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. Author manuscript; available in PMC: 2013 Jun 12.
Published in final edited form as: Circulation. 2012 Jun 12;125(23):2933–2943. doi: 10.1161/CIRCULATIONAHA.111.069450

Table 2.

Selected scoring systems for symptoms related to AF.

Measure, Year Described Description Scores Design/Validation Cohort Comments/Limitations
Symptom Checklist - Frequency and Severity Scale,62–65 1989 Score based on severity and frequency of symptoms (palpitations, dyspnea, dizziness, exercise intolerance, chest discomfort, and syncope) 0–64 for frequency
0–48 for severity		 Validated in multiple cohorts (pacemaker, atrioventricular node ablation for AF, radiofrequency catheter ablation for supraventricular arrhythmias, and pulmonary vein ablation for AF) Advantages:

  • Most extensively validated

  • Reproducible
Limitations:

  • Relatively time-consuming

  • Uncertain generalizability

University of Toronto Atrial Fibrillation Severity Scale,66–69 1998 14-item disease-specific scale - subjective and objective ratings of AF disease burden, including frequency, duration, and patient perceived severity of episodes, and health care utilization 3–30 Validated in patients with paroxysmal and persistent AF, included in the Canadian Trial of Atrial Fibrillation Advantages:

  • Validated and reproducible
Limitations:

  • Relatively time-consuming

  • Uncertain generalizability

Canadian Cardiovascular Society Severity of Atrial Fibrillation Scale,70,71 2009 Score determined using three steps:

  1. Identification of the major AF-related symptoms (palpitations, dyspnea, dizziness/syncope, chest pain, weakness/fatigue)

  2. Determination of symptom-rhythm correlation

  3. Assessment of symptom impact on daily activities and quality of life

 0–4 Designed by members of the Primary Panel of the Canadian Cardiovascular Society Consensus Conference on Atrial Fibrillation Advantages:

  • Simple

  • Correlates with SF-36 quality of life scores and University of Toronto Atrial Fibrillation Severity Scale
Validated in large cohort of paroxysmal, persistent and permanent AF Limitations:

  • Rather poor correlation with subjective AF burden

  • Uncertain generalizability
Atrial Fibrillation 6 Scale,72 2009 6 questions focusing on dyspnea at rest, exertion, limitations in daily life, feeling of discomfort, fatigue and worry/anxiety 0–60 (1–10 on a Likert scale for each question) Designed for patients at the AF clinic Advantages:

  • Items based on patient interviews

  • Satisfactory reliability and validity
Validated in AF patients peri-cardioversion Limitations:

  • Relatively time-consuming

  • Uncertain generalizability
European Heart Rhythm Association (EHRA) classification,73 2007 Classification based exclusively on patient reported symptoms and impact on normal daily activities EHRA class I–IV Proposed by panel of experts of European Heart Rhythm Association Proposed advantage:

  • Simple
No validation Limitations:

  • Not used in studies yet

  • Unknown validity, generalizability, and reproducibility