Cabanelas, N., Calvert, M., Camm, A. J., CHLOUVERAKIS, G. I., Dan, G., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad771 · Cited by 53
“The arrhythmia burden in a patient with ECG-diagnosed AF not undergoing rhythm control is likely to be higher (estimated at 11% 19 ).”
BackgroundLuongo, G., Azzolin, L., Schuler, S., Rivolta, M. W., de Almeida, T. P., Martínez, J. P., Soriano, D. C., Luik, A., Müller‐Edenborn, B., Jadidi, A., et al. (2021) · Cardiovascular Digital Health Journal · doi:10.1016/j.cvdhj.2021.03.002 · Cited by 46
“This classification, however, is based on observed AF episodes, and it might correlate poorly with the actual AF burden—and, consequently, with the extension of substrate remodeling—in many patients.(16) Moreover, in the case of extra-PV drivers, a subsequent classification whether the left atrium (LA) or right atrium…”
BackgroundRomanov, A. B., Martinek, M., Pürerfellner, H., Chen, S., Melis, M. D., Grazhdankin, I. O., Ponomarev, D., Losik, D., Григорьевич, С. А., Шабанов, В. В., et al. (2016) · EP Europace · doi:10.1093/europace/euw344 · Cited by 47
“More recently, a pooled-analysis from the OMNI and the TRENDS trials with over 1100 patients with implanted devices demonstrated that the clinical AF diagnosis was significantly discordant with the device-derived AF classification.(6) These data reveal that there is a ‘blinding and blurring’ of the AF diagnosis in the…”
MethodSelf-citationAblation to Reduce Atrial Fibrillation Burden and Improve Outcomes
Schwennesen, H. T., Andrade, J. G., Wood, K., & Piccini, J. P. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.06.029 · Cited by 53
Oluleye, O. W., Rector, T. S., Win, S., McMurray, J. J. V., Zile, M. R., Michel Komajda, N., McKelvie, R. S., Massie, B. M., Carson, P. E., & Anand, I. S. (2014) · Circulation Heart Failure · doi:10.1161/circheartfailure.114.001523 · Cited by 43
Artificial intelligence for a personalized diagnosis and treatment of atrial fibrillation
Nava, A., Atienza, F., Bermejo, J., & Fernández‐Avilés, F. (2021) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00764.2020 · Cited by 43
Knecht, S., Pradella, M., Reichlin, T., Mühl, A., Bossard, M., Stieltjes, B., Conen, D., Bremerich, J., Osswald, S., Kühne, M., et al. (2016) · EP Europace · doi:10.1093/europace/euw376 · Cited by 40
“It has been shown that, despite being classified in identical categories, patients may be inherently heterogeneous with regards to AF burden.(19) The herein used score comprising the frequency of episodes, the duration of the (longest) episode, and the cumulative burden of episodes to assess symptomatic AFB based on a…”
BackgroundInfluence of atrial fibrillation type on outcomes of ablation vs. drug therapy: results from CABANA
Monahan, K. H., Bunch, T. J., Mark, D. B., Poole, J. E., Bahnson, T. D., Al‐Khalidi, H. R., Silverstein, A. P., Daniels, M. R., Lee, K. L., Packer, D. L., et al. (2022) · EP Europace · doi:10.1093/europace/euac055 · Cited by 39
Morishima, I., Okumura, K., Morita, Y., Kanzaki, Y., Takagi, K., Yoshida, R., Nagai, H., Ikai, Y., Furui, K., Yoshioka, N., et al. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.118.009158 · Cited by 35
“However, recent reports have highlighted the heterogeneity within patients with paroxysmal AF, indicating that a subgroup of paroxysmal AF has the same arrhythmia substrate as nonparoxysmal AF and is resistant to PVI as a result.(15,16) The ablation strategy taken in the present study was mostly limited to PVI.”
BackgroundBowyer, J., Tully, P. J., Ganesan, A. N., Chahadi, F. K., Singleton, C. B., & McGavigan, A. D. (2016) · Heart Lung and Circulation · doi:10.1016/j.hlc.2016.04.024 · Cited by 37
“A paradox of AF, however, is that the actual burden of AF-related symptoms frequently has a limited relationship to the actual presence of AF[45,46].”
