Classification and clinical types of atrial fibrillation

Classification of atrial fibrillation

A simple classification scheme has been proposed based on presentation and duration of the arrhythmia (1).

• recent onset or first diagnosed
  • patients who presents with AF for the first time regardless of the duration of arrhythmia or the presence and severity of AF-related symptoms
  • may or may not recur
    
    
• paroxysmal
  • is self terminating (usually within 48 hours)
  • although episodes may generally last up to 7 days, the 48 hour time point is clinically important since probability of spontaneous conversion is low after this time and anticoagulation must be considered
  • recurrent
    
• persistent
  • does not self terminate and last for more than 7 days or cardioversion (either with drugs or by direct current cardioversion (DCC)) is needed to restore sinus rhythm
  • recurrent
    
    
• long standing persistent
  • continuous AF for more than 1 year duration
    
    
• permanent AF
  • rhythm control interventions have been abandoned and the arrhythmia is accepted by the patient (and physician)

Note:

• first diagnosed AF may be either paroxysmal or persistent or already be deemed permanent
• after 2 or more episodes AF is considered as recurrent and both paroxysmal and persistent AF may be recurrent
• arrhythmia tends to progress from paroxysmal to persistent long-standing persistent and eventually to permanent.

Reference:

1. Hindricks G et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020 Aug 29