What are the guidelines for classification of atrial fibrillation (Afib) (AF)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Classification of atrial fibrillation (AF) begins with distinguishing a first detectable episode, irrespective of whether it is symptomatic or self-limited. Published guidelines from an American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Rhythm Society (HRS) committee of experts on the treatment of patients with atrial fibrillation recommend classification of AF into the following three patterns (also see the image below) [1] :

  • Paroxysmal AF: Episodes of AF that terminate spontaneously within 7 days (most episodes last less than 24 hours)

  • Persistent AF: Episodes of AF that last more than 7 days and may require either pharmacologic or electrical intervention to terminate

  • Long-standing persistent AF: AF that has persisted for more than 12 months, either because cardioversion has failed or because cardioversion has not been attempted

  • Permanent AF: When both patient and clinician have decided to abort any further restoration strategies after shared clinical decision making

Classification scheme for patients with atrial fib Classification scheme for patients with atrial fibrillation (AF).

This classification schema pertains to cases that are not related to a reversible cause of AF (eg, thyrotoxicosis, electrolyte abnormalities, acute ethanol intoxication). In current clinical practice, atrial fibrillation secondary to acute myocardial infarction, cardiac surgery, pericarditis, sepsis, pulmonary embolism, or acute pulmonary disease is considered separately. This is because, in these situations, AF is thought to be less likely to recur once the precipitating condition has been treated adequately and has resolved.

However, data from the Framingham Heart Study suggest that over 60% of the participants with secondary AF developed recurrent AF over 15-years of follow-up. [2] Furthermore, the long-term risks of stroke and all-cause mortality were similar between participants without a secondary precipitant and those with secondary precipitants. Thus, long-term AF screening strategies can be considered in these patients similar to the current standard of practice for patients with cryptogenic stroke. [3]

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