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What is Paroxysmal Atrial Fibrillation?

By Kristi L. Lenz
Updated Mar 03, 2024
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Atrial fibrillation is an irregular heart rhythm associated with disorganized electrical activity in the upper two chambers of the heart. Abnormal electrical impulses cause the atria to beat very fast and in an uncoordinated manner. This is called fibrillation. Paroxysmal atrial fibrillation indicates that the arrhythmia occurs at varying intervals, rather than consistently or constantly. The result of the rapid, irregular beats is ineffective filling of the ventricles, the bottom two chambers of the heart that pump blood out to the body.

Atrial fibrillation is the most common heart arrhythmia. The underlying cause is often unknown, but the risk increases with age. As many as 4% of those over the age of 65 are affected by atrial fibrillation. Other risk factors include coronary artery disease, uncontrolled high blood pressure, and obesity.

Some non-cardiac conditions can also cause this condition. This includes hyperthyroidism and imbalances of potassium, calcium, or magnesium. In these cases, atrial fibrillation usually reverses when the underlying condition is treated.

Many of the symptoms associated with atrial fibrillation are due to rapid heart rate. A normal resting heart rate is 60 to 100 beats per minute. During an episode of paroxysmal atrial fibrillation, the heart may beat as many as 175 times per minute. Some patients actually feel the rapid irregular beats of the heart. These are called palpitations.

Ineffective filling of the ventricles also leads to many symptoms of atrial fibrillation. Patients often experience shortness of breath and chest pain. Fatigue, decreased ability to exercise, and dizziness are also common. When atrial fibrillation is severe, confusion and fainting may occur.

Atrial fibrillation is often first detected by a health care provider listening to the heart. The diagnosis is then confirmed with an electrocardiogram (EKG), which takes readings of the electrical activity of the heart. Occasionally, an echocardiogram of the heart may be necessary. This is a test that visualizes the heart while it is beating.

For paroxysmal atrial fibrillation, episodes occur intermittently and may only last a few seconds or minutes. To confirm this diagnosis, patients may wear a portable, continuous EKG for one or two days. This is called a Holter monitor. A similar device, called an event monitor, only takes EKG readings when the patient experiences symptoms and pushes a button. An event monitor can be worn for several months.

Due to the intermittent nature of this condition, many patients with this condition do not require any treatment at all. This is particularly true if they do not experience symptoms. Patients are advised to minimize stress whenever possible. Over half of patients with paroxysmal atrial fibrillation list stress as the number one trigger of fibrillation episodes.

There are other steps patients can take to prevent episodes. Caffeine, alcohol, and nicotine should be avoided, as all have been shown to be triggers. Over-the-counter cold medications such as pseudoephedrine can precipitate episodes and should be avoided as well. Stopping smoking is also encouraged, as it significantly contributes to the development of heart disease. High blood pressure should be controlled for the same reason.

If symptoms begin to occur more frequently, patients with paroxysmal atrial fibrillation may take medications that slow the heart rate to less than 80 beats per minutes. This includes beta-blockers, calcium channel blockers, and digoxin. Rate control allows the ventricles more time to completely fill with blood. Note that this strategy manages the symptoms but does not correct the underlying arrhythmia.

When symptoms are not managed effectively with rate control alone, patients may take medications that correct the underlying rhythm problem. Examples include sotalol, amiodarone, and ibutilide. Long-term therapy has the potential to cause many side effects, so patients are screened carefully before starting antiarrhythmic drugs.

There are also non-drug treatment options for atrial fibrillation. The most commonly used is electrical cardioversion. This is a procedure that attempts to convert the abnormal rhythm to a normal one with a controlled electrical current passed through the heart.

Atrial fibrillation itself is not a life-threatening condition, but there are two potentially life-threatening complications: stroke and heart failure. The risk of stroke results from the pooling of blood in the atria during fibrillation. This can cause a blood clot to form, and in some cases, break free and go to the brain. Persistent or permanent atrial fibrillation requires treatment with blood thinners to decrease this risk.

The ineffective filling of the ventricles means that the heart is not pumping enough oxygenated blood to the tissues of the body. This is heart failure, and once it occurs, it often cannot be reversed. Educating patients about the reversible risk factors, such as obesity and high blood pressure, will help to prevent atrial fibrillation before it occurs.

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Discussion Comments
By anon995280 — On Apr 17, 2016

Be careful mixing heart drugs with other medication. Check for contraindications and be aware some drugs can cause paroxysmal atrial fibrillation.

By anon309679 — On Dec 17, 2012

I was diagnosed with PAF two years ago, and was put on aspirin and a beta blocker. I didn't like the BB so I went off it six months ago and never felt better.

