Classification of Atrial Fibrillation

Introduction

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is associated with an increased risk of stroke, heart failure, and overall mortality. Understanding its classification helps guide treatment decisions.

Types of Atrial Fibrillation

AF is classified based on its duration and persistence:

1. Paroxysmal Atrial Fibrillation

• Episodes last less than 7 days (usually less than 48 hours) and terminate spontaneously.
• Patients may have recurrent episodes but not continuously.
• Often triggered by stress, alcohol, or sleep disturbances.

2. Persistent Atrial Fibrillation

• Lasts more than 7 days but can be terminated with therapy (e.g., electrical or pharmacological cardioversion).
• Requires treatment to restore normal rhythm.

3. Long-Standing Persistent Atrial Fibrillation

• Continuous for more than 12 months.
• Often requires more intensive treatment, including catheter ablation or medication-based rhythm control.

4. Permanent Atrial Fibrillation

• The condition is accepted by both patient and physician as unresponsive to treatment.
• Rate control rather than rhythm control is the primary focus.

Clinical Implications

• Classification affects treatment choice: rhythm vs. rate control.
• Stroke prevention is crucial in all forms (CHA2DS2-VASc score used to guide anticoagulation).
• Underlying causes such as hypertension, valvular disease, or structural heart abnormalities should be assessed.

Conclusion

AF classification helps tailor treatment strategies, mitigate complications, and improve patient outcomes. If you experience palpitations, dizziness, or breathlessness, seek medical attention.

Source recommendations

1. 2023 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation
3. https://pubmed.ncbi.nlm.nih.gov/32860505/
4. https://www.jacc.org/doi/10.1016/j.jacc.2023.10.021
5. https://academic.oup.com/eurheartj/pages/esc_guidelines

2. 2023 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
2. https://pubmed.ncbi.nlm.nih.gov/38033089/
3. https://www.hrsonline.org/guidance/clinical-resources/2023-accahaaccphrs-guideline-diagnosis-and-management-patients-atrial-fibrillation
4. https://www.jacc.org/doi/10.1016/j.jacc.2023.10.021
5. https://professional.heart.org/en/science-news/2023-acc-aha-accp-hrs-guideline-for-the-diagnosis-and-management-of-atrial-fibrillation