In the classification of AF, what is defined as Permanent AF?

Permanent atrial fibrillation refers to a situation in which the arrhythmia is sustained and has been accepted as ongoing by the patient and healthcare provider. It is characterized by the failure of attempts to restore normal sinus rhythm through methods such as cardioversion, and the decision is made to not pursue further attempts for restoration of rhythm control. This can occur for various reasons, including patient preference or underlying health issues that make rhythm control strategies impractical.

The other definitions, while related to the characteristics of atrial fibrillation, do not align with the criteria for permanent AF. For instance, episodes that resolve spontaneously or are of short duration, such as those lasting less than 24 hours, are classified as paroxysmal AF or self-limited, not permanent. Similarly, AF occurring only once would not meet the criteria for permanence, as permanent AF implies a continuous presence of the arrhythmia over time. Thus, the defining feature of permanent AF is the lack of successful cardioversion and the acceptance of AF as the ongoing rhythm.