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 (1,2).

• 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 (2)
  • may or may not reoccur (3)
    
    
• 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 (2)
  • recurrent (3)
    
    
• 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 (2)
  • recurrent (3)
    
    
• 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) (2)

Note:

• first diagnosed AF may be either paroxysmal or persistent or already be deemed permanent (2)
• after 2 or more episodes AF is considered as recurrent and both paroxysmal and persistent AF may be recurrent (1)
• arrhythmia tends to progress from paroxysmal to persistent long-standing persistent and eventually to permanent. (2)

Reference:

• (1) American Heart Association (2011). ACCF/AHA Pocket Guideline. Management of patients with atrial fibrillation.
• (2) European Heart Rhythm Association et al.Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010 (19):2369-429.
• (3) Lafuente-Lafuente C, Mahé I, Extramiana F.Management of atrial fibrillation. BMJ. 2009;339:b5216.