Atrial fibrillation (AFib) is a heart condition that is becoming increasingly common worldwide and is estimated to affect more than 5.6 million people in the United States. AFib is a type of arrhythmia, meaning the heart beats irregularly and often too fast.

There are four main types of AFib: paroxysmal, persistent, long-term persistent, and permanent. These types were originally defined by how long AFib symptoms lasted and how severe they were. Now, they are seen as stages of a disease that can get worse over time.

Here’s what you need to know about the four types of AFib.

Atrial Fibrillation Types Are Fluid

The types of AFib are fluid. People may move between different stages over time, and some may never progress beyond their initial classification. Older terms were also once used to classify AFib. For example, valvular and nonvalvular AFib were poorly defined categories that are no longer used to distinguish between types of AFib.

Understanding your type can help you seek treatment early, with the goal of preventing AFib from progressing to more advanced stages. Without treatment, AFib is more likely to worsen and can lead to cardiovascular complications such as stroke, heart attack, or heart failure.

Without treatment, AFib is more likely to worsen and can lead to cardiovascular complications such as stroke, heart attack, or heart failure.

Paroxysmal Atrial Fibrillation

A paroxysm is a sudden episode. Paroxysmal AFib, also called occasional AFib, occurs when symptoms happen for a short time. Episodes can last from a few minutes to a few days. Paroxysmal AFib is diagnosed when symptoms last fewer than seven days. Episodes can also occur repeatedly over time.

Symptoms of AFib often resolve on their own, but treatment may sometimes be needed. Untreated paroxysmal AFib can progress to persistent AFib.

Procedures for Paroxysmal Atrial Fibrillation

A cardiologist (heart specialist) may recommend treatment to prevent progression or lower risks. Options may include cardioversion, catheter ablation, and pulsed field ablation.

Cardioversion

Cardioversion resets the heart to a normal rhythm. It’s sometimes considered a short-term solution. In many cases, cardioversion alone won’t prevent AFib from progressing, especially if medications that help maintain a sinus (normal) rhythm aren’t used afterward. Cardioversion can be done with medications (chemical cardioversion) or with electrical shocks delivered through paddles placed on the chest (electrical cardioversion).

Catheter Ablation

With catheter ablation — also called cardiac ablation — a long, thin tube called a catheter is inserted into the groin and guided through blood vessels to the heart. The catheter’s tip delivers energy that damages the small area of heart tissue causing abnormal electrical signals. The resulting scar tissue can help restore a normal heart rhythm. Ablation may offer longer-lasting results, although AFib can still return later in life.

Pulsed Field Ablation

Pulsed field ablation is a newer type of catheter ablation that uses high-energy electrical pulses to target the heart tissue causing irregular rhythms. One advantage is that the procedure may shorten procedure time compared with some traditional ablation methods.

Medications for Paroxysmal Atrial Fibrillation

Medications may help control both heart rate and heart rhythm. A cardiologist may prescribe:

• Beta-blockers — Help slow heart rate
• Digoxin — Helps control resting heart rate by slowing the heart and helping it pump blood more effectively
• Calcium channel blockers — Help slow heart rate and reduce how strongly the muscle contracts
• Anti-arrhythmic drugs — Help control the heart’s electrical signals and maintain a normal rhythm
• Potassium channel blockers — Help control the heart’s rhythm by slowing electrical signals in the heart
• Sodium channel blockers — Help control heart rhythm by reducing how easily the heart conducts electricity

Persistent Atrial Fibrillation and Long-Term Persistent Atrial Fibrillation

Persistent AFib is diagnosed when symptoms last more than seven days and require treatment to restore a normal heart rhythm. Long-term persistent AFib occurs when symptoms continue for at least 12 months without resolving on their own. These two types are often discussed together because their treatment approaches are largely the same.

Procedures for Persistent and Long-Term Persistent Atrial Fibrillation

Treatment for persistent AFib aims to slow the heart rate, restore a normal heart rhythm, and reduce the risk of blood clots, stroke, and heart attack. Many of the treatments used for paroxysmal AFib are also used for persistent and long-term persistent AFib. These approaches include the following:

• Cardioversion can also be an effective treatment for persistent AFib. In many cases, it’s combined with medication to help prevent symptoms from returning.
• Catheter ablation (including pulsed field ablation) may also help treat persistent AFib.
• The maze procedure is a type of open-heart surgery that creates scar tissue in the atria to block abnormal electrical signals and help the heart return to its normal rhythm. The procedure has an 80 percent to 90 percent success rate, and its effects may last for years.
• Hybrid AFib ablation combines catheter ablation with surgery. This approach may be recommended if medication or catheter ablation alone hasn’t controlled symptoms.

Medications for Persistent and Long-Term Persistent Atrial Fibrillation

Medication options for persistent and long-term persistent AFib are similar to those used for paroxysmal AFib. Recommended medications may include:

• Beta-blockers, digoxin, or calcium channel blockers to regulate the heart rate
• Anti-arrhythmic drugs that control the heart’s electrical signaling process, including potassium channel blockers and sodium channel blockers, which may help restore a normal rhythm

Permanent Atrial Fibrillation

Permanent AFib, also called chronic AFib, is diagnosed when a normal heart rhythm can’t be restored — even after treatment — and you and your cardiologist decide to stop trying to restore it. People with permanent AFib usually live with the condition long term.

Permanent AFib is the point when you and your cardiologist decide to stop trying to restore a normal heart rhythm.

Permanent AFib develops from structural changes to the heart over time. These changes affect the heart’s upper chambers, called the atria, which are involved in AFib. Eventually, these changes may make it difficult or impossible to restore a normal rhythm with procedures or medications. Because of this, most treatments used for persistent or long-term persistent AFib aren’t used to try to correct the rhythm in permanent AFib. Instead, treatment focuses on controlling heart rate and lowering the risk of complications. Options include:

• Atrioventricular (AV) node ablation — This procedure may be used if the heart rate remains high despite medication or other treatments. It creates scar tissue in the AV node, which connects the upper and lower chambers of the heart, and a pacemaker is implanted to help control the heart’s rhythm.
• Implantable devices — Devices such as pacemakers or defibrillators may be used to help regulate the heartbeat. Pacemakers are typically used if the heart rate becomes very slow, whereas defibrillators help treat dangerous fast heart rhythms.
• Left atrial appendage occlusion (LAAO) — This procedure closes a small pouch in the left atrium where blood can collect and form clots in people with AFib. LAAO may be recommended for people who can’t take blood thinners.

Medications for Permanent Atrial Fibrillation

In permanent AFib, treatment focuses on managing symptoms and lowering the increased risk of stroke and other complications rather than restoring normal rhythm. Beta-blockers, calcium channel blockers, or digoxin may be used to help control heart rate. Blood thinners (anticoagulants) may also be prescribed to reduce the risk of blood clots and stroke. These medications may be used in people with any of the four types of AFib.

Lifestyle Changes

Your healthcare provider may also recommend lifestyle changes to help manage AFib, including:

• Maintaining a healthy weight
• Eating a nutritious diet
• Getting regular exercise
• Limiting alcohol, caffeine, and tobacco
• Managing high blood pressure

Your healthcare team can help you understand what type of diet and physical activity may be appropriate for your type of AFib and your overall health.

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