Perspective:

There may be several reasons that help explain the discordance between clinical and device-based AF behavior. For example, after an initial episode of AF, patients may go several years without recurrence. In this study, one-third of the patients experienced no AF during the follow-up period, making it impossible to assess the validity of the clinical classification. The authors also report that a patient’s comorbidities often influenced the clinician’s adjudication, as opposed to the actual arrhythmia duration. Also, many patients in the current study had advanced heart disease, which makes it difficult to generalize the results to patients with AF at large. Last, little information is available regarding antiarrhythmic usage, which obviously impacts AF burden. To be sure, continuous monitoring is the ideal method to assess arrhythmia burden and follow response to intervention. Nevertheless, the current clinical classification scheme distinguishing paroxysmal from persistent and longstanding persistent AF is simple, clinically useful, and has been shown to be prognostically important.