What is Permanent Atrial Fibrillation?

Permanent atrial fibrillation refers to a condition where a patient's irregular heart rhythm—known as atrial fibrillation (AFib)—cannot be restored to a normal sinus rhythm, or when it recurs quickly after being restored. According to the latest expert consensus on atrial fibrillation, permanent AFib is defined as a joint clinical decision made by both the physician and the patient to no longer attempt rhythm control strategies. This decision is typically based on individual factors such as symptom severity, overall health status, and treatment response, rather than solely on the physiological characteristics of the disease itself.

Understanding the Clinical Decision

It's important to note that labeling AFib as "permanent" does not necessarily mean that restoring normal rhythm is impossible. Instead, it reflects a mutual agreement between the patient and healthcare provider that the risks, burdens, or limited benefits of rhythm control therapies outweigh the potential advantages. However, if a patient's condition or preferences change in the future, treatment strategies may be revisited.

Types of Atrial Fibrillation

Atrial fibrillation is characterized by the loss of coordinated electrical activity in the heart's upper chambers, causing them to quiver rapidly—at a rate of approximately 400 to 500 beats per minute. Based on the duration and pattern of episodes, AFib can be classified into several types:

Paroxysmal Atrial Fibrillation

This type involves episodes that start suddenly and stop on their own or with medical intervention within seven days. These episodes may occur occasionally and can vary in frequency and duration among individuals.

Persistent Atrial Fibrillation

This refers to AFib that lasts longer than seven days and typically requires medical treatment such as medication or cardioversion to restore normal heart rhythm.

Long-Standing Persistent Atrial Fibrillation

When atrial fibrillation continues continuously for more than one year, it is classified as long-standing persistent AFib. In such cases, the heart may have undergone structural changes that make restoring and maintaining sinus rhythm more challenging.