From the Guidelines
Atrial fibrillation (AF) is classified into five main types: paroxysmal, persistent, long-standing persistent, permanent, and first diagnosed AF, as defined by the most recent guidelines 1. The classification of AF is based on the presentation and duration of the arrhythmia.
- Paroxysmal AF is characterized by self-terminating episodes that usually last less than 7 days, although they may continue for up to 7 days 1.
- Persistent AF is present when an AF episode lasts longer than 7 days or requires termination by cardioversion, either with drugs or by direct current cardioversion (DCC) 1.
- Long-standing persistent AF has lasted for more than 12 months when it is decided to adopt a rhythm control strategy 1.
- Permanent AF is said to exist when the presence of the arrhythmia is accepted by the patient (and physician), and rhythm control interventions are not pursued 1.
- First diagnosed AF refers to the first documentation of AF, regardless of previous symptoms 1. The distinction between valvular and non-valvular AF has been abandoned, as it is no longer considered useful for defining the etiology of AF or guiding treatment decisions 1. The classification of AF is important for determining appropriate management strategies, which may include rate control medications, rhythm control medications, anticoagulation therapy, and procedures such as cardioversion, catheter ablation, or surgical interventions 1. The most recent guidelines recommend a heart rate control strategy for symptomatic management of AF, with a goal of achieving a resting heart rate of less than 80 beats per minute 1.
From the Research
Types of Atrial Fibrillation (AF)
- Paroxysmal AF: defined as attacks of arrhythmia lasting < 7 days separated by prolonged periods of sinus rhythm 2
- Persistent AF: AF established for > 7 days 2
- Long-term persistent AF: a subtype of AF that is persistent for an extended period 3, 4
- Permanent AF: a subtype of AF where the arrhythmia is permanent 4, 5
Classification of AF
- The classification of AF is based on the duration of the arrhythmia and the presence of symptoms 2
- The distinction between paroxysmal and persistent AF is not always clear-cut, and the utility of this classification system in predicting outcomes is questionable 5
- Other factors such as left atrial size, morphology, and function, as well as the presence of underlying heart disease, may be important in determining the prognosis and treatment of AF 6, 5
Subtypes of AF
- Recent onset AF: the first episode of persistent AF or the first discovery of AF 2
- Lone AF: AF that occurs in the absence of detectable organic heart disease 2
- Idiopathic AF: AF that occurs without any detectable etiology, including hyperthyroidism, overt sinus node dysfunction, and overt or concealed preexcitation 2