Atrial fibrillation classification

Resident Survival Guide

Sinus rhythm

Atrial fibrillation

Atrial Fibrillation Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Atrial Fibrillation from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Special Groups Postoperative AF Acute Myocardial Infarction Wolff-Parkinson-White Preexcitation Syndrome Hypertrophic Cardiomyopathy Hyperthyroidism Pulmonary Diseases Pregnancy ACS and/or PCI or valve intervention Heart failure
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram EKG Examples A-Fib with LBBB
Chest X Ray
Echocardiography
Holter Monitoring and Exercise Stress Testing
Cardiac MRI
Treatment
Rate and Rhythm Control
Cardioversion Overview Electrical Cardioversion Pharmacological Cardioversion
Anticoagulation Overview Warfarin Converting from or to Warfarin Converting from or to Parenteral Anticoagulants Dabigatran
Maintenance of Sinus Rhythm
Surgery Catheter Ablation AV Nodal Ablation Surgical Ablation Cardiac Surgery
Specific Patient Groups
Primary Prevention
Secondary Prevention
Supportive Trial Data
Cost-Effectiveness of Therapy
Case Studies
Case #1
Atrial fibrillation classification On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Atrial fibrillation classification
CDC on Atrial fibrillation classification
Atrial fibrillation classification in the news
Blogs on Atrial fibrillation classification
Directions to Hospitals Treating Atrial fibrillation classification
Risk calculators and risk factors for Atrial fibrillation classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Although several clinical classification plans and protocols have been proposed, none of them fully account for all aspects of atrial fibrillation. Previously the American Heart Association, American College of Cardiology, and the European Society of Cardiology had proposed a classification system based on simplicity and clinical relevance. It contained four main categories of atrial fibrillation; first detected or diagnosed, paroxysmal, persistent, and permanent. More recently, a new classification was proposed by a task force writing group which composed of experts representing seven organizations: the American College of Cardiology (ACC), the American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), the European Cardiac Arrhythmia Society (ECAS), the European Heart Rhythm Association (EHRA), the Society of Thoracic Surgeons (STS), and the Heart Rhythm Society (HRS).

Classification

AF Category	Defining Characteristics
Atrial fibrillation episode	Atrial fibrillation with duration of at least 30 seconds or if less than 30 seconds, is present continuously throughout the ECG monitoring tracing. Sinus rhythm is documented in between AF episodes.
Paroxysmal atrial fibrillation	Recurrent episodes (≥two episodes) that self-terminate in less than 7 days. Episodes of AF of ≤48 hours duration that are terminated with electrical or pharmacologic cardioversion are also included.
Persistent atrial fibrillation	Recurrent episodes (≥two episodes) that last more than 7 days and may require pharmacologic or electrical intervention. Episodes of AF of ≥48 hours duration, but prior to 7 days, which are terminated with electrical or pharmacologic cardioversion are also included.
Longstanding persistent atrial fibrillation	Continuous atrial fibrillation of greater than 12 months duration.
Permanent atrial fibrillation	Atrial fibrillation which has been decided not to be restored or maintained in sinus rhythm by any means, including catheter or surgical ablation.

The term "chronic atrial fibrillation" has no standardized definition.

Atrial Fibrillation Episode

An atrial fibrillation episode is defined as AF which is documented by ECG monitoring and has a duration of at least 30 seconds, or if less than 30 seconds, is present continuously throughout the ECG monitoring tracing. The presence of subsequent episodes of AF requires that sinus rhythm be documented by ECG monitoring between AF episodes.

Paroxysmal Atrial Fibrillation

Paroxysmal atrial fibrillation is defined as recurrent episodes (≥two episodes) of AF that self-terminate in less than 7 days. Most episodes are brief and last < 24 hours. Episodes of AF of ≤48 hours duration that are terminated with electrical or pharmacologic cardioversion are also included.

Persistent Atrial Fibrillation

Recurrent episodes (≥two episodes) that last more than 7 days that may require pharmacologic or electrical intervention are called as persistent atrial fibrillation. Episodes of AF in which a decision is made to electrically or pharmacologically cardiovert the patient after ≥48 hours of AF, but prior to 7 days, are also classified as persistent AF.

Longstanding Persistent Atrial Fibrillation

Longstanding persistent atrial fibrillation is a continuous atrial fibrillation of greater than 12 months duration. Continuous AF is an AF that is documented to be present on all ECG monitoring performed during a defined period of time.

Permanent Atrial Fibrillation

Permanent atrial fibrillation is an atrial fibrillation in patients in whom a decision has been made not to restore or maintain sinus rhythm by any means, including catheter or surgical ablation. If a patient who was previously classified as having permanent AF is to undergo catheter or surgical ablation, then AF should be reclassified.

References

Template:WikiDoc Sources