Page 39 - Read Online

Pardo et al. Vessel Plus 2022;6:36 https://dx.doi.org/10.20517/2574-1209.2021.120 Page 5 of 20

Table 1. POAF characteristics
AHA ACC
Characteristics - subcomponents STS AATS ACS SCAI ACCP HFSA ESC Count
& HRS
EKG finding Absence of P waves * * * 3
Irregular RR intervals * * * 3
Episode duration < 30 s * 1
> 30 s * 1
> 1 h * 1
First observation New onset POAF: < 48 h * 1
timing Persistent POAF: > 48 h * 1
Symptoms Severe hypotension * * 2
Acute MI * 1
Ischemia * 1
Pulmonary edema/HF * * 2
Chest pain * 1
Syncope * 1
Asymptomatic * 1
General Def. Clinically significant POAF: requires rhythm control, * 1
anti-coagulation, and/or extends hospitalization
New-onset POAF: working diagnosis in a patient w/o * 1
history of AF
POAF definition: atrial fibrillation requiring treatment * 1
Inclusivity Restrictive * * * 3
Inclusive * * 2
3 11 0 8 0 2 0 2

POAF definitions among ten professional medical societies with “*” designating inclusion of criteria. Rows and columns are tallied up. The table
provided is not meant to be an exhaustive set of definitions provided by the respective societies to account for training manuals or other such
material not available to the public [1,2,6,8-13] . POAF: Post-operative atrial fibrillation; STS: Society of Thoracic Surgeons; AATS: American
Association for Thoracic Surgery; AHA: American Heart Association; ACC: American College of Cardiology; HRS: Heart Rhythm Society; ACS:
American College of Surgeons; SCAI: Society for Cardiovascular Angiography and Interventions; ACCP: American College of Chest Physicians;
HFSA: Heart Failure Society of America; ESC: European Society of Cardiology; HF: heart failure; EKG: Electrocardiogram; RR: RR the time between
two consecutive QRS signals' R waves.

The STS’s POAF definition described in [Table 1] was updated in 2014. Prior to this update, its definition
was “atrial fibrillation requiring treatment”, and this was the most frequently referenced by independent
manuscripts (n = 13/71; 18%).

Tables 2 and 3 classify the POAF definitional characteristics from the 51 independent manuscripts. Specific
electrocardiogram characteristics were most frequently mentioned at 86% (n = 44) along with new-onset
POAF (53%; n = 27). All but one publication stated that the clinical significance of a POAF episode should
be less than or equal to one hour; thus, there was the most uniformity in this PAOF component. While not
clearly a majority, the largest consensus among publications (n = 22/71; 31%) considered at least 30 s to be
clinically significant POAF; this was a point also shared by professional societies where 2 of the 3 that noted
episode duration criteria also used 30 s as their standard.

Based on this detailed review, great variability was observed across all three tables. In [Table 1] 76%
(n =13/17) of the criteria used was used by only one society. In [Table 2] 71% (n = 20/28) of the criteria was
used by only one independent manuscript and in [Table 3] it was 42% (n = 8/19). Of all of the criteria used
to compare societies and independent manuscripts, the criteria for both electrocardiogram findings and
episode duration were the only categories that reached a consensus (i.e., reported above 50%).