What Is Paroxysmal Atrial Fibrillation?

Atrial fibrillation (AFib) is a type of irregular heartbeat. If you have it, your doctor will classify yours by the reason for it and on how long it lasts. When your heartbeat returns to normal within 7 days, on its own or with treatment, it's known as paroxysmal atrial fibrillation.

It can happen a few times a year or as often as every day. It often becomes a permanent condition that needs regular treatment.

Symptoms

You might feel:

  • Heat palpitations -- a flutter in your chest or rapid heartbeat
  • Chest pain or pressure
  • Confused
  • Weak or short of energy
  • Dizzy
  • Short of breath
  • Like you have to pee more often
  • Like it’s hard to exercise
  • Tired

You may feel chest pain or pressure. If you do, call 911 right away. You may be having a heart attack.

Causes & Risk Factors

Doctors don't always know what causes paroxysmal atrial fibrillation. It often happens because things like coronary heart disease or high blood pressure damage your heart. If that damage affects the part of your heart that sends the electrical pulses that control your heartbeat, those pulses can come too fast or at the wrong time.

You're more likely to have paroxysmal atrial fibrillation as you get older. Your odds also go up if you have:

People who drink several alcoholic drinks at a time sometimes have paroxysmal atrial fibrillation. Doctors don't know, though, why this happens. This is sometimes called "holiday heart syndrome" because it was first noticed after weekends or holidays when many people drink more.

Diagnosis

If your doctor thinks you have atrial fibrillation, he'll give you an exam and ask questions about your medical and family history. He'll also ask about your symptoms and if you smoke or drink caffeine or alcohol.

You might have some of the following tests:

  • Electrocardiogram, also known as an EKG, which records your heart's rate, rhythm, and electrical impulses
  • Echocardiogram, which uses sound waves to make a picture of your heart
  • X-ray to look for signs of related heart problems
  • Blood tests to look for signs of other illnesses that can cause fibrillation
  • Stress test , in which doctors check your heart's performance after exercise
  • Holter monitor, a wearable device that measures and records your heart's activity for a day or two
  • Event monitor, a portable EKG that measures heart activity for a few week or a few months.

 

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Treatment

There are several options to control AFib, or maybe stop it altogether.

Medications

If your problem comes from a condition like an overactive thyroid gland or high blood pressure, your doctor will give you medications to control those issues.

Generally, your doctor will try to keep your heartbeat steady and prevent problems like blood clots.

Heart rate control: The most common way to treat atrial fibrillation is with drugs that control your heartbeat. Most people take a medication called digoxin (Lanoxin).

You may need other drugs. Some are called beta-blockers. They also slow your heart rate. Examples are:

  • Atenolol (Tenormin)
  • Bisoprolol (Zebeta, Ziac)
  • Carvedilol (Coreg)
  • Metoprolol (Lopressor, Toprol)
  • Nadolol (Alti-Nadolol, Corgard, Corzide)
  • Propranolol (Hemangeol, Inderal)
  • Timolol (Betimol, Istalol)

Others are known as calcium channel blockers. They slow your heart rate and tone down contractions:

  • Diltiazem (Cardizem, Dilacor)
  • Verapamil (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan)

Heart rhythm control: When your doctor gets your heart rate under control, he’ll give you medications to return the rhythm to normal. He may call this chemical cardioversion. Medications for this process include:

Sodium channel blockers, which slow your heart's ability to conduct electricity:

  • Flecainide (Tambocor)
  • Propafenone (Rythmol)
  • Quinidine

Potassium channel blockers, which slow the electrical signals that cause AFib:

  • Amiodarone (Cordarone, Nexterone, Pacerone)
  • Dofetilide (Tikosyn)
  • Sotalol (Betapace, Sorine, Sotylize)

You might get them in your doctor's office or at a hospital. Your doctor will monitor you to make sure the medicine is working.

Blood clots and stroke prevention: These medications thin your blood to lower your chance of having these conditions. These can make you bleed more easily, though, so you might have to cut back on some activities that can lead to injuries. The most common are:

 

Surgery and Other Procedures

If medications don't get your AFib under control, your doctor might recommend one of these:

Electrical cardioversion : The doctor gives your heart a shock to regulate your heartbeat. She’ll use paddles, or she'll stick patches called electrodes to your chest.

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First, you'll get medicine to make you fall asleep. Then, your doctor will put the paddles on your chest, and sometimes your back. These will give you a mild electrical shock to get your heart's rhythm back to normal.