BackgroundA New Therapeutic Framework for Atrial Fibrillation Drug Development
Ang, Y.-S., Rajamani, S., Haldar, S. M., & Hüser, J. (2020) · Circulation Research · doi:10.1161/circresaha.120.316576 · Cited by 38
Risk Factors for Atrial Fibrillation Progression
Heijman, J., LUERMANS, J. G. L. M., Linz, D., Gelder, I. C. V., & Crijns, H. J. G. M. (2021) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2020.10.011 · Cited by 35
Berntsson, J., Smith, J. G., Johnson, L., Söderholm, M., Borné, Y., Melander, O., Orho‐Melander, M., Nilsson, J. Å., & Engström, G. (2018) · Heart · doi:10.1136/heartjnl-2018-313684 · Cited by 34
Wolfes, J., Ellermann, C., Frommeyer, G., & Eckardt, L. (2022) · Reviews in Cardiovascular Medicine · doi:10.31083/j.rcm2302056 · Cited by 32
“Although AF duration is a classification suggested by the three guidelines and relatively easy to define at first glance, this classification bares some shortcomings to be mentioned in the following: (1) the anamnestic AF pattern does not necessarily correlate with the AF burden in ECG monitoring [7], (2) AF duration…”
BackgroundAtrial fibrillation patterns are associated with arrhythmia progression and clinical outcomes
Schnabel, R. B., Pecen, L., Engler, D., Lucerna, M., Sellal, J., Ojeda, F., Caterina, R. D., & Kirchhof, P. F. (2018) · Heart · doi:10.1136/heartjnl-2017-312569 · Cited by 32
Impact of Atrial Fibrillation Burden on Health Care Costs and Utilization
Peigh, G., Zhou, J., Rosemas, S. C., Roberts, A. I., Longacre, C. F., Nayak, T., Schwab, G., Soderlund, D. M., & PASSMAN, R. S. (2024) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2023.12.011 · Cited by 32
Sanders, P., Svennberg, E., Diederichsen, S. Z., Crijns, H. J. G. M., Lambiase, P. D., Boriani, G., & Gelder, I. C. V. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae365 · Cited by 35
Reddy, V. Y., Langbein, A., Petrů, J., Szili‐Törok, T., Funasako, M., Dinshaw, L., Wijchers, S. A., Rillig, A., Spitzer, S. G., Bhagwandien, R. E., et al. (2024) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2024.03.040 · Cited by 29
Positionspapier zur Detektion von Vorhofflimmern nach ischämischem Schlaganfall
Häusler, K., Gröschel, K., Köhrmann, M., Schnabel, R. B., Anker, S. D., Brachmann, J., Böhm, M., Diener, H., Doehner, W., Endres, M., et al. (2017) · Aktuelle Neurologie · doi:10.1055/s-0043-118476 · Cited by 27
“…derzeit keine Be-rücksichtigung finden, zumal die klinische Klassifikation des Vorhofflimmer-Typs bei einem relevanten Anteil von Patienten nicht korrekt erfolgt, wenn die klinische Präsentation und klinisch indizierte EKGs, nicht jedoch eine Schrittmacherabfrage berücksichtigt werden [41].”
Wolfes, J., Ellermann, C., Frommeyer, G., & Eckardt, L. (2025) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2024.12.018 · Cited by 27
Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström‐Lundqvist, C., Boriani, G., Castellà, M., Dan, G., Dilaveris, P., et al. (2021) · Revista Española de Cardiología · doi:10.1016/j.recesp.2020.10.022 · Cited by 34
Zaman, J. A. B., Baykaner, T., Clopton, P., Swarup, V., Kowal, R. C., Daubert, J. P., Day, J. D., Hummel, J. D., Schricker, A. A., Krummen, D. E., et al. (2017) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2016.10.006 · Cited by 26
“Indeed, studies suggest that PAF is a heterogeneous population that may overlap with persistent AF (7), which may have substrate mechanisms remote from the PVs.”
Subclinical Atrial Fibrillation and Risk of Stroke: Past, Present and Future
AlTurki, A., Marafi, M., Russo, V., Proietti, R., & Essebag, V. (2019) · Medicina · doi:10.3390/medicina55100611 · Cited by 27
“Charitos and colleagues showed that while the majority of patients with AF are clinically classified as paroxysmal AF, this correlates poorly with the temporal persistence of AF based on continuous device monitoring [47].”
BackgroundHolter ECG for pacemaker/defibrillator carriers: what is its role in the era of remote monitoring?
