Persistent atrial fibrillation vs paroxysmal atrial fibrillation: differences in management

ABSTRACT

Introduction: Atrial fibrillation (AF) is the most common human arrhythmia. AF is a progressive disease, initially being nonsustained and induced by trigger activity, and progressing towards persistent AF through alteration of the atrial myocardial substrate. Treatment of AF aims to decrease the risk of stroke and improve the quality of life, by preventing recurrences (rhythm control) or controlling the heart rate during AF (rate control). In the last 20 years, catheter-based and, less frequently, surgical and hybrid ablation techniques have proven more successful compared with drug therapy in achieving rhythm control in patients with AF. However, the efficiency of ablation techniques varies greatly, being highest in paroxysmal and lowest in long-term persistent AF.

Areas covered: In this review, we discuss the fundamental differences between paroxysmal and persistent AF and the potential impact of those differences on patient management, emphasizing the available therapeutic strategies to achieve rhythm control.

Expert commentary: Treatment to prevent AF recurrences is suboptimal, particularly in patients with persistent AF. Emerging technologies, such as documentation of atrial fibrosis using magnetic resonance imaging and documentation of electrical substrate using advanced electrocardiographic imaging techniques are likely to provide valuable insights about patient-specific tailoring of treatments.

KEYWORDS:

• Atrial fibrillation
• ablation
• persistent
• paroxysmal
• treatment

Acknowledgements

We thank Mrs. Elaine Lilly, PhD; Writer’s First Aid (WFA) for English language revision.

Declaration of interest

Dr Lluís Mont is consultant, lecturer, or has received research funding from Biosense Webster, Boston Scientific, Medtronic, and St Jude Medical. He also has stock options of Galgo Medical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This manuscript has been supported by an European Heart Rhythm Association (EHRA) Training Grant in Advanced Electrophysiology, to Dr Andrei D Margulescu.