Most people only need one. Because you’re sedated, you probably won’t remember being shocked. You can usually go home the same day.

Your skin may be irritated where the paddles touched it. Your doctor can point you toward a lotion to ease pain or itching.

Cardiac Ablation: There are two major options:

Catheter ablation , also called radiofrequency or pulmonary vein ablation, isn’t surgery, and it’s the less invasive of the two options. Your doctor puts a thin, flexible tube into a blood vessel in your leg or neck. Then she guides it into your heart. When it reaches the area that’s causing the arrhythmia, it sends out electrical signals that destroy those cells. The treated tissue helps get your heartbeat regular again. There are two main types:

  • Radiofrequency ablation: The doctor uses catheters to send radiofrequency energy (similar to microwave heat) that creates circular scars around each vein or group of veins.
  • Cryoablation: A single catheter sends a balloon tipped with a substance that freezes the tissues to cause a scar.

Surgical ablation involves cutting into your chest. There are three kinds:

Maze procedure: This is usually done while you’re having open-heart surgery for another problem, like a bypass or valve replacement. The surgeon makes small cuts in the upper part of the heart. They’re stitched together to form a maze of scar tissue that stops abnormal signals.

Mini maze:  Most people with AFib don’t need open-heart surgery. That’s where this minimally invasive option comes in. The doctor makes several small cuts between your ribs and uses a camera to guide catheters for either cryoablation or radiofrequency ablation. Some hospitals offer robot-assisted surgery that uses smaller cuts and allows for greater precision. Your doctor will put a video camera or tiny robot into your chest. It’ll guide the creation of scar tissue that may help keep your heartbeat at the right pace.

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Convergent procedure: This pairs catheter ablation with a mini maze. The doctor uses radiofrequency ablation in the pulmonary vein, and a surgeon makes a small cut under your breastbone to use radiofrequency energy on the outside of your heart.

AV node ablation: You might get this procedure if:

  • You don’t respond to medications
  • You can’t take medications because of side effects
  • You aren’t a good candidates for a procedure that cures you  

Your doctor will insert a catheter into a vein in your groin and slide it up to the AV node, a nerve that conducts electrical impulses between the top and bottom chambers of your heart. She’ll send radiofrequency energy through the catheter to destroy the AV node. This stops the signals that lead to AFib.

Then she’ll implant a pacemaker into your chest. This electronic device lies under the skin of your upper chest. It’s connected to one or two wires that are inserted through a vein and sit in your heart. It delivers painless electric pulses that make your heart beat.

Lifestyle Changes

Your doctor also might recommend you take some simple steps to help keep your heart healthy:

  • Change your diet: Eat heart-healthy, low-salt food. Go for fruits, veggies, and whole grains.
  • Get more exercise: More physical activity strengthens your heart

And make other changes to lower your odds of heart disease:

  • Quit smoking
  • Stay at, or try to reach, a healthy weight
  • Control your blood pressure
  • Manage your cholesterol
  • Drink alcohol in moderation
  • Keep doctor appointments

 

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on May 2, 2018

Sources

SOURCES:

American Heart Association: “Ablation or Arrhythmias,” “Atrial Fibrillation Medications,” “Non-surgical Procedures for Atrial Fibrillation (AFib or AF),” “Surgical Procedures for Atrial Fibrillation (AFib or AF).”

National Heart, Lung and Blood Institute: "What Is Atrial Fibrillation?"

American Family Physician: "Diagnosis and Treatment of Atrial Fibrillation," "Catheter Ablation of Supraventricular Arrhythmias and Atrial Fibrillation."

American College of Cardiology/American Heart Association: "Management of Patients with Atrial Fibrillation."

Heart Rhythm Society: "Atrial Fibrillation," “Symptoms of Atrial Fibrillation (AFib),” “Types of Ablations.”

Mayo Clinic: “Atrial Fibrillation,” “Cardioversion.”

American College of Cardiology: “Recommended Doses of Anticoagulant/Antithrombotic Therapies for Patients with Atrial Fibrillation.”

StopAfib.org: “Maze Procedure (Surgical Ablation),” “Using Electrical Cardioversion for Atrial Fibrillation.”

Keck School of Medicine of USC: “Robotic-Assisted Maze Surgery.”

Frankel Cardiovascular Center: “AV Node Ablation.”

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