Diemberger, I., Gardini, B., Martignani, C., Ziacchi, M., Corzani, A., Biffi, M., & Boriani, G. (2015) · Heart · doi:10.1136/heartjnl-2015-307614 · Cited by 24
Charitos, E. I., Ziegler, P., Stierle, U., Graf, B., Sievers, H., & Hanke, T. (2015) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1093/icvts/ivv248 · Cited by 23
“In the present study, we could reproduce a previously published finding [24] that the duration of AF as derived from the patient’s history and not the clinical AF classification was associated with increased AF burden development post-ablation.”
MethodResultSelf-citationvan Wijk, S. W., Ramos, K. S., & Brundel, B. J. J. M. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22010442 · Cited by 23
“Currently, accurate staging of AF lacks sophisticated diagnostic tools, which hampers the selection of patient-tailored therapy [9].”
BackgroundSandgren, E., Wickbom, A., Kalm, T., Ahlsson, A., Edvardsson, N. G., & Engdahl, J. (2021) · Heart Rhythm O2 · doi:10.1016/j.hroo.2021.05.001 · Cited by 22
“It is established that continuous ECG monitoring with an ILR captures significantly more paroxysmal episodes of AF than noninvasive modalities, and routine clinical AF classification based on intermittent ECG monitoring poorly reflects AF temporal persistence.(26) The ILR is capable of assessing the AF burden from the…”
BackgroundPrimary Persistent Atrial Fibrillation: A Distinct Arrhythmia Subentity of an Ablation Population
Konrad, T., Theis, C., Mollnau, H., Sonnenschein, S., Ocete, B. Q., Bock, K., Münzel, T. F., & Rostock, T. (2015) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12818 · Cited by 21
Ding, W. Y., Proietti, M., Boriani, G., Fauchier, L., Blomström‐Lundqvist, C., Marín, F. R., Potpara, T., Lip, G. Y. H., the ESC-EHRA EORP-AF Long-Term General Registry Investigators, Boriani, G., et al. (2021) · EP Europace · doi:10.1093/europace/euab280 · Cited by 21
Ejima, K., Henmi, R., Iwanami, Y., Yagishita, D., Shoda, M., & Hagiwara, N. (2017) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13159 · Cited by 20
Long-term risk of adverse outcomes according to atrial fibrillation type
Blum, S., Aeschbacher, S., Coslovsky, M., Meyre, P. B., Reddiess, P., Ammann, P., Erné, P., Moschovitis, G., Valentino, M. D., Shah, D. C., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-05688-9 · Cited by 20
Liu, D., Han, X., Zhang, Z., Tse, G., Shao, Q., & Liu, T. (2022) · Cells · doi:10.3390/cells12010151 · Cited by 19
Peigh, G., Zhou, J., Rosemas, S. C., Roberts, A. I., Longacre, C. F., Trinh, K. V., Nayak, T., Soderlund, D. M., & PASSMAN, R. S. (2024) · Circulation · doi:10.1161/circulationaha.124.069757 · Cited by 20
“5,7 If a device detected AF through embedded algorithms”
Berntsson, J., Smith, J. G., Nilsson, P. M., Hedblad, B., Melander, O., & Engström, G. (2017) · European Journal of Preventive Cardiology · doi:10.1177/2047487317693948 · Cited by 20
“Furthermore, many individuals with AF are undiagnosed and asymptomatic.(35) However, previous validation studies from these registers have shown high case validity for these diagnoses.”
BackgroundPersistent Atrial Fibrillation Ablation: Where Do We Go From Here?