By anon249413 — On Feb 20, 2012

@Colin, Post 7: Sounds like you need to find another cardiologist. My father has A Fib, and I have learned not all meds help everyone. Digoxin is a good med to help control the heart rate. Dad was on metoprolol which seemed to be ineffective. He takes Lisinopril and Digoxin which seem to keep his A Fib under control. If you are having episodes of high hr please seek another cardiologist.

By anon218781 — On Sep 30, 2011

I had paroxysmal atrial fib for about seven years. I continued to exercise mostly road bike riding. Took Rhythmol with good effects. I had one episode while riding a 70 mile bike ride which wouldn't go away until I had a bowel movement which stopped it immediately. So it would appear that increased vagal tone may help. At any rate I am now off drugs and without any episodes of atrial fibrillation for the past four years.

By anon182156 — On Jun 01, 2011

I had vf for the past eight years. I had various monitors for weeks at a time and nothing showed up. I had a five-year gap between really bad episodes, but have had two in the last month.

I went through the usual tests: monitors, etc. and saw my cardio today and was told to pop in to the nearest place for an ecg if it happens again. He offered me beta blockers and said no diagnosis, no pills.

I'm waiting for the next episode now and they might give me an implant. I really don't think they believe me and it's wrecking my life. I'm 57 and had three spine ops in three years. I don't need this on top of that, but I don't know what to do or where to turn. Every time it feels like this is it and I'm having a heart attack. They just don't care. I'm fed up and depressed.

By colin — On Mar 15, 2011

I was just diagnosed with AF about eight months ago, put on baby aspirin and bisoprolol (slows heart rate) then proceeded to have a minor stroke in January. I am now on Coumadin and the bisoprolol.

As many of you know, these treatments do not stop AF from occurring. I have been tracking my occurrences of AF since leaving the hospital. I have episodes (that I recognize) on about 40 percent of the days. They last from 10 minutes to 8 hours.

A typical episode would be for two to four hours.

I am trying to correlate their onset to some factor; my cardiologist told me not to bother, and he might be right. Often they occur from mid-day on and usually when at rest. Actually, once I start doing vigorous exercise (stairmaster) they have not occurred.

My question I want to throw out to any of you with AF, once an episode starts, have you found a way to get back into sinus rhythm?

By Alun — On Jan 16, 2011

I suffer from P.A.F. When diagnosed I had a heart rate of 220 and the cardiologist who was working casualty that evening (most unusual; she must have been on a rotation) administered Flecainide, followed up later by another cardiologist with diltiazem. I take them both together.

In answer to the question at the top of this discussion that a trigger for AF is licorice, it lowers the potassium levels and away the heart goes. Also I have found that high energy drinks do the same thing. Strangely, coffee, no matter how much I drink, does not have that much an effect on me. Do a search for licorice ingredients and potassium and you will hit a page on people's pharmacy. do a find there for heart and you will see just who should avoid licorice.

Otherwise, with my meds, my condition is very well controlled. As for wesley91, follow their advice. I don't know about Amiodarone but what i am taking works well. I also have to take Warfarin for the clotting that can occur and that is what is the real danger -- not so much that the heart will give out but that the blood not clearing the heart chambers will pool and clot. You then have a very high risk of strokes. One way of looking at the Warfarin is that you will be unlikely to suffer from a DVT on long distance flights.

By anon122232 — On Oct 27, 2010

What would you say are the best triggers for a Paroxysmal Atrial Fibrillation?

By googie98 — On Jul 26, 2010

@wesley91: I agree about the amiodarone. It is not usually given with beta-blockers because the side effects can be severe. Usually, when those two drugs are given together, it is in a hospital setting.

Maybe she looked at her discharge summary or something. It might have been something about the drugs that she had in the hospital. You definitely need to double check the prescription. Your pharmacist should be able to tell you the drug interactions.

By christym — On Jul 26, 2010

@wesley91: Atenolol (Tenormin) is a beta-blocker. I have been taking it for years for my high blood pressure. Beta-blockers affect the heart and circulation. It is used to treat chest pain (angina) and high blood pressure.

Amiodarone is an antiarrhythmic that is primarily used in hospitals. It is used to help keep the heart beating normally and it treats atrial fibrillation symptoms, ventricular tachycardia, ventricular fibrillation, and atrial flutter.

I would check with her doctor because amiodarone is normally given for home use in more serious situations. Double check the prescription and make sure that’s what it says.

By wesley91 — On Jul 26, 2010

My mom recently had a scare with her heart. Once we arrived at the hospital, all kinds of tests were done. They determined that she had paroxysmal atrial fibrillation.

She was released from the hospital 4 days later and was given a prescription for atenolol and amiodarone. She refuses to take them because she doesn't understand what they are.

Are those two drugs common for treating atrial fibrillation?

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