Paroxysmal and non-paroxysmal atrial fibrillation: does the arrhythmia type influence thromboembolic risk?

Atrial fibrillation (AF) is the most commonly diagnosed rhythmic disorder in clinical practice. Thromboembolic events are the main problem caused by the disease. Incidence, morbidity, and affected population are significantly different for the different types of AF. This quite logically raises the question of possible differences in the thromboembolic potential of paroxysmal and non-paroxysmal (persistent and permanent) AF. However, most studies address the problem for the entire population of AF patients. Those who distinguish between the paroxysmal and the non-paroxysmal type produce contradictory results. There is no consensus on the thromboembolic risk depending on the disease duration (paroxysmal/non-paroxysmal AF). According to current clinical guidelines, anticoagulant therapy is independent of AF type. The fact that AF has a dynamic nature and its paroxysmal form often progresses to non-paroxysmal cannot be overlooked. Further studies in search of the embologenic threshold of AF and biomarkers for its diagnosis are necessary for optimization of anticoagulant prophylaxis.