Types of Atrial Fibrillation: What You Need to Know

Medically reviewed by University of Illinois-Chicago, College of Medicine on April 18, 2017Written by Annette McDermott

Overview

Atrial fibrillation (AFib) is a type of arrhythmia, or irregular heartbeat. It causes the upper and lower chambers of your heart to beat out of sync, fast, and erratically.

AFib used to be classified as either chronic or acute. But in 2014, new guidelines from the American College of Cardiology and American Heart Association changed the classification of atrial fibrillation from two types to four:

  1. paroxysmal AFib
  2. persistent AFib
  3. long-standing persistent AFib
  4. permanent AFib

You can start with one type of AFib that eventually becomes another type as the condition progresses. Keep reading to learn more about each type.

1. Paroxysmal atrial fibrillation

Paroxysmal AFib comes and goes. It begins and ends spontaneously. The irregular heartbeat may last anywhere from several seconds to a week. However, most episodes of paroxysmal AFib resolve themselves within 24 hours.

Paroxysmal AFib may be asymptomatic, which means that you experience no apparent symptoms. The first line of treatment for asymptomatic paroxysmal AFib may be lifestyle changes, such as eliminating caffeine and reducing stress, in addition to medications as preventative measures.

2. Persistent atrial fibrillation

Persistent AFib also begins spontaneously. It lasts at least seven days and may or may not end on its own. Medical intervention such as cardioversion, in which your doctor shocks your heart into rhythm, may be needed to stop an acute, persistent AFib episode. Lifestyle changes and medications may be used as preventive measures.

3. Long-standing persistent atrial fibrillation

Long-standing persistent AFib lasts at least a year without interruption. It’s often associated with structural heart damage.

This type of AFib can be the most challenging to treat. Medications to maintain a normal heart rate or rhythm are often ineffective. More invasive treatments may be needed. These can include:

  • electrical cardioversion
  • catheter ablation
  • pacemaker implantation

4. Permanent atrial fibrillation

Long-standing persistent AFib can become permanent when treatment doesn’t restore normal heart rate or rhythm. As a result, you and your doctor make a decision to stop further treatment efforts. This means your heart is in a state of AFib all the time. According to research, this type of AFib may result in more severe symptoms, lower quality of life, and an increased risk of a major cardiac event.

Comparing the four types of atrial fibrillation

The main difference between the four types of AFib is the duration of the episode. Symptoms aren’t unique to the type of AFib or the duration of an episode. Some people experience no symptoms when they’re in AFib for a long time, while others are symptomatic after a brief period. But in general, the longer AFib is sustained, the more likely it is that symptoms will occur.

The goals of treating all types of AFib are to restore your heart’s normal rhythm, slow down your heart rate, and prevent blood clots that may lead to stroke. Your doctor may suggest medications to prevent blood clots and treat any underlying conditions such as heart disease, thyroid problems, and high blood pressure. But there are some differences in treatment options depending on which type of AFib you have.

Here’s a side-by-side look at the main differences between the four types of AFib:

Type of AFibDuration of episodesTreatment options
paroxysmalseconds to less than seven days
  • lifestyle changes
  • medications to restore heart rhythm or heart rate such as beta-blockers, calcium channel blockers, or antiarrhythmics
  • anticoagulants to prevent blood clots when AFib reoccurs
persistentmore than seven days, but less than one year
  • lifestyle changes
  • medications to restore heart rhythm and heart rate such as beta-blockers, calcium channel blockers, or antiarrhythmics
  • anticoagulants to prevent blood clots
  • electrical cardioversion
  • catheter ablation
  • electrical pacing (pacemaker)
long-standing persistentat least 12 months
  • lifestyle changes
  • medications to restore heart rhythm and heart rate such as beta-blockers, calcium channel blockers, or antiarrhythmics
  • anticoagulants to prevent blood clots
  • electrical cardioversion
  • catheter ablation
  • electrical pacing (pacemaker)
permanentcontinuous — it doesn’t end
  • no treatment to restore normal heart rhythm
  • medications to restore normal heart rate such as beta-blockers and calcium channel blockers
  • medications to prevent blood clots or improve heart function

Learn more: What’s my prognosis with atrial fibrillation? »

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