From the Guidelines
Paroxysmal atrial fibrillation (AFib) is a type of irregular heart rhythm that starts suddenly and stops on its own, typically lasting less than 7 days and often resolving within 24 hours. According to the 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation 1, paroxysmal AF is defined as AF that is intermittent and terminates within ≤7 d of onset. This type of AF is characterized by irregular R-R intervals, absence of distinct P waves, and irregular atrial activity also known as fibrillatory waves.
Some key points to consider in paroxysmal AFib include:
- The distinction between clinical and subclinical AF has become increasingly blurred with the increasing availability of wearable devices and other continuous monitoring technologies 1
- Paroxysmal AFib can cause symptoms like heart palpitations, shortness of breath, fatigue, dizziness, or chest discomfort, but some people may not experience any symptoms at all
- Management of paroxysmal AFib typically includes rate control medications, rhythm control medications, and blood thinners to reduce stroke risk
- Catheter ablation may be recommended for recurrent episodes of paroxysmal AFib
It's worth noting that the term "lone AF" has been used in the past to identify AF in younger patients without structural heart disease, but this term does not enhance patient care and should be abandoned 1. Additionally, the distinction between "valvular" and "nonvalvular" AF remains a matter of debate, and these terms should be abandoned for the purpose of defining the etiology of AF 1.
In terms of management, the 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation provide some guidance, but the more recent 2023 guideline 1 should be prioritized. The most recent and highest quality study, the 2023 ACC/AHA/ACCP/HRS guideline, should be used to guide management decisions for paroxysmal AFib.
From the FDA Drug Label
Sotalol AF has been studied in patients with symptomatic AFIB/AFL in two principal studies, one in patients with primarily paroxysmal AFIB/AFL, the other in patients with primarily chronic AFIB. Patients with paroxysmal AFIB whose AFIB/AFL that is easily reversed (by Valsalva maneuver, for example) should usually not be given Sotalol AF
Paroxysmal AFIB is a type of atrial fibrillation that is characterized by episodes of irregular heart rhythm that can be reversed, such as by a Valsalva maneuver. It is a type of AFIB that is not continuous, but rather occurs in episodes or bouts. 2 2
- Key characteristics:
- Episodes of irregular heart rhythm
- Can be reversed, such as by a Valsalva maneuver
- Not continuous, but rather occurs in episodes or bouts
- Important consideration: Patients with paroxysmal AFIB whose AFIB/AFL is easily reversed should usually not be given Sotalol AF. 2
From the Research
Definition of Paroxysmal AFib
- Paroxysmal atrial fibrillation (AFib) refers to an irregular heartbeat that occurs in episodes, typically lasting from a few seconds to days, and then stops on its own 3, 4, 5, 6, 7.
- These episodes can occur at any time and may be triggered by various factors, such as stress, caffeine, or certain medical conditions.
Characteristics of Paroxysmal AFib
- The condition is characterized by an abnormal heart rhythm, where the upper chambers of the heart beat too quickly and irregularly 3, 4, 5, 6, 7.
- Symptoms may include palpitations, shortness of breath, fatigue, and chest pain, although some people may not experience any symptoms at all.
Treatment and Management
- Treatment for paroxysmal AFib typically involves medications to control heart rate and prevent blood clots, such as apixaban and rivaroxaban 3, 4, 5, 6, 7.
- Studies have compared the effectiveness and safety of these medications, with some findings suggesting that apixaban may be associated with a lower risk of stroke and bleeding compared to rivaroxaban 5, 6, 7.
Key Findings
- A meta-analysis of observational studies found that apixaban was associated with a significantly lower hazard of stroke/systemic embolism and major bleeding compared to rivaroxaban 7.
- Another study found that apixaban was associated with a lower rate of ischemic stroke or systemic embolism and bleeding compared to rivaroxaban in patients with nonvalvular atrial fibrillation 6.