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 24-48 hours without treatment. It occurs when the upper chambers of the heart (atria) beat chaotically and out of sync with the lower chambers (ventricles), disrupting normal blood flow. Unlike persistent or permanent AFib, paroxysmal AFib comes and goes intermittently, with normal heart rhythm between episodes. Patients may experience symptoms such as heart palpitations, shortness of breath, fatigue, dizziness, or chest discomfort during episodes, though some people have no symptoms at all. The condition is caused by abnormal electrical signals in the heart, often triggered by factors like alcohol consumption, stress, caffeine, or underlying heart conditions. While paroxysmal AFib itself isn't immediately life-threatening, it increases the risk of stroke due to potential blood clot formation in the atria, so patients may require anticoagulant medications like warfarin, apixaban, or rivaroxaban depending on their stroke risk factors. Treatment approaches include rate control medications (beta-blockers, calcium channel blockers), rhythm control medications (antiarrhythmics), and in some cases, procedures like catheter ablation to prevent recurrences, as supported by the most recent guidelines 1. Key characteristics of paroxysmal AFib, as defined in the 2023 ACC/AHA/ACCP/HRS guideline, include termination within ≤7 days of onset, distinguishing it from persistent AFib which sustains for >7 days 1. This definition is crucial for guiding treatment decisions and predicting outcomes. In clinical practice, the management of paroxysmal AFib should prioritize stroke prevention, symptom management, and addressing underlying risk factors, aligning with a holistic approach to AF management 1. Given the potential for paroxysmal AFib to increase the risk of stroke, antithrombotic therapy is a critical consideration, with the choice of anticoagulant depending on the patient's stroke risk factors and other clinical characteristics 1. Overall, the management of paroxysmal AFib requires a comprehensive approach that considers the patient's overall health status, symptoms, and risk factors for stroke and other complications.
From the Research
Definition of Paroxysmal Atrial Fibrillation (Afib)
Paroxysmal atrial fibrillation (afib) is a type of atrial fibrillation that is characterized by:
- Recurrent episodes of atrial fibrillation that stop on their own within 7 days 2
- Episodes of atrial fibrillation that can be symptomatic or asymptomatic 3, 4, 5
- Atrial fibrillation that increases the risk of stroke, even in asymptomatic patients 6, 4
Key Characteristics
- Paroxysmal afib is a common arrhythmia that increases with age 2
- It presents with a wide spectrum of symptoms and severity 2
- Asymptomatic episodes of paroxysmal afib can occur more frequently than symptomatic episodes 4
- Intermittent monitoring may be more sensitive than continuous monitoring for detecting episodes of paroxysmal afib 5
Management and Treatment
- The management of paroxysmal afib involves individualized approaches, including restoration and maintenance of sinus rhythm, control of ventricular rate, and prevention of stroke 6, 2
- Antiarrhythmic drugs, radiofrequency ablation techniques, and device therapy may be used to prevent recurrent atrial fibrillation 2
- The goals of treatment include prevention of thromboemboli, control of ventricular response, restoration of sinus rhythm, and maintenance of sinus rhythm by preventing recurrences 2