Persistent Atrial Fibrillation

What is persistent atrial fibrillation?

Persistent atrial fibrillation (PersAfib or AF) is the most common type of abnormal, rapid heartbeat (arrhythmia). When you have this condition, your heart beats in an irregular pattern and often beats faster than usual. It cannot get back to its regular rhythm on its own. Common symptoms include feeling that your heart is:

• Racing (heart palpitations).
• Quivering.
• Skipping a beat.

How does persistent atrial fibrillation affect me?

Persistent Afib occurs when your heart's two upper chambers (atria) don't beat at a regular rhythm or rate. The chaotic pulse causes the lower chambers (ventricles) to pump too quickly. When that happens, they can't properly deliver oxygen-rich blood to your body.

This type of atrial fibrillation lasts for at least seven days in a row. You may experience daily symptoms for several minutes or hours. Some people experience no symptoms at all. Persistent Afib is progressive, which means it worsens and may become permanent.

Persistent Afib has no cure. But treatment can restore the heart’s normal rhythm and reduce symptoms. Early detection and management can also help prevent complications such as:

• Blood clots.
• Stroke.
• Pulmonary embolism.
• Heart failure.

Other heart conditions have similar symptoms to Afib. Chest pain or pressure is a medical emergency. If you think you are having a heart attack, call 911 immediately.

What does persistent mean?

Persistent means continuously. Persistent atrial fibrillation means that an abnormal heartbeat continues for at least seven days straight.

Persistent Afib differs from other types of atrial fibrillation, including:

• Paroxysmal atrial fibrillation occurs over fewer than seven days, on and off, and returns to a normal rhythm on its own.
• Long-standing persistent atrial fibrillation lasts for more than a year.
• Permanent atrial fibrillation does not improve with treatment.

Persistent atrial fibrillation often develops in people who have paroxysmal Afib. When paroxysmal atrial fibrillation becomes persistent, your heart cannot get back to a regular rhythm without treatment.

How common is persistent atrial fibrillation?

At least 2.7 million Americans live with atrial fibrillation. Researchers believe an estimated 70% of those cases are persistent or long-standing persistent Afib.

Can children develop persistent atrial fibrillation?

Children rarely develop atrial fibrillation. When they do, their symptoms, diagnosis and treatment are usually similar to adults.

Some children with Afib may have difficulty describing symptoms. Talk to your healthcare provider if your child experiences:

• Chest pain, pressure or pounding (heart palpitations).
• Dizziness, lightheadedness or fainting.
• Shortness of breath (dyspnea).
• Unusual weakness or fatigue.

What are the risk factors for persistent atrial fibrillation?

Risk factors may also involve genetic changes (mutations) in families.

Other factors include heart damage or defects linked to:

• Cardiomyopathy.
• Congenital (at birth) heart disease.
• Coronary artery disease.
• Heart failure.
• Heart surgery (post-surgery).
• Heart valve disease.
• High blood pressure (hypertension).
• Inflammation of the heart (pericarditis).

Lung conditions that can lead to persistent Afib include:

• Chronic obstructive pulmonary disease (COPD).
• Pulmonary hypertension.

You may also be at higher risk due to:

• Age, as Afib occurs most often in adults over age 60 and those with heart disease.
• Certain medications.
• Chronic health conditions such as kidney disease, asthma, sleep apnea, metabolic syndrome or diabetes.
• Ethnicity, as people who are white and of European ancestry are at higher risk of Afib.
• Electrolyte issues or metabolic disorders.
• Family history or genetic factors.
• Hyperthyroidism.
• Severe infection.

Lifestyle factors can raise your risk as well if you:

• Engage in high-intensity exercise or sports.
• Experience frequent stress.
• Use alcohol, caffeine, tobacco or recreational drugs.

What causes persistent atrial fibrillation?

The cause of persistent atrial fibrillation is an abnormal signal that interferes with the heart’s electrical system.

The heart is a muscular organ that pumps blood through your body at a steady rhythm. Two upper chambers (atria) pump blood into two lower chambers (ventricles), which send blood to the lungs and throughout the body.

Your heartbeat is part of a complex electrical system. Cells in a part of the atria called the sinus node (SA node) produce electrical signals to squeeze your heart (make it contract). Abnormal signals interfere with this electrical process. It then becomes more difficult for the heart to pump at a steady pace, affecting blood flow to the rest of the body.

When this occurs, blood can collect in the heart and lead to blood clots which can cause a stroke. You’ll need treatment to restore normal blood flow. If normal heart rhythm and blood flow cannot be restored, you might need treatment with blood thinners.

What are the symptoms of persistent atrial fibrillation?

Some people have no symptoms, while others feel fluttering or pounding in the chest. Other common symptoms include:

• Dizziness or lightheadedness.
• Fatigue.
• Shortness of breath.

If you have any of these symptoms, see your healthcare provider. Early detection and treatment can help avoid complications. People with atrial fibrillation are five times more likely to have a stroke than those without the condition.

And if you have chest pain or pressure, call 911 immediately. You may be having a heart attack.

How is persistent atrial fibrillation diagnosed?

Healthcare providers diagnose persistent atrial fibrillation with a physical exam and questions about your symptoms. Your provider may already be checking you regularly for paroxysmal Afib, which often develops into persistent Afib.

If no Afib is present at the time of your exam, your provider may ask you to wear a portable device, such as a Holter monitor or ambulatory monitor. These devices track your heart rhythms for 24 hours or longer. Fitness tracker data can also help detect arrhythmia.

What diagnostic tests might I have?

Electrocardiogram (EKG) is a painless test that helps healthcare providers diagnose all types of atrial fibrillation. Your provider attaches electrodes (sensors) to your chest using tape (adhesive). The electrodes record your heart’s electrical activity over several minutes.

Providers may also perform tests such as:

• Complete blood count (CBC).
• Stress test.
• Sleep study.
• X-ray and echocardiogram (echo), additional imaging tests.

Is there a cure for persistent atrial fibrillation?

There is no cure for persistent atrial fibrillation. But treatment can slow or prevent symptoms, making it easier for you to manage the condition. Lifestyle changes such as quitting smoking and drinking less alcohol can also help reduce abnormal heart rhythms and prevent complications.

What is the goal of treatment for persistent atrial fibrillation?

The goal of treatment for persistent atrial fibrillation is to:

• Restore your heart's normal rhythm.
• Lower your heart rate.
• Reduce the risk of blood clots, stroke and heart attack.

Your treatment plan may depend on:

• The severity of your symptoms.
• Whether you have an underlying condition.
• Whether you had previous heart surgery.

What are nonsurgical treatments for persistent Afib?

Healthcare providers often use nonsurgical techniques to treat persistent Afib, including:

• Medications such as beta-blockers, digoxin (Lanoxin™), blood thinners (including warfarin) or calcium channel blockers.
• Catheter ablation.
• Electrical cardioversion (shocking the heart back into a normal rhythm).

Will I need surgery for persistent Afib?

If your provider recommends surgery, procedures include:

• Left atrial appendage closure.
• Permanent pacemaker.
• Heart surgery (MAZE).

You can also ask your provider if you’re eligible to participate in any clinical trials. These studies test promising new therapies not widely available.

Which providers might be involved in my treatment?

Persistent atrial fibrillation requires a team of specialists for accurate diagnosis and effective treatment. Your care team may include:

• Cardiologists.
• Electrophysiologists (heart rhythm experts).
• Heart surgeons.
• Pulmonologists (lung doctors).

How can I reduce my risk of developing persistent atrial fibrillation?

Along with treatment, lifestyle changes can help control persistent atrial fibrillation. Your healthcare provider may recommend that you avoid or adjust activities that trigger a rapid, irregular heart rate.

You may also be advised to:

• Eat a healthy diet.
• Get regular exercise.
• Ask your provider before using products such as cold and cough medications that may increase the risk of abnormal heart rhythms.
• Limit your intake of alcohol or caffeine.
• Maintain a healthy weight.
• Manage high blood pressure, cholesterol and blood sugar levels.
• Treat sleep apnea.
• Quit smoking.

What can I expect if I have persistent atrial fibrillation?

With the right treatment and regular management, most people with persistent atrial fibrillation can live active, healthy lives. The longer persistent Afib goes without treatment, however, the harder it is to manage. It may become permanent or lead to severe complications such as blood clots or stroke.

When should I seek treatment for persistent Afib?

Make an appointment with your healthcare provider if you have any signs of persistent atrial fibrillation. These signs include heart palpitations or shortness of breath. If you experience chest pain or pressure, call 911 or seek immediate medical help.

Do I need to restrict or limit travel or other activities?

Extreme temperatures and high altitudes may affect the heart. You may also be concerned about whether you can drive safely or participate in competitive sports. Talk to your healthcare provider so that you are prepared and can continue to do the activities you enjoy.

How do I take care of myself?

Follow your healthcare provider’s recommendations to manage complications and treat symptoms of persistent Afib. Your provider can work with you to develop a personalized care plan to optimize your health.

A note from Cleveland Clinic

Persistent atrial fibrillation is one of the most common heart conditions in the U.S. Early diagnosis and treatment can help restore regular heart function. With the right treatment, you can reduce symptoms and avoid complications. Talk to your healthcare provider about the steps you can take to stay active and manage symptoms.