Verma, A., & Macle, L. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.08.008 · Cited by 20
Blum, S., & Conen, D. (2022) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2022.10.013 · Cited by 21
Integrated care of patients with atrial fibrillation: the 2016 ESC atrial fibrillation guidelines
Kirchhof, P. F. (2017) · Heart · doi:10.1136/heartjnl-2016-310843 · Cited by 18
Baysal, E., Okşul, M., Burak, C., Yalın, K., Soysal, A. U., Yalman, H., Bozyel, S., Güler, T. E., Tanboğa, İ. H., & Aksu, T. (2022) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-022-01167-3 · Cited by 18
Agnino, A., Giroletti, L., Graniero, A., Gerometta, P., Parrinello, M., Albano, G., Celentano, E., Cristiano, E., Nasso, G., & de Groot, N. M. S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13061563 · Cited by 17
An, Y., Ogawa, H., Esato, M., Ishii, M., Iguchi, M., Masunaga, N., Aono, Y., Ikeda, S., Doi, K., Tsuji, H., et al. (2019) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2019.07.048 · Cited by 17
Inflammatory proteomics profiling for prediction of incident atrial fibrillation
Börschel, C. S., Ortega‐Alonso, A., Havulinna, A. S., Jousilahti, P., Salmi, M., Jalkanen, S., Salomaa, V. V., Niiranen, T., & Schnabel, R. B. (2023) · Heart · doi:10.1136/heartjnl-2022-321959 · Cited by 16
Eckardt, L., Deneke, T., Diener, H., Hindricks, G., Hoffmeister, H. M., Hohnloser, S. H., Kirchhof, P. F., & Stellbrink, C. (2017) · Der Kardiologe · doi:10.1007/s12181-017-0141-5 · Cited by 16
“Schrittmacherabfragen zeigen eine sehr schlechte Korrelation zwischen der klinischen Einteilung in paroxysmales oder persistierendesAF und der tatsächlichen AF-Last der Patienten [9].”
BackgroundNovel Low-Voltage MultiPulse Therapy to Terminate Atrial Fibrillation
Ng, F. S., Toman, O., Petrů, J., Peichl, P., Winkle, R. A., Reddy, V. Y., Neužil, P., Mead, R. H., Qureshi, N. A., Whinnett, Z. I., et al. (2021) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2020.12.014 · Cited by 16
Brundel, B. J. J. M., Ai, X., Hills, M. T., Kuipers, M. F., Lip, G. Y. H., & de Groot, N. M. S. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.17 · Cited by 18
Xing, L. Y., Diederichsen, S. Z., Højberg, S., Krieger, D. W., Graff, C., OLESEN, M. S., Nielsen, J. B., Brandes, A., Køber, L., Haugan, K., et al. (2023) · EP Europace · doi:10.1093/europace/euad014 · Cited by 15
“0% among paroxysmal AF patients with cardiac implantable electronic device (CIED).(25) However, this difference comes as no surprise, since our study population exclusively comprised AF-naïve subjects at baseline, with an average time of 1.”
BackgroundSzili‐Törok, T., Neužil, P., Langbein, A., Petrů, J., Funasako, M., Dinshaw, L., Wijchers, S. A., Bhagwandien, R. E., Rillig, A., Spitzer, S. G., et al. (2023) · Heart Rhythm O2 · doi:10.1016/j.hroo.2023.04.001 · Cited by 15
“OBJECTIVE The primary objective of the FLOW-AF trial is to evaluate the reliability of the EGF algorithm technology (Ablamap software) to identify AF sources and guide ablation therapy in patients with persistent AF.”
BackgroundInfluentialCho, S., Kim, J., Kim, J., Park, J., Park, J., Kang, K., Uhm, J., Choi, E., Lee, Y. S., Park, H. W., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-63370-4 · Cited by 15
Dekker, L., Pokushalov, E. A., Sanders, P., Lindborg, K. A., Maus, B., & Pürerfellner, H. (2016) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12897 · Cited by 14
Self-citationDifferentiating Paroxysmal From Persistent Atrial Fibrillation
Mittal, S. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.04.020 · Cited by 14
“(2) provide compelling evidence to challenge this premise.”
BackgroundMethodInfluentialHennings, E., Coslovsky, M., Paladini, R. E., Aeschbacher, S., Knecht, S., Schlageter, V., Krisai, P., Badertscher, P., Sticherling, C., Osswald, S., et al. (2023) · Cardiovascular Digital Health Journal · doi:10.1016/j.cvdhj.2023.01.003 · Cited by 15
Charitos, E. I., Herrmann, F. E. M., & Ziegler, P. (2021) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15126 · Cited by 12
“Data from CM devices provide the opportunity to quantify AF recurrence,(5) identify patterns of AF recurrence and its temporal aggregation,(10) and provide a more quantitative AF classification.(9) The aim of the present work was two‐fold.”
BackgroundMethodInfluentialSelf-citationInsights into the Role of Galectin-3 as a Diagnostic and Prognostic Biomarker of Atrial Fibrillation
Kia, Y. M., Cannavò, A., Bahiraie, P., Alilou, S., Saeedian, B., Babajani, N., Ghondaghsaz, E., Khalaji, A., & Behnoush, A. H. (2023) · Disease Markers · doi:10.1155/2023/2097012 · Cited by 13
Ablation of atrial fibrillation
Wright, M. J., & Narayan, S. M. (2014) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2014.11.009 · Cited by 12
“[24] Charitos EI, Purerfellner H, Glotzer TV, Ziegler PD.”
