What Is Persistent Atrial Fibrillation?

Could your heart rhythm problem last for a while? If your irregular heartbeat episode lasts for more than a week, it’s called persistent atrial fibrillation.

Atrial fibrillation (AFib) is the most common type of heart arrhythmia. Your heartbeat is uneven and can be too fast. AFib can put you at risk for a stroke or heart failure.

While a short-term episode of AFib may get better on its own, persistent AFib usually needs treatment.

What Happens?

In AFib, electrical signals that set your heart’s rhythm go haywire. These signals affect the two upper chambers of your heart, called the atria. They disrupt your heart’s normal rhythm.

Your atria then pump blood to the lower chambers of your heart in an offbeat way. Your heart may pump too little blood on one beat, then too much blood on the next beat.

What Are the Symptoms?

Some people with atrial fibrillation have no symptoms and don't know they have it until their doctor finds it during a routine physical.

If you do have symptoms, you might notice:

  • Heart feels like it skips a beat, thumps, or beats too hard or too fast
  • Confusion
  • Dizziness
  • Fatigue (feel weak or very tired), especially when you’re active
  • Pain or pressure in your chest
  • Shortness of breath
  • Sweating
  • Weakness

Causes and Risk Factors

Persistent AFib usually starts as short-term AFib, also called paroxysmal AFib. Over time, AFib can damage your heart’s tissues. It becomes persistent. Your episodes happen more often or last longer.

You’re more likely to get persistent AFib if you’re:

Diagnosis

Your regular doctor will do a physical exam and ask about your medical history. Your doctor will ask you about your symptoms and how long they last. Let your doctor know if you smoke or drink alcohol or caffeine.

For further tests, your doctor may also refer to you to a cardiologist, or heart specialist. You may also need to see an electrophysiologist, a cardiologist who diagnoses and treats heart rhythm problems.

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Tests

Your doctor might have you wear a small electrocardiogram (EKG) device called a Holter monitor or an event monitor. They test your heart rate over time and can help your doctor diagnose persistent AFib. You wear a Holter monitor for 1 or 2 days as you go about your daily life. You wear an event monitor for weeks.

Other tests to help your doctor diagnose persistent AFib include:

  • A stress test, which measures your heart rate while you walk or run on a treadmill
  • An echocardiogram, which uses sound waves to show your heart’s chambers and how they beat
  • A transesophageal echocardiogram (TEE), which uses a thin tube placed down your esophagus to show blood clots caused by AFib
  • A chest X-ray if your doctor thinks you may also have a lung problem
  • Blood tests

Medications to Treat Persistent AFib

Certain drugs may ease symptoms and prevent more episodes. 

Your doctor may prescribe these medications to help treat or prevent complications from persistent AFib:

  • Blood thinners to help prevent clots caused by persistent AFib
  • Medications like beta-blockers, calcium channel blockers, or digitalis to slow your heart’s rate
  • Medications to reset your heart’s rhythm and keep it regular, which may help you if rate control medicines don’t work well
  • If high blood pressure or a thyroid problem causes your persistent AFib, your doctor may prescribe medicines to treat those conditions.

Procedures to Treat Persistent AFib

If your medicines don't work or they cause side effects, you can try one of two procedures called cardioversion or ablation. These treat AFib without surgery.

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

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 shock. Because you’re sedated, you probably won’t remember being shocked. You can usually go home the same day.

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

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

There are two main types of catheter ablation:

  • Radiofrequency ablation: The doctor uses catheters to send radiofrequency energy (similar to microwave heat) that makes circular scars around each vein or group of veins.
  • Cryoablation: A single catheter sends a balloon tipped with a substance that freezes the tissue so signals can’t cross it.

Surgical procedures may help reset your heart’s rhythm, too:

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 the 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.

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: 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 AFib. Then the doctor will 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.

You might get this procedure if:

  • Your AFib doesn't get better with medications.
  • You can’t take medications because of side effects.
  • You shouldn't get a curative procedure.

 

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Prevention

Healthy changes to your lifestyle may help prevent persistent AFib episodes or treat its causes:

  • Eat a healthy diet.
  • Cut back on salt, which can cause high blood pressure.
  • Quit smoking.
  • Get your stress in check.
  • Don’t drink alcohol or caffeine, or limit them. They make your heart beat faster.
  • If you're obese, lose weight to ease AFib symptoms, prevent episodes, and have a better result from ablation surgery.

Exercise may improve your AFib symptoms and quality of life. It can trigger symptoms in some people, though.

Talk to your doctor first to make sure you’re healthy enough to exercise. Start slowly with short, gentle activities. If exercise makes you too tired or lightheaded, let your doctor know.

WebMD Medical Reference Reviewed by Neha Pathak, MD on May 21, 2018

Sources

SOURCES:

National Heart, Lung, and Blood Institute: “Atrial Fibrillation.”

My AFib Experience: “Exercising With Atrial Fibrillation,” “Symptoms of Atrial Fibrillation,” “What Do I Need to Know About Exercise and AFib?”

Expert Reviews in Cardiovascular Therapy: “Persistent atrial fibrillation versus paroxysmal atrial fibrillation: differences in management.”

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

European Heart Journal: “Catheter ablation in patients with persistent atrial fibrillation.”

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

Europace: “The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management.”

Heart Rhythm Society: “Types of Ablations.”

University of Michigan, Frankel Cardiovascular Center: “AV Node Ablation.”

Mayo Clinic: “Cardioversion.”

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