What is the AHA/ACC/HRS classification schema for atrial fibrillation relevant to holiday heart syndrome (HHS)?

Updated: May 30, 2018
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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In 2014, the AHA/ACC/HRS released updated guidelines for the management of patients with AF. These guidelines supersede the AF guideline published in 2006 and updated in 2011. The guidelines provide the following revised classification schema, based on duration of episodes [30]

  • Paroxysmal AF: Episodes of AF that terminate spontaneously or with intervention within 7 days; may recur with variable frequency

  • Persistent AF: Episodes of continuous AF that last more than 7 days and do not self-terminate

  • Long-standing persistent AF: Episodes of continuous AF that last more than 12 months

  • Permanent AF: Applies when a joint physician/patient decision has been made to accept the presence of AF and stop further attempts to restore and/or maintain sinus rhythm (as this represents clinical acceptance rather than an inherent pathophysiological attribute of AF, it is understood that acceptance of AF may change as symptoms, efficacy of interventions, and patient/physician preferences evolve)

  • Nonvalvular AF: AF in the absence of rheumatic mitral valve disease, a prosthetic heart valve, or mitral valve repair

It is further noted that episodes often increase in frequency and duration over time. In addition, the term “lone AF” to identify AF in typically younger patients without structural heart disease, hypertension, or diabetes mellitus is deemed potentially confusing and should not be used to guide treatment decisions. [30]

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