TABLE 3.

Management strategy for recurrent Atrial Fibrillation based on episode duration.

AF classification	Paroxysmal	Persistent a	Permanent a
AF episode duration	≤7 days	>7 days and ≤1 year	Typically >1 year
Structural remodeling  Severity	Atrial fibrosis  Minimal to mild	Atrial fibrosis  Mild to moderate	Atrial and ventricular fibrosis  Moderate to severe
Electrical remodeling  Severity	Pulmonary veins  Focal	Atria  Diffuse	Atria  Diffuse
Pathology	Minimal	Atriomyopathy	Cardiomyopathy
Main strategy	Rhythm control	Rhythm or rate control b	Rate control only
First-line therapy b	Catheter ablation	Antiarrhythmic drugs c	Antiarrhythmic drugs d
Second-line therapy	Antiarrhythmic drugs c	Catheter ablation	N/A

AF, atrial fibrillation.

^aLongstanding persistent AF straddles persistent and permanent AF because cardiac remodeling severities and pathology resemble those in permanent AF, but rhythm-control strategy is an option.

^bExceptions: other clinical factors for considerations, such as drug side effect profile, tolerability, and ease of administration or patients’ age, therapeutic preferences, therapeutic contraindications, and comorbidities (hemodynamic status, ongoing myocardial infarction, hypotension, decompensated heart failure, pre-excitation, hypertrophic cardiomyopathy, other structural heart abnormalities unrelated to AF, etc.).

^cFor rhythm or rate control.

^dFor rate control only.