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Categories

• First detected episode
• Recurrent (after 2 or more episodes)
• Paroxysmal (if recurrent AF terminates spontaneously)
• Persistent (if sustained beyond 7 days)

Atrial Fibrillation Category	Definition
Paroxysmal	AF that terminates spontaneously or with intervention within 7 d of onset. Episodes may recur with variable frequency.
Persistent	Continuous AF that is sustained >7 d.
Long-standing persistent AF	Continuous AF >12 mo in duration.
Permanent	The term “permanent AF” is used when the patient and clinician make a joint decision to stop 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 AF. Acceptance of AF may change as symptoms, efficacy of therapeutic interventions, and patient and clinician preferences evolve.
Nonvalvular	AF in the absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair.

Causes

• Cardiac (atrial enlargement)
  • Hypertension
  • Ischemic heart disease
  • Rheumatic heart disease
    • Valvular heart disease (any lesion that leads to significant stenosis or regurgitation)
• Noncardiac (increased automaticity)
  • Thyrotoxicosis
  • Chronic lung disease
  • Pericarditis
  • Ethanol ("holiday heart")
  • PE
  • Drugs (cocaine, TCA)