Classification
| Type | Definition |
|---|---|
| Paroxysmal | Self-terminates within 7 days |
| Persistent | Continuous, lasting longer than 7 days |
| Permanent | Sustained AF where rhythm control is no longer pursued |
Rate vs. Rhythm Control
Rate control (beta-blockers or rate-limiting calcium channel blockers) is first-line for most patients and focuses on symptom control without necessarily restoring sinus rhythm. Rhythm control (antiarrhythmics or cardioversion) is considered for persistently symptomatic patients or new-onset AF, particularly in younger patients or those with heart failure.
Stroke Risk: CHA₂DS₂-VASc
Use the CHA₂DS₂-VASc calculator to estimate stroke risk and guide whether anticoagulation is warranted. It does not apply to valvular AF (rheumatic mitral stenosis or mechanical valves), which follows its own approach.
Bleeding Risk: HAS-BLED
The HAS-BLED score flags bleeding risk and modifiable factors to address — it should not, by itself, be used to withhold anticoagulation when stroke risk is significant.
Cardioversion
Emergency synchronized cardioversion is indicated for hemodynamic instability. For elective cardioversion in stable patients, anticoagulation status and AF duration (commonly the 48-hour rule, or transesophageal echocardiography to exclude a left atrial thrombus) determine timing and safety.