BackgroundPiccini, J. P., Clark, R. L., Kowey, P. R., Mittal, S., Dunnmon, P. M., Stockbridge, N., Reiffel, J. A., Turakhia, M. P., Ziegler, P., Kleiman, R., et al. (2017) · American Heart Journal · doi:10.1016/j.ahj.2017.01.012 · Cited by 12
“In this study, authors observed that fewer than 50% of patients diagnosed with paroxysmal AF truly had paroxysmal AF that terminated within 7 days as defined by continuous device monitoring.(13) Given these contributions in the clinical and arrhythmia science realm, how can “big data” in heart rhythm diagnostics posit…”
BackgroundSelf-citationIdentifying Atrial Fibrillation Mechanisms for Personalized Medicine
Deb, B., Ganesan, P., Feng, R., & Narayan, S. M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10235679 · Cited by 12
“While clinically useful, patients grouped by these detected AF episode durations overlap considerably in their actual AF burdens on implanted monitors [10] and their response to drug or ablation therapy [11–15].”
BackgroundPI3K(p110α) as a determinant and gene therapy for atrial enlargement in atrial fibrillation
Ezeani, M., & Prabhu, S. (2022) · Molecular and Cellular Biochemistry · doi:10.1007/s11010-022-04526-w · Cited by 11
Imaging Mass Spectrometry for Characterization of Atrial Fibrillation Subtypes
Klein, O., Hanke, T., Nebrich, G., Yan, J., Schubert, B., Giavalisco, P., NOACK, F., Thiele, H., & Mohamed, S. A. (2018) · PROTEOMICS - CLINICAL APPLICATIONS · doi:10.1002/prca.201700155 · Cited by 12
Zeemering, S., Borof, K., Schotten, U., Obergassel, J., Camm, A. J., Crijns, H. J. G. M., Eckardt, L., Fabritz, L., Goette, A., Habibi, Z., et al. (2025) · EClinicalMedicine · doi:10.1016/j.eclinm.2025.103457 · Cited by 13
“24 The same method was also used to estimate recurrent AF in the GAPAF-AFNET 1 25 and in the Flec SL-AFNET 3 trials.”
Peigh, G., Koehler, J. L., Majumder, S., Cho, Y. W., Landman, S. R., Sarkar, S., Ziegler, P., & PASSMAN, R. S. (2024) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2024.06.020 · Cited by 11
Self-citationEspnes, H., Ball, J., Løchen, M., Wilsgaard, T., Njølstad, I., Mathiesen, E. B., Gerdts, E., & Sharashova, E. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10071514 · Cited by 12
“It has also been shown that pre-hypertension (blood pressure between 120–139/80–89 mmHg and no antihypertensive medication use) is associated with a higher risk of AF [24], which is consistent with our finding of an increased risk of AF for an SBP of 130 mmHg compared to an SBP of 120 mmHg.”
Result
Metadata
- Authors
- Charitos, E. I., Pürerfellner, H., Glotzer, T. V., & Ziegler, P. D.
- Affiliations
- University of Lübeck (DE)
- Krankenhaus der Elisabethinen (AT)
- Hackensack University Medical Center (US)
- Medtronic (United States) (US)
- Corresponding author
- Charitos, Efstratios I.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-07
- Volume
- 63
- Issue
- 25
- Pages
- 2840-2848
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W191924134
- Cited by
- 188
- References
- 35
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 23 · 2023: 11 · 2022: 14 · 2021: 20 · 2020: 15 · 2019: 9 · 2018: 17 · 2017: 18 · 2016: 13 · 2015: 15 · 2014: 7
- FWCI
- 12.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- atrial fibrillation, temporal persistence, clinical classification, paroxysmal atrial fibrillation, persistent atrial fibrillation, atrial fibrillation burden, cardiac implantable electronic devices, ejection fraction, coronary artery disease, patient selection
- MeSH terms
- Aged, Atrial Fibrillation, Equipment Design, Female, Heart Rate, Humans, Male, Middle Aged, Monitoring, Physiologic, Prospective Studies, Treatment Outcome, Cardiac Resynchronization Therapy Devices
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
