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J Thorac Cardiovasc Surg 2003;126:1686-1692
© 2003 The American Association for Thoracic Surgery

Editorial

Atrial fibrillation I: a new classification system

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo, USA

Received for publication May 30, 2003; accepted for publication June 9, 2003.

^* Address for reprints: James L. Cox, MD, 13523 Rosewood Ln, Naples, FL 34119, USA
jamescoxmd@aol.com

The first 300 words of the full text of this article appear below.

In the past, many relatively simple electrophysiologic concepts were made to seem complex because of the confusing and inconsistent terminology used to describe them. For example, the terms nonuniform refractoriness, inhomogeneous recovery, nonuniform repolarization, dispersion of refractoriness, and desynchronized repolarization all refer to the same electrophysiologic abnormality. We are now facing a similar problem with atrial fibrillation. Previously, atrial fibrillation could be treated within acceptable standards by physicians who possessed only a superficial understanding of the arrhythmia itself because the only options for treatment were rhythm-control or rate-control drugs. However, the recent introduction of surgical and catheter interventional treatment for atrial fibrillation has changed the requirements for therapeutic competence and, as a result, has generated the usual bewildering terminology that occurs when an entity is poorly understood and has no accurate classification system.

The confusing terminology surrounding atrial fibrillation has resulted in faulty concepts, unsound treatment schemes, and misleading claims regarding the results of interventional therapy. This problem stems primarily from the vague meaning and multiple uses of the term chronic. The descriptors paroxysmal and chronic have traditionally been used to characterize atrial fibrillation clinically, although their precise meaning has never been clarified. Most authors, including this one, have used the term paroxysmal to denote episodic or intermittent atrial fibrillation and the term chronic to denote continuous, unrelenting atrial fibrillation, both terms being applied without regard to how long the patient had the fibrillation. Recently, however, the term chronic has been used to describe atrial fibrillation of long duration, regardless of whether the atrial fibrillation is intermittent or continuous.

Because chronic in other areas of medicine means long standing, it is understandable that the term has evolved to describe long-standing atrial fibrillation. However, because chronic, when applied to atrial fibrillation, has traditionally meant continuous, . . . [Full Text of this Article]

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