What Is Paroxysmal Atrial Fibrillation?

Do you experience chest pain, lightheadedness, and heart palpitations? Are there moments when you can't catch your breath?

If so, you may have atrial fibrillation. Atrial fibrillation occurs when the atria, or upper chambers of the heart, lose their normal rhythm and beat chaotically. It's commonly known as AF or AFib.

When it happens, blood doesn't flow through the heart and body efficiently. Inefficient flow can cause the blood to pool inside the atria, which increases the risk of blood clots.

Paroxysmal AFib are episodes of AFib that occur occasionally and then stop spontaneously. Episodes can last a few seconds or a few days before stopping and returning to normal sinus rhythm.

Some people may have single episodes of AFib. However, people with permanent damage to their heart may experience constant, or chronic AFib. There are three types of AFib: paroxysmal, persistent, and chronic (or permanent).

Persistent AFib lasts longer than seven days. It doesn't stop without treatment. Normal rhythm may be achieved with medication or electric shock treatment.

Chronic or permanent AFib is ongoing for many years. It can't be changed back to normal rhythm, even with medication or electrical shock therapy.

It's not uncommon for you to develop persistent or chronic atrial fibrillation if you have paroxysmal AFib.

Research has shown that 9 percent to 30 percent of cases of paroxysmal AFib progress into a more serious case after one year. Age, hypertension, obesity, and overall health all factor into your risk of developing chronic AFib.

According to data from the Centers for Disease Control and Prevention (CDC), between 2.7 and 6.1 million people in the United States have some type of AFib. It's the most common abnormal heart rhythm.

Studies have shown that around 40 percent of people with AFib have paroxysmal AFib. However, estimates vary widely due to the difficulty of diagnosing different types.

AFib occurs more often in older people. The older you are, the more likely you are to have it. However, younger people are more likely to have paroxysmal AFib than other types.

You're also at greater risk for the condition if you have:

• heart disease
• thyroid problems
• high blood pressure
• sleep apnea
• diabetes
• kidney disease
• alcohol misuse problems

AFib is caused by damage to the heart from heart disease or high blood pressure. Medications and other factors can also lead to AFib. These factors include:

• binge drinking, or consuming 4 to 5 drinks within 2 hours
• stimulant medications and drugs, such as methylphenidate, pseudoephedrine, or cocaine
• nicotine
• caffeine
• low potassium levels, which can lead to an electrolyte imbalance
• low magnesium levels
• a significant illness or surgery
• viral infections
• heart or heart valve defects
• hyperthyroidism (overactive thyroid)
• inflammation
• family history of AFib

Symptoms of AFib can include:

• lightheadedness
• weakness
• pounding heart
• chest pain

You may not have any symptoms at all. However, complications can occur in anyone with AFib.

Complications

Stroke and embolism are the most serious and the most common complications of AFib. If you have AFib, you're 4 to 5 times more likely to have a stroke than people without it. This is because blood pooling inside the heart can coagulate and form clots.

Those clots can travel to your brain and cause a stroke. They can also lodge in your gut, limbs, and kidneys, blocking blood flow and starving the tissue.

If your AFib persists over a long period without treatment, the heart may no longer effectively push blood and oxygen throughout the body. This could result in heart failure.

Treatment for AFib involves:

• resetting the heart's rhythm
• controlling the heart's speed
• preventing blood clots

If you have paroxysmal AFib, your normal heart rate can return. Therefore, doctors may try to reset the normal rhythm with medications or electrical shock, also known as cardioversion.

Your doctor may suggest an antiarrhythmic medication, such as amiodarone (Cordarone) or propafenone (Rythmol), even when normal rhythm has returned. They also may prescribe beta-blockers to control blood pressure.

Another option for the treatment of AFib is ablation. Ablation is done by a heart rhythm specialist.

The doctor inserts an instrument that goes through your groin and up into the areas around your heart. Then, they disable the source of your abnormal rhythm. In certain people, this intervention can treat AFib permanently.

If you have ongoing AFib, your doctor may prescribe blood-thinning medications such as non-vitamin K oral anticoagulants (NOACs) or warfarin (Coumadin) to prevent blood clots. NOACs are now recommended for most people over warfarin unless you have moderate to severe mitral stenosis, or you have an artificial heart valve.

Examples of NOACs include:

• dabigatran (Pradaxa)
• rivaroxaban (Xarelto)
• apixaban (Eliquis)
• edoxaban (Savaysa)

Staying healthy is key to living a normal, active life with AFib. Underlying conditions, such as high blood pressure, thyroid disease, diabetes, and obesity, are common risk factors for developing an AFib episode.

To prevent additional paroxysmal AFib episodes, avoid excessive alcohol consumption and stimulants such as caffeine and nicotine.

Lastly, always remember to talk to your doctor and schedule regular checkups.