Atrial fibrillation (AF) can present in several ways and correct classification can guide the choice of treatment. AF can present in several ways (Table 2) from a single isolated episode to a constant arrhythmia.
Table 2. Classification of atrial fibrillation.5
Occasionally, in about 2–3% of patients, AF remains paroxysmal for several decades5. Paroxysmal AF is more common than the persistent arrhythmia in young people and women.12 However, AF usually progresses: “AF begets AF”.6 Paroxysmal and persistent AF each occur in about 20–30% of patients.2 Persistent AF may spontaneously regress to paroxysmal AF.5 Overall about 40–50% of AF patients develop permanent atrial arrhythmias.2
Up to a third of patients do not experience symptoms during an episode – so-called silent or subclinical AF.19 Indeed, people with asymptomatic AF can experience clinically silent episodes.5 Symptomatic and silent AF share the same electrophysiological and mechanical pathogenesis. However, as silent AF is generally untreated, the progression from paroxysmal to persistent or permanent AF might be more rapid than in patients with documented AF.19
Mortality is between 1.5 and 1.9 higher among AF patients than in people without the arrhythmia, after adjusting for other cardiovascular risk factors,11 partly because of the increased stroke risk, discussed in the next section.