Atrial Fibrillation: Classification

Key points

• AF is classified by temporal pattern: first-diagnosed, paroxysmal, persistent, long-standing persistent and permanent — retained unchanged in the 2024 ESC guideline.
• First-diagnosed: first detected, irrespective of symptoms, duration or self-termination.
• Paroxysmal: self-terminates (or is cardioverted) within 7 days, often within 24 hours. Persistent: sustained beyond 7 days, or requires cardioversion. Long-standing persistent: continuous AF of 12 months or more where a rhythm-control strategy is being pursued.
• Permanent: AF accepted by patient and clinician with no further attempts at rhythm control, or where cardioversion is inappropriate/unsuccessful → rate control + anticoagulation based on stroke risk.

Decision points in this pathway

• First ever episode?
• Self-terminating?
• Cardiovertible/appropriate?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.