Types of Atrial fibrillation
Types of Atrial fibrillation
Types of Atrial Fibrillation
- Paroxysmal AF
- Definition: Episodes that start suddenly and stop spontaneously within 7 days (usually <48 hours).
- Features: May recur; often intermittent.
- Management: Rhythm or rate control; anticoagulation depends on stroke risk.
- Persistent AF
- Definition: AF that lasts >7 days and does not terminate on its own.
- Requires intervention: Electrical cardioversion, antiarrhythmic drugs, or ablation.
- Long-standing Persistent AF
- Definition: Continuous AF lasting ≥12 months.
- Management: Usually more difficult to maintain sinus rhythm; advanced therapies considered.
- Permanent AF
- Definition: AF that is accepted by patient and physician, and no further attempts to restore sinus rhythm are planned.
- Management: Focuses on rate control + anticoagulation.
- First-detected (New-onset) AF
- Definition: The very first documented episode of AF (regardless of duration or symptoms).
- Importance: Helps guide initial workup and decision-making.
- Valvular vs. Non-valvular AF
- Valvular AF: AF in the presence of moderate-to-severe mitral stenosis or mechanical heart valves (high thromboembolic risk).
- Non-valvular AF: AF without these conditions (most common).
Summary Table
| Type of AF | Definition | Key Features |
|---|---|---|
| Paroxysmal AF | Terminates spontaneously within 7 days (usually <48h) | Intermittent, recurrent |
| Persistent AF | Lasts >7 days, requires intervention to stop | Needs cardioversion/therapy |
| Long-standing Persistent AF | Continuous for ≥12 months | Harder to maintain sinus rhythm |
| Permanent AF | Rhythm control not pursued | Rate control + anticoagulation |
| First-detected AF | First documented AF episode | Triggers full evaluation |
| Valvular AF | Associated with MS or mechanical valve | High stroke risk |
| Non-valvular AF | No MS/mechanical valve | Majority of AF cases |
Non-valvular AF: Atrial fibrillation that is not caused by rheumatic mitral valve disease, mitral valve repair, or the presence of a prosthetic heart valve.
1. Paroxysmal atrial fibrillation is defined as AF that:
C) Terminates spontaneously within 7 days
A) Persists >7 days
B) Lasts ≥12 months
D) Is accepted with no rhythm control attempts
Paroxysmal AF resolves spontaneously, usually within 48 hours but up to 7 days.
2. AF that lasts >7 days and requires intervention to restore sinus rhythm is called:
B) Persistent AF
A) Permanent AF
C) Paroxysmal AF
D) Long-standing AF
Persistent AF lasts longer than 7 days and usually needs cardioversion or other intervention.
3. Continuous atrial fibrillation for ≥12 months is classified as:
C) Long-standing persistent
A) Paroxysmal
B) Permanent
D) Valvular
Long-standing persistent AF refers to continuous AF lasting ≥12 months.
4. In permanent AF:
C) Rhythm control is not pursued
A) Rhythm control is always attempted
B) AF terminates spontaneously
D) Duration is always less than 7 days
In permanent AF, both patient and physician decide not to pursue rhythm control.
5. Which of the following is NOT a classification of AF based on duration?
D) Valvular
A) Paroxysmal
B) Persistent
C) Permanent
Valvular vs non-valvular is a separate etiological classification, not duration-based.
6. The first documented episode of atrial fibrillation, regardless of duration, is called:
C) First-detected AF
A) Paroxysmal AF
B) Persistent AF
D) Permanent AF
First-detected AF refers to the initial recognized episode of AF, irrespective of duration.
7. Which of the following is considered valvular AF?
A) AF with severe mitral stenosis
B) AF with mitral valve prolapse
C) AF with aortic regurgitation
D) AF with mild mitral regurgitation
Valvular AF is mainly associated with moderate-to-severe mitral stenosis and prosthetic valves.
8. Atrial fibrillation lasting 5 days that stops spontaneously is classified as:
C) Paroxysmal AF
A) Persistent AF
B) Permanent AF
D) Long-standing persistent AF
Paroxysmal AF lasts less than 7 days and terminates spontaneously.
9. A 68-year-old with AF for 2 years, with no rhythm control attempts, is classified as:
B) Permanent AF
A) Long-standing persistent AF
C) Paroxysmal AF
D) First-detected AF
Permanent AF is when rhythm control is no longer attempted.
10. Non-valvular AF excludes which of the following?
A) AF with mechanical mitral valve
B) AF with hypertension
C) AF with ischemic heart disease
D) AF with diabetes mellitus
AF with mechanical valves or severe MS is “valvular AF,” all others are “non-valvular.”
11. Which AF type is most likely to spontaneously terminate within 48 hours?
A) Paroxysmal AF
B) Persistent AF
C) Long-standing persistent AF
D) Permanent AF
Paroxysmal AF often terminates within 48 hours without intervention.
12. Which type of AF is a therapeutic decision rather than time-based?
D) Permanent AF
A) Paroxysmal AF
B) Persistent AF
C) Long-standing persistent AF
Permanent AF is defined by the decision not to restore sinus rhythm, not duration alone.
13. AF with rapid ventricular response despite rate-control therapy is classified by:
C) Hemodynamic impact, not type
A) Paroxysmal AF
B) Persistent AF
D) Long-standing persistent AF
AF types are classified by duration, not by ventricular response rate.
14. AF due to untreated severe mitral stenosis is considered:
A) Valvular AF
B) Non-valvular AF
C) Persistent AF
D) Permanent AF
Moderate to severe mitral stenosis is a defining criterion for valvular AF.
15. Which AF classification is essential for stroke risk calculation with CHA₂DS₂-VASc?
B) Valvular vs Non-valvular
A) Paroxysmal vs Persistent
C) Permanent vs First-detected
D) Long-standing vs Persistent
CHA₂DS₂-VASc is applied only to non-valvular AF, not valvular AF.
16. The category “long-standing persistent AF” applies when AF has lasted:
C) ≥12 months continuously
A) ≤7 days
B) 1–6 months
D) ≥2 weeks
Long-standing persistent AF applies to AF lasting ≥12 months.
17. Atrial fibrillation detected incidentally on ECG in an asymptomatic patient for the first time is:
B) First-detected AF
A) Paroxysmal AF
C) Persistent AF
D) Permanent AF
Any first recognized AF episode, regardless of symptoms, is called first-detected AF.
18. Which AF type often requires electrical or pharmacological cardioversion?
C) Persistent AF
A) Paroxysmal AF
B) First-detected AF
D) Permanent AF
Persistent AF usually needs intervention as it does not stop spontaneously.
19. A patient with AF for 14 months is still being considered for rhythm control. This is:
D) Long-standing persistent AF
A) Paroxysmal AF
B) Permanent AF
C) First-detected AF
Long-standing persistent AF is ≥12 months in duration, rhythm control still possible.
20. Once both clinician and patient decide not to restore sinus rhythm, AF is:
A) Permanent AF
B) Paroxysmal AF
C) Persistent AF
D) Long-standing persistent AF
Permanent AF is a decision-based classification: rhythm control is not pursued.
Q1. Paroxysmal atrial fibrillation is defined as AF that:
✅ Correct: Paroxysmal AF terminates spontaneously, usually within 48 hours but up to 7 days.
Q2. AF that lasts >7 days and requires intervention to restore sinus rhythm is called:
✅ Correct: Persistent AF continues beyond 7 days and does not stop without intervention.
Q3. Continuous atrial fibrillation for ≥12 months is classified as:
✅ Correct: AF lasting 12 months or longer is termed long-standing persistent AF.
Q4. In permanent AF:
✅ Correct: In permanent AF, both patient and physician agree not to attempt rhythm control.
Q5. Which of the following is NOT a classification of AF based on duration?
✅ Correct: “Valvular” vs “non-valvular” AF is a separate classification (based on etiology, not duration).
Q6. The first documented episode of atrial fibrillation, regardless of duration, is called:
✅ Correct: First-detected (new-onset) AF refers to the first recognized episode.
Q7. Which of the following is considered valvular AF?
✅ Correct: Valvular AF = AF with moderate/severe mitral stenosis or mechanical heart valve.
Q8. Atrial fibrillation lasting 5 days that stops spontaneously is classified as:
✅ Correct: Since it terminates spontaneously within 7 days, it is paroxysmal AF.
Q9. A 68-year-old with AF for 2 years, with no further attempts for rhythm control, is best classified as:
✅ Correct: Once AF is accepted and rhythm control not pursued, it is “permanent AF.”
Q10. Non-valvular AF excludes which of the following?
✅ Correct: Presence of mechanical heart valve or moderate-severe MS defines valvular AF.
