Challenges in the classification of atrial fibrillation

The incidence and prevalence of atrial fibrillation (AF) are increasing worldwide. AF is of public health importance because it accounts for substantial morbidity, mortality, and health-care costs. AF may be transient initially, but many patients have progressive disease marked by increasing frequency and duration of episodes. Various classification schemes for AF have been proposed, although current guidelines are based on temporal rhythm-based patterns. We discuss existing schemes for the classification of AF, focusing on the advantages and limitations of the pattern-based scheme, in the context of new knowledge about AF pathophysiology, AF patterns, and clinical outcomes. Furthermore, we address gaps in knowledge that present opportunities to re-examine the current pattern-based classification of AF. A future classification scheme should ideally combine elements such as the risk of stroke, an assessment of symptoms, and the degree of impairment of the atrial substrate.