Diagnosis
Table 1. Definitions
Term Definitions
Paroxysmal AF • AF that terminates spontaneously or with intervention within 7 d
of onset.
• Episodes may recur with variable frequency.
Persistent AF • Continuous AF that is sustained >7 d.
Longstanding
persistent AF
• Continuous AF of >12 mo duration.
Permanent AF • Permanent AF is used when there has been a joint decision by the
patient and clinician to cease further attempts to restore and/or
maintain sinus rhythm.
• Acceptance of AF represents a therapeutic attitude on the
part of the patient and clinician rather than an inherent
pathophysiological attribute of the AF.
• Acceptance of AF may change as symptoms, the efficacy of
therapeutic interventions, and patient and clinician preferences
evolve.
Nonvalvular AF • AF in the absence of rheumatic mitral stenosis, a mechanical or
bioprosthetic heart valve, or mitral valve repair.
Î The diagnosis of AF in a patient is based on the patient's clinical
history and physical examination and is confirmed by ECG, ambulatory
rhythm monitoring (e.g., telemetry, Holter monitor, event recorders),
implanted loop recorders, pacemakers or defibrillators, or, in rare
cases, by electrophysiological study. The clinical evaluations,
including additional studies that may be required, are summarized in
Table 3.
Î The initial evaluation of a patient with suspected or proven AF involves
characterizing the pattern of the arrhythmia (paroxysmal, persistent,
longstanding persistent, or permanent), determining its cause,
defining associated cardiac and extracardiac disease, and assessing
thromboembolic risk.
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