Paroxysmal AFib

Paroxysmal AFib is an early stage of atrial fibrillation in which episodes of an irregular heart rhythm last fewer than seven days. You may have symptoms like a fluttering or racing heart during an episode. Or you may feel nothing at all. Without treatment, paroxysmal AFib may increase your risk of a stroke. Over time, paroxysmal AFib may become more frequent, last longer and cause more symptoms.

It’s important to see a healthcare provider if you think there’s any chance you may have AFib. The sooner you get a diagnosis, the better your chances of stopping the progression and preventing serious complications.

Symptoms of paroxysmal AFib

While episodes are short compared to later stages of AFib, the symptoms can range from manageable to severe. Many people have no symptoms. In that case, the only way to know you’re in AFib is through medical tests or wearable devices that check for abnormal rhythms. If you do have symptoms, they can include:

• Heart palpitations (most common symptom)
• Shortness of breath when you’re active or even when you’re resting
• Extreme tiredness
• Fainting or feeling like you might faint
• Chest tightness or discomfort

Up to 1 in 3 people with paroxysmal AFib have severe episodes that greatly impact their quality of life.

Paroxysmal AFib causes

Paroxysmal AFib is a stage of atrial fibrillation (an irregular heart rhythm that starts in your heart’s upper chambers), not a separate type of the condition. That means it has the same causes as AFib overall. These vary widely but commonly include other heart issues that change your heart’s electrical system, like coronary artery disease or valve disease.

Complications of this condition

Even though episodes are short-lived, paroxysmal AFib may still increase your risk of a stroke. That’s because the chaotic heart rhythm makes it easier for blood clots to form in your heart. These clots can break free and move through your arteries to other areas of your body, like your brain. A clot that blocks blood flow to your brain can lead to a stroke. 

How doctors diagnose this condition

Healthcare providers use tests that record your heart’s electrical activity to diagnose paroxysmal AFib. You may need more than one test. With this form of AFib, the episodes come and go but don’t last long. So, it’s hard to record them right when they’re happening. It’s like trying to take a photo of lightning. By the time your camera’s out, the moment has passed.

The first step is usually an electrocardiogram (EKG/ECG). You get this test at your provider’s office. It records your heart rate and rhythm for about 10 seconds.

That likely won’t be long enough to capture paroxysmal AFib. So, your provider may recommend a device that monitors your heart for days, weeks or even longer. You typically wear these devices as you go about your usual routine. That gives you a better chance of recording an episode. Your provider then reviews the data from the monitor and uses it to guide treatment.

How is paroxysmal AFib treated?

The goal of treatment is to stop or slow AFib progression. This usually involves making changes to your daily habits, plus taking some medications. In some cases, a procedure at this early stage is helpful.

Your healthcare provider may recommend:

• Managing risk factors: Certain health conditions raise your risk of AFib progressing from paroxysmal to persistent. These include having overweight/obesity, diabetes, high blood pressure and sleep apnea. Your provider will offer guidance unique to your needs.
• Limiting or avoiding alcohol: To slow AFib progression and reduce symptoms, don’t have more than three drinks per week. If possible, don’t have any alcohol at all.
• Medications: Your provider may prescribe blood thinners to reduce your risk of a stroke. You may also need medications to control your heart rate and/or rhythm. These can help your heart beat normally and reduce symptoms.
• Procedures: Catheter ablation can improve symptoms and slow progression. Your provider will talk with you about whether ablation is right for you and the best timing. Cardioversion can stop an episode as it’s happening. You may need it for severe episodes.

Does paroxysmal AFib always progress?

No. It’s possible to stop or slow the progression from paroxysmal to persistent AFib. The most important things you can do are:

• Get a diagnosis early
• Follow your treatment plan
• See your healthcare provider for any needed follow-up visits
• Tell your provider about new or changing symptoms

Despite your best efforts, AFib may still progress. The good news is that providers can treat AFib at later stages, too.

Once you’ve been diagnosed with atrial fibrillation, it’s generally considered a lifelong condition that can remit and relapse. Your healthcare team will help you